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This study investigated whether neurofeedback (NFB) training and swimming exercise (Swim) would reduce the stress, anxiety, depression, severity of dependence, and cravings in patients addicted to methamphetamines. Participants were allocated randomly to four groups: control group, NFB, Swim, and NFB/Swim. All groups completed the study questionnaire before and after treatment. The NFB, Swim, and NFB/Swim groups reported significantly less stress, cravings, and severity of dependence than the control group. The Swim and NFB/Swim groups had significantly lower depression scores than the control group. Also, the NFB/Swim group experienced less anxiety than the control group. However, the NFB/Swim group had lower levels of stress than the Swim group, and lower levels of anxiety and severity of dependence than the NFB group. These findings suggest that NFB training along with swimming exercise was effective in managing methamphetamine-related behavioral disturbances, which may help patients to manage their cravings. [ABSTRACT FROM AUTHOR]

Frontal midline theta power (FMT) has been associated with superior rifle shooting performance. Our experiment examined whether electroencephalographic-based training could increase FMT, shooting performance, and attentional focus in highly trained/elite biathletes. Participants (n = 28; age, M = 21.7, SD = 2.3) were assigned to a control group or an intervention group (with 3 hr of neurofeedback training). FMT increased from baseline during the neurofeedback training sessions (p ≤.05). However, there were no Group × Pre–post training (test) interactions for FMT or shooting performance (p >.05). There was a small Group × Test effect for attentional focus (p =.07, η p 2 =.12), indicating a potential benefit of neurofeedback training. Superior shooters were more proficient at increasing FMT during neurofeedback training, but this did not translate to greater improvements in shooting performance. Our findings suggest that the effects of neurofeedback training are transient and do not necessarily benefit performance. [ABSTRACT FROM AUTHOR]

Stress is a psychophysical condition that causes an impairment in athletes' performance by causing an increase in sympathetic activity and an autonomic imbalance. The current methods for the measurement of psychophysiological stress introduce the use of the heart rate variability as a useful index of the well-being of these people. The heart rate variability corresponds to the time intervals between consecutive heartbeats, such as an irregularity in the normal sinus heart rhythm whose variability is due to the control exercised by a complex system of mechanisms, including the respiratory control system, and provides information about the activity of the sympathetic and parasympathetic branches of the autonomic nervous system. This review aims at summarizing the promising results, despite small amount, of the recent literature on the efficacy of heart rate variability biofeedback on the autonomic imbalance and psychophysical well-being of athletes as well as cognitive and motor performance. [ABSTRACT FROM AUTHOR]

Psychophysiology pertains to the study of the reciprocal and "many to many" relations between the mind and the body. Accordingly, this special issue includes a collection of articles examining psychophysiological mechanisms implicated in the performance and well-being of athletes and exercisers. More specifically, this issue contains a literature review on the effects of heart rate variability biofeedback and athletic performance, as well as two empirical articles on the effects of neurofeedback on myriad psychological variables, such as attentional focus, anxiety, stress, and depression. There is also a paper on the effects of a self-talk intervention on free-throw performance in basketball and somatic reactions and a novel study on the effects of repeated transcranial direct current stimulation on decision making among soccer players. Collectively, the articles included in this issue advance our understanding of how psychophysiological theories and methodologies can inform the development of applied interventions in sport, exercise, and performance psychology. [ABSTRACT FROM AUTHOR]

Context: Sport-related dystonia is a rare form of activity-specific dystonia that can severely impair an athlete's ability to perform. Due to a lack of data on the condition, it is difficult to diagnose and often overlooked, and no gold standard treatment has yet been defined. Case Presentation: We present a rare and challenging case of sport-related dystonia that affected a 24-year-old male professional soccer player. The patient presented with severe rigidity and dystonia of the right lower-extremity, particularly the ankle and foot. The symptoms set on >1 year prior to the presentation to our outpatient clinic. He began to complain of stiffness and difficulty moving his lower limbs, especially his right leg, initially when playing soccer, but then also when walking normally. On presentation, he was unable to run and walked with difficulty, supporting his body weight only on the outside of his right foot. He also reported a motor trick and reverse motor trick involving the oral musculature in order to move his lower limb more freely. Management and Outcomes: An integrated rehabilitation approach based on postural rehabilitation, neuromuscular rehabilitation, and dental intervention was used to successfully treat this condition. The approach included: (1) postural rehabilitation with the Mézières-Bertelè method to reduce muscular stiffness, (2) neuromuscular re-education with Tai Chi exercises and electromyography-guided biofeedback, and (3) dental intervention and swallowing rehabilitation to limit impaired oral habits (due to the relationship between his impaired lower limb movements and motor tricks of the oral musculature). After 7 months of integrated rehabilitation, the patient returned to professional soccer. Conclusions: This case report highlights the potential efficacy of an integrative rehabilitation approach for sports dystonia, particularly in cases where traditional treatments may not be effective. Such an approach could be considered a valuable option in the management of this rare, but debilitating, condition in athletes. Further research is needed to assess the effectiveness of this approach in larger populations. [ABSTRACT FROM AUTHOR]

Multiple sclerosis is a neurodegenerative disease that causes balance deficits, even in early stages. Evidence suggests that people with multiple sclerosis (PwMS) rely more on vision to maintain balance, and challenging balance with optical flow perturbations may be a practical screening for balance deficits. Whether these perturbations affect standing balance in PwMS is unknown. Therefore, the purpose of this study was to examine how optical flow perturbations affect standing balance in PwMS. We hypothesized that perturbations would cause higher variability in PwMS compared with matched controls during standing and that standing balance would be more susceptible to anterior–posterior (A–P) perturbations than medial–lateral (M–L) perturbations. Thirteen PwMS and 13 controls stood under 3 conditions: unperturbed, M–L perturbation, and A–P perturbations. A–P perturbations caused significantly higher A–P trunk sway variability in PwMS than controls, although both groups had similar center-of-pressure variability. Both perturbations increased variability in A–P trunk sway and center of pressure. Trunk variability data supported the hypothesis that PwMS were more susceptible to optical flow perturbations than controls. However, the hypothesis that A–P perturbations would affect balance more than M–L perturbations was partially supported. These results suggest potential for optical flow perturbations to identify balance deficits in PwMS. [ABSTRACT FROM AUTHOR]

It is not currently possible to directly and noninvasively measure in vivo patellofemoral joint contact force during dynamic movement; therefore, indirect methods are required. Simple models may be inaccurate because patellofemoral contact forces vary for the same knee flexion angle, and the patellofemoral joint has substantial out-of-plane motion. More sophisticated models use 3-dimensional kinematics and kinetics coupled to a subject-specific anatomical model to predict contact forces; however, these models are time consuming and expensive. We applied a principal component analysis prediction and regression method to predict patellofemoral joint contact forces derived from a robust musculoskeletal model using exclusively optical motion capture kinematics (external approach), and with both patellofemoral and optical motion capture kinematics (internal approach). We tested this on a heterogeneous population of asymptomatic subjects (n = 8) during ground-level walking (n = 12). We developed equations that successfully capture subject-specific gait characteristics with the internal approach outperforming the external. These approaches were compared with a knee-flexion based model in literature (Brechter model). Both outperformed the Brechter model in interquartile range, limits of agreement, and the coefficient of determination. The equations generated by these approaches are less computationally demanding than a musculoskeletal model and may act as an effective tool in future rapid gait analysis and biofeedback applications. [ABSTRACT FROM AUTHOR]

Background: There is growing interest in the use of biofeedback-augmented gait training in cerebral palsy (CP). Audiovisual, sensorimotor, and immersive biofeedback paradigms are commonly used to elicit short-term gait improvements; however, outcomes remain variable. Because biofeedback training requires that individuals have the capacity to both adapt their gait in response to feedback and retain improvements across sessions, changes in either capacity may affect outcomes. Yet, neither has been explored extensively in CP. Methods: In this study, we evaluated the extent to which adolescents with CP (7M/1F; 14 years (12.5,15.26)) could adapt gait and retain improvements across four, 20-minute sessions using combined audiovisual and sensorimotor biofeedback. Both systems were designed to target plantarflexor activity. Audiovisual biofeedback displayed real-time soleus activity and sensorimotor biofeedback was provided using a bilateral resistive ankle exoskeleton. We quantified the time-course of change in muscle activity within and across sessions and overground walking function before and after the four sessions. Results: All individuals were able to significantly increase soleus activity from baseline using multimodal biofeedback (p < 0.031) but demonstrated heterogeneous adaptation strategies. In-session soleus adaptation had a moderate positive correlation with short-term retention of the adapted gait patterns (0.40 ≤ ρ ≤ 0.81), but generally weak correlations with baseline walking function (GMFCS Level) and motor control complexity (ρ ≤ 0.43). The latter indicates that adaptation capacity may be a critical and unique metric underlying response to biofeedback. Notably, in-session gains did not correspond to significant improvements in overground walking function (p > 0.11). Conclusions: This work suggests that individuals with CP have the capacity to adapt their gait using biofeedback, but responses are highly variable. Characterizing the factors driving adaptation to biofeedback may be a promising avenue to understand the heterogeneity of existing biofeedback training outcomes and inform future system optimization for integration into clinical care. [ABSTRACT FROM AUTHOR]

ABSTRACT We examined the feasibility of using the neofunctional deep breathing (NDB) technique to reduce the allostatic load following the Trier Social Stress Test (TSST). Forty‐four healthy subjects were randomised into experimental and control groups. Following the TSST procedure, participants underwent either a single session of NDB or an attention control intervention. The Procomp Infinity Biofeedback system measured breath per minute (BPM), respiratory amplitude, HRV linear domains, skin conductance, and trapezius muscle electromyographic activity. Cortisol and cytokine salivary concentrations, perceived stress, and anxiety levels were also assessed. These parameters were combined into an allostatic load index (ALI) to measure the intervention's effect. This pilot RCT demonstrated the feasibility of the study design and practicality of the intervention. The NDB group showed reduced ALI, increased respiratory abdominal amplitude, decreased BPM, increased HRV indicating parasympathetic activation, and decreased cortisol and inflammatory cytokines. This study highlighted the feasibility of testing the NDB technique in reducing allostatic load through a neurobiological and anti‐inflammatory response after exposure to psychosocial stress. This protocol can represent a non‐invasive therapeutic adjutant in disorders related to a dysregulation of the HPA axis or to an inflammatory state.Trial Registration: NCT04102813 [ABSTRACT FROM AUTHOR]

This study investigates the effectiveness of a Low-Cost Single-Channel BCI system in improving mathematical learning outcomes, self-efficacy, and alpha power in university students. Eighty participants were randomly assigned to either a BCI group receiving real-time neurofeedback based on alpha rhythms or a sham feedback group. Results showed that the BCI group had significantly higher mathematical performance, self-efficacy, and alpha power compared to the sham feedback group. Mathematics performance, alpha wave intensity, and self-efficacy showed significant positive correlations after training, indicating that neurofeedback training may have promoted their interaction and integration. These findings demonstrate the potential of BCI technology in enhancing mathematical learning outcomes and highlight the importance of considering pre-test performance and self-efficacy in predicting learning outcomes, with implications for personalized learning interventions and the integration of BCI technology in educational settings. [ABSTRACT FROM AUTHOR]

Background: Mindfulness training has been shown to promote positive mental health outcomes and related changes in neural networks such as the default mode network, which has a central node in the posterior cingulate cortex (PCC). Previous work from our group reported on the impact of a novel, neurofeedback augmented mindfulness training (NAMT) task on regulation of PCC hemodynamic activity in typically developing adolescents. The present pilot study aimed to expand on this finding by examining the pre-post changes of the NAMT task on resting-state functional connectivity of the PCC. Methods: Thirty-one typically developing adolescents (14.77 ± 1.23 years; 45% female) underwent a resting-state functional magnetic resonance imaging scan both before and after completing the NAMT task. A linear mixed effects model was used to assess for changes in functional connectivity of the PCC across the two resting-state runs. Results: Data did not support the hypothesized decrease in connectivity between the PCC seed and other DMN regions from pre- to post-NAMT task. However, we observed a significant increase in functional connectivity between the PCC and a cluster encompassing the left hippocampus and amygdala following completion of the NAMT task (run 1 Fisher's Z = 0.16; run 2 Fisher's Z = 0.26). Conclusion: Although preliminary, this finding suggests NAMT has the potential to strengthen connectivity between default mode and salience regions. We speculate that such changed connectivity may facilitate enhanced self-referential and emotional processing in adolescents. Clinical trial registration: https://clinicaltrials.gov/, identifier NCT04053582. [ABSTRACT FROM AUTHOR]

Introduction: Cancer frequently leads to psychological challenges, among them emotion regulation problems. These can be alleviated with the help of mindfulness therapies or neurofeedback (NF) interventions. Possible intervention effects on emotion procession can be detected in clinical EEG studies by exploring event-related potentials, e.g., early posterior negativity (EPN), which recently has been established to investigate emotional processing and represents very early attention to affective stimuli. Therefore, this clinical-experimental study investigated the efficacy of mindfulness and NF (10 sessions each) on the EPN in oncology patients. Method: The study enrolled 42 cancer patients (age: 31–73 years; gender: 28 female, 14 male). The study design was an RCT with a parallel group [NF (n = 21) versus mindfulness (n = 21)] waitlist paradigm. EEG recordings in an oddball task with neutral, rare positive and negative valence and high and low arousal stimuli were performed at three measurement time points (T0 = before waitlist, T1 = before intervention, T2 = after intervention). Following preprocessing, data from electrodes O1, Oz and O2 were analyzed for EPN amplitudes. Results: Response time did not differ across groups and conditions. Comparing EPN at T1 and T2, there was a significant interaction of time, valence, and intervention (p = 0.042). Descriptive statistics showed increased EPN for negative stimuli after the NF intervention (T1 to T2), while EPN for positive stimuli only slightly increased. For mindfulness, positive stimuli evoked stronger amplitudes after the intervention, while EPN for negative stimuli increased from T1 to T2. Conclusion: Distinct effects were observed for the EPN for pictures with negative valence. Here, it is presumed that mindfulness treatment led to a refocusing of attention with a focus on positive valence, whereas NF seems to entail a different processing of images with negative valence and is therefore to be seen more in the sense of a confrontational approach. Our results suggest that both interventions are suitable for modulating EPN. However, it is not clear to what extent the effects are due to the interventions alone and how other factors might have affected the amplitudes, which highlights the need for further research in this area. [ABSTRACT FROM AUTHOR]

The unpredictability of bipolar disorder is highly distressing for family caregivers, who differ in their needs and preferences for stress-reducing or educational interventions. Applying Ryan and Sawin's model, this study examined associations between caregiver demographics (age, gender, and race) as contextual factors and caregiver needs and preferences for three interventions as process factors within a preliminary descriptive analysis of 306 family caregivers from a randomized clinical trial. Caregiver needs for education about bipolar disorder, biofeedback, and Resourcefulness Training© were determined by established cut scores on validated measures of bipolar knowledge, heart rate variability, and resourcefulness. Frequencies for need and preference for intervention were compared by caregiver age, gender, and race. Discrepancies between caregiver need and preference for interventions were analyzed. Non-White caregivers showed greater need for education (X2=33.68, p < 0.001). Middle-aged caregivers showed greatest need for biofeedback (X2=19.58, p < 0.001). Need for Resourcefulness Training© was similar across age, gender, and race. We found 58% needed biofeedback, 34% education, and 18% Resourcefulness Training©; 46% of those in the preference group chose Resourcefulness Training©. Further caregiver intervention research should consider the effect of caregiver needs and preferences on their health. The findings support the essentiality of assessing caregiver demographics, needs, and preferences before implementing interventions. [ABSTRACT FROM AUTHOR]

Background: Although psychological factors have been implicated in patients with functional dysphonia (FD), conventional voice therapy (CVT) typically targets the aberrant voice symptoms exclusively. Yet, CVT is not always successful, and in view of the significant adverse quality of life impact combined with the financial burden on the healthcare system and society, research is needed to elucidate the underlying psychophysiology of FD and improve treatment outcomes. Objectives: The first objective of this research project is to compare the occurrence and frequency of symptoms and/or disorders related to autonomic nervous system (ANS) dysfunction in patients with FD with gender‐ and age‐matched vocally healthy controls, using a case‐control study. The second objective is to compare the effects of a novel therapy for FD based on ANS regulation (i.e., ANS therapy: heart rate variability (HRV) biofeedback) on both autonomic function and voice function versus CVT alone or in combination with ANS therapy (i.e., ANS therapy + CVT), using a randomized controlled trial (RCT). Methods: Case‐control study: Autonomic (dys)function of patients with FD will be compared with gender‐ and age‐matched vocally healthy controls, using both physiological measures (e.g., HRV, skin conductance level) and psychological patient‐reported outcome measures (PROMs, e.g., Neuroception of Psychological Safety Scale, Depression Anxiety and Stress Scale). RCT: The FD group will be randomly assigned to the innovative ANS therapy group, the CVT group or the ANS therapy + CVT group. All patients received 1 month of treatment with 20 min of daily practice. Both the autonomic assessment and the voice assessment will be performed pretherapy and immediately after therapy by assessors blinded to group allocation and study phase. Expected results: Higher occurrences of symptoms and/or disorders related to autonomic dysfunction are expected in patients with FD compared with vocally healthy controls. Physiological outcomes: lower HRV, lower cardiac pre‐ejection period, higher respiration rate and higher skin conductance level are hypothesized in patients with FD compared with vocally healthy controls. Psychological PROMs: higher self‐report of feelings/symptoms related to autonomic dysfunction (e.g., perceived stress, anxiety) is expected in patients with FD compared with vocally healthy controls. The autonomic function is hypothesized to improve more after the ANS therapy and the ANS therapy + CVT compared with the CVT only. Voice function is expected to improve more after the ANS therapy + CVT compared with the ANS therapy and the CVT alone. WHAT THIS PAPER ADDS: What is already known on the subject: Autonomic dysfunction is well recognized in the field of psychology but remains understudied in the area of voice. Given that the vagus nerve, innervating the larynx, also helps to regulate the ANS, and psychological symptoms commonly observed in patients with FD may reflect ANS dysregulation, research in this area is needed. There is some preliminary evidence that autonomic dysfunction might indeed be associated with FD. However, physiological ANS measures are needed, as well as validated psychological PROMs. What this paper adds to the existing knowledge: The first objective of this study is to investigate the occurrence and frequency of symptoms and/or disorders related to autonomic dysfunction in patients with FD as compared with a gender‐ and age‐matched vocally healthy control group. Autonomic (dys)function will be determined by employing both physiological measures (e.g., HRV, skin conductance level) and psychological PROMs (e.g., Neuroception of Psychological Safety Scale, Depression Anxiety and Stress Scale). The second objective is to compare the effects of a novel therapy for FD based on ANS regulation (HRV biofeedback) versus CVT alone or in combination with ANS therapy. What are the potential or actual clinical implications of this work?: Success rates of symptomatic CVT for FD are highly variable. This study is expected to lead to innovative results related to the pathogenesis and psychophysiology of FD, a prevalent voice disorder associated with a significant adverse quality of life impact and a substantial financial burden on the healthcare system and society. The results of this study will lead to crucial new insights into both the diagnosis and treatment of FD, contributing to evidence‐based practice in the field of voice. [ABSTRACT FROM AUTHOR]

In this opinion piece I reiterate the concepts of near and far transfer as previously described in the psychological literature. I show that despite very limited evidence, many technologies, tools and methods make questionable claims of eliciting far transfer from generic perceptual and/or cognitive training to sports performance. Specifically, this commentary illustrates with studies on stroboscopic vision, neurofeedback training and executive functions that the claims made for the beneficial effects of these training methods are currently unsubstantiated. I conclude that greater scrutiny by researchers is needed in order to assist practitioners to make better-informed decisions about tools, methods and technologies that may aid sports performance. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated articulatory patterns for American English /ɹ/ in children with and without a history of residual speech sound disorder (RSSD). It was hypothesized that children without RSSD would favor bunched tongue shapes, similar to American adults reported in previous literature. Based on clinical cueing practices, it was hypothesized that children with RSSD might produce retroflex tongue shape patterns at a higher relative rate. Finally, it was hypothesized that, among children who use a mixture of bunched and retroflex shapes, phonetic context would impact tongue shape as reported in the adult literature. Method: These hypotheses were tested using ultrasound data from a stimul-ability task eliciting /ɹ/ in syllabic, postvocalic, and onset contexts. Participants were two groups of children/adolescents aged 9-15 years: 36 with RSSD who completed a study of ultrasound biofeedback treatment and 33 with no history of RSSD. Tongue shapes were qualitatively coded as bunched or retroflex using a flowchart from previous research. Results: Children with no history of RSSD were found to use bunched-only tongue shape patterns at a rate higher than adults, but those who used a mixture of shapes for /ɹ/ followed the expected phonetic contextual patterning. Children with RSSD were found to use retroflex-only patterns at a substantially higher rate than adults, and those using a mixture of shapes did not exhibit the expected patterning by phonetic context. Conclusions: These findings suggest that clients receiving ultrasound biofeedback treatment for /ɹ/ may be most responsive to clinician cueing of retroflex shapes, at least early on. However, retroflex-only cueing may be a limiting and insufficient strategy, particularly in light of our finding of a lack of typical variation across phonetic contexts in children with remediated /ɹ/. Future research should more specifically track cueing strategies to better understand the relationship between clinician cues, tongue shapes, and generalization across a range of contexts. [ABSTRACT FROM AUTHOR]

Aim: A new closed‐loop functional magnetic resonance imaging method called multivoxel neuroreinforcement has the potential to alleviate the subjective aversiveness of exposure‐based interventions by directly inducing phobic representations in the brain, outside of conscious awareness. The current study seeks to test this method as an intervention for specific phobia. Methods: In a randomized, double‐blind, controlled single‐university trial, individuals diagnosed with at least two (one target, one control) animal subtype‐specific phobias were randomly assigned (1:1:1) to receive one, three, or five sessions of multivoxel neuroreinforcement in which they were rewarded for implicit activation of a target animal representation. Amygdala response to phobic stimuli was assessed by study staff blind to target and control animal assignments. Pretreatment to posttreatment differences were analyzed with a two‐way repeated‐measures anova. Results: A total of 23 participants (69.6% female) were randomized to receive one (n = 8), three (n = 7), or five (n = 7) sessions of multivoxel neuroreinforcement. Eighteen (n = 6 each group) participants were analyzed for our primary outcome. After neuroreinforcement, we observed an interaction indicating a significant decrease in amygdala response for the target phobia but not the control phobia. No adverse events or dropouts were reported as a result of the intervention. Conclusion: Results suggest that multivoxel neuroreinforcement can specifically reduce threat signatures in specific phobia. Consequently, this intervention may complement conventional psychotherapy approaches with a nondistressing experience for patients seeking treatment. This trial sets the stage for a larger randomized clinical trial to replicate these results and examine the effects on real‐life exposure. Clinical Trial Registration: The now‐closed trial was prospectively registered at ClinicalTrials.gov with ID NCT03655262. [ABSTRACT FROM AUTHOR]

Background: Neurofeedback is a non-invasive brain training technique used to enhance and treat hyperactivity disorder by altering the patterns of brain activity. Nonetheless, the extent of enhancement by neurofeedback varies among individuals/patients and many of them are irresponsive to this treatment technique. Therefore, several studies have been conducted to predict the effectiveness of neurofeedback training including the theta/beta protocol with a specific emphasize on slow cortical potential (SCP) before initiating treatment, as well as examining SCP criteria according to age and sex criteria in diverse populations. While some of these studies failed to make accurate predictions, others have demonstrated low success rates. This study explores functional connections within various brain lobes across different frequency bands of electroencephalogram (EEG) signals and the value of phase locking is used to predict the potential effectiveness of neurofeedback treatment before its initiation. Methods: This study utilized EEG data from the Mendelian database. In this database, EEG signals were recorded during neurofeedback sessions involving 60 hyperactive students aged 7-14 years, irrespective of sex. These students were categorized into treatable and non-treatable. The proposed method includes a five-step algorithm. Initially, the data underwent preprocessing to reduce noise using a multi-stage filtering process. The second step involved extracting alpha and beta frequency bands from the preprocessed EEG signals, with a particular emphasis on the EEG recorded from sessions 10 to 20 of neurofeedback therapy. In the third step, the method assessed the disparity in brain signals between the two groups by evaluating functional relationships in different brain lobes using the phase lock value, a crucial data characteristic. The fourth step focused on reducing the feature space and identifying the most effective and optimal electrodes for neurofeedback treatment. Two methods, the probability index (p-value) via a t-test and the genetic algorithm, were employed. These methods showed that the optimal electrodes were in the frontal lobe and central cerebral cortex, notably channels C3, FZ, F4, CZ, C4, and F3, as they exhibited significant differences between the two groups. Finally, in the fifth step, machine learning classifiers were applied, and the results were combined to generate treatable and non-treatable labels for each dataset. Results: Among the classifiers, the support vector machine and the boosting method demonstrated the highest accuracy when combined. Consequently, the proposed algorithm successfully predicted the treatability of individuals with hyperactivity in a short time and with limited data, achieving an accuracy of 90.6% in the neurofeedback method. Additionally, it effectively identified key electrodes in neurofeedback treatment, reducing their number from 32 to 6. Conclusions: This study introduces an algorithm with a 90.6% accuracy for predicting neurofeedback treatment outcomes in hyperactivity disorder, significantly enhancing treatment efficiency by identifying optimal electrodes and reducing their number from 32 to 6. The proposed method enables the prediction of patient responsiveness to neurofeedback therapy without the need for numerous sessions, thus conserving time and financial resources. [ABSTRACT FROM AUTHOR]

Background/Objectives: Aging-related physical changes and dysfunctions in the autonomic nervous system (ANS) often lead to orthostatic hypotension (OH) in older adults. OH negatively impacts both the physical and psychological well-being of those affected. Previous studies have demonstrated that the biofeedback-based integrated program (BBIP), a multicomponent intervention focused on heart rate variability biofeedback, effectively improves OH, as well as symptoms related to ANS function. This substudy aims to examine the effects of the BBIP on psychological health outcomes among community-dwelling older adults with OH. Methods: This study employed a non-randomized controlled trial design with a convenience sampling strategy. A total of 51 older adults with OH were recruited from two senior welfare centers and randomly assigned to either the intervention group (n = 27) or the control group (n = 24). The intervention group participated in a 12-week BBIP, which included weekly biofeedback sessions and group education on lifestyle modification to alleviate OH. Telephone counseling was also provided to promote compliance. Results: The intervention group showed significant improvements in health-related quality of life, depression, anxiety, and fall efficacy after the 12-week BBIP, whereas the control group exhibited no significant changes. There was a significant reduction in the percentage of participants in the intervention group reporting problems in all five dimensions of the EQ-5D (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression). Conclusions: The BBIP was effective in improving the psychological health outcomes of older adults with OH. Future studies should explore the long-term effects of the BBIP using a larger sample size and a randomized controlled trial design. [ABSTRACT FROM AUTHOR]

"The Tongue as a Gateway to Voice, Resonance, Style, and Intelligibility" by Angelika Nair explores the impact of the tongue on vocal production, combining voice science and pedagogy to enhance healthy vocal techniques. The book is structured into two parts, with the first focusing on foundational concepts and the second on applying these principles to consonant formation in English, Italian, German, and French. While the text is geared towards classical singers, actors, and voice practitioners may also find the research, definitions, and exercises beneficial for improving vocal clarity and precision. [Extracted from the article]

The current study sought to explain the connection between biological control and video game usage. Specifically, the study examined video game usage at three levels to determine if there were differences in the ability to control biological responses such as heart rate variability to complete different biofeedback activities. A biological feedback software package, ALIVE, was used to measure "heart rate smoothness" and time task completion during a tutorial training, autopilot control video game car race, and manual control video game car race. Participants were instructed to use biological control techniques including breathing and heart rate "smoothness" to complete the biofeedback video games. Results found that there were significant differences in average heart rate smoothness in autopilot and manual car races and the amount of time it took for participants to complete the manual car race between three levels of video game usage. Implications for individuals' biological control on behaviors such as relaxation and emotions were discussed. [ABSTRACT FROM AUTHOR]

In today's rapidly evolving technological landscape, this study investigates the impact of new technology on organizational work dynamics. By integrating the Job Demands-Resources theory and the Episodic Process Model, we examine the cognitive mechanisms that influence task performance during decision-making episodes. Our research focuses on episodic job demands and resources, emphasizing the mediating role of task absorption in the relationship between these factors and task performance. Our findings reveal that episodic job resources positively affect task absorption and performance, while job demands moderate the relationship between job resources and task absorption. Employing the Beer Distribution Game alongside neuroscience-based eye-tracking techniques, we analyze visual attention dynamics during decision-making episodes, providing novel insights into the interplay between task absorption and task performance. Theoretically, our study highlights the significance of task absorption in understanding how episodic job resources impact decision-making performance. Practically, our results advocate for the implementation of decision-making-focused skills development through physiological measures such as neurofeedback training programs. This research underscores the importance of individual time management in enhancing task performance, contributing to a nuanced understanding of job resources, job demands, and task absorption in the context of technological transformation. [ABSTRACT FROM AUTHOR]

This study investigates the technology acceptance of a proposed multimodal wearable sensing framework, named mSense, within the context of non-invasive real-time neurofeedback for student stress and anxiety management. The COVID-19 pandemic has intensified mental health challenges, particularly for students. Non-invasive techniques, such as wearable biofeedback and neurofeedback devices, are suggested as potential solutions. To explore the acceptance and intention to use such innovative devices, this research applies the Technology Acceptance Model (TAM), based on the co-creation approach. An online survey was conducted with 106 participants, including higher education students, health researchers, medical professionals, and software developers. The TAM key constructs (usage attitude, perceived usefulness, perceived ease of use, and intention to use) were validated through statistical analysis, including Partial Least Square-Structural Equation Modeling. Additionally, qualitative analysis of open-ended survey responses was performed. Results confirm the acceptance of the mSense framework for neurofeedback-based stress and anxiety management. The study contributes valuable insights into factors influencing user intention to use multimodal wearable devices in educational settings. The findings have theoretical implications for technology acceptance and practical implications for extending the usage of innovative sensors in clinical and educational environments, thereby supporting both physical and mental health. [ABSTRACT FROM AUTHOR]

Background: Schizophrenia is one of the most severe mental disorders, frequently associated with aggression and violence, particularly in male patients. The underlying mechanisms of violent behavior in these patients remain unclear, limiting effective treatment options and highlighting the need for further research into interventions for impulsive behaviors. This study aims to evaluate the clinical efficacy of neurofeedback treatment in hospitalized male schizophrenia patients exhibiting impulsive behaviors. Methods: The study was designed as a single-center, randomized, single-blind, sham-controlled parallel trial. Eighty patients were randomly assigned to either a study group or a control group. The control group received risperidone and sham neurofeedback,while the study group received risperidone and active neurofeedback therapy. Both groups underwent training five timesperweek,with eachsession lasting 20 minutes, over a six-week period. Clinical symptoms were assessed at baseline, threeweeks and six weeks using the Positive andNegative Syndrome Scale (PANSS), theModified Overt Aggression Scale (MOAS), and the Rating Scale for Extrapyramidal Side Effects (RSESE). Statistical analyses were conducted to compare the therapeutic effects between the two groups at the study's conclusion. Results: Initial comparisons showed no significant differences in baseline data, except for the number of prior hospitalizations (P<0.018). By the end of the study, the study group demonstrate significant improvements in MOAS and PANSS scores (including the Excited, Positive, Cognitive, and Depressive/Anxiety Components), with no significant changes in RSESE scores. Discussion: Both time and group interactions were significant across most outcomes, underscoring the efficacy of neurofeedback in reducing the severity of impulsive behaviors and associated schizophrenia symptoms. [ABSTRACT FROM AUTHOR]

Background: Directional vibrotactile biofeedback for balance control can be instructed in the form of Repulsive (to move in the opposite direction of vibrations) or Attractive (to move in the direction of vibrations) stimulus encodings. However, which of these encodings is less cognitively demanding and poses less interference with high-level cognitive processes of conflict resolution remains unresolved. Methods: In two between-subject studies with 30 (16 females) and 35 (23 females) healthy young adults, respectively, we investigated the cognitive load of Attractive and Repulsive vibrotactile biofeedback on 1) working memory (Study I) and 2) cognitive conflict resolution (Study II). Both studies also examined the effectiveness of both feedback stimulus encodings on balance control during quiet standing with eyes closed. Results: Both Attractive and Repulsive vibrotactile biofeedback increased balance stability (reduced trunk sway variability) in both the working memory and the conflict resolution study (Study I and II, respectively) with a greater increase of stability for the Repulsive encoding during multitasking demanding cognitive conflict resolution (Study II). Cognitive costs, measured in terms of the Linear Integrated Speed-Accuracy Score (LISAS), were greater for the Attractive encoding during multitasking with working memory demands. When cognitive conflict resolution was required as a secondary cognitive task, both stimulus encodings increased cognitive costs equally. Conclusions: The effects of instructed Repulsive and Attractive stimulus encodings for the response-related interpretation of vibrotactile biofeedback of body sway were contrasted with respect to cognitive processing demands and balance stabilisation benefits. Both encodings improved balance stability but at certain cognitive costs. Regarding interference with specific high-level cognitive processes, however, a distinction has to be made between both encodings. Repulsive feedback encoding seems to cause less cognitive costs on working memory load and slightly greater stabilisation when cognitive conflict resolution is required. These results are discussed in the context of the known benefits of avoidance actions on cognitive control. [ABSTRACT FROM AUTHOR]

Physiological regulation strategies can be effective in reducing anxiety. However, while these strategies are often learned and practised under low‐stress conditions, they are more likely to be required under conditions of high stress. We created virtual reality (VR) biofeedback games to both teach participants a breathing technique and then practise that technique under stress. We present two studies: the first provides a proof of concept, demonstrating that participants can apply the breathing technique during stress, with a significant lowering of both respiration rate and increase in heart rate variability (HRV) under stress (p < .001). The second study explicitly evaluated the effectiveness of training by comparing trained and untrained groups. Training was associated with a significantly greater HRV (p = .008) under stress. In within‐group comparisons of HRV during stress compared to a baseline stressor presented before training, the trained group showed a significantly greater increase compared to untrained controls (p = .025). Our results show the feasibility and potential effectiveness of VR‐based games for biofeedback training under experimentally applied stress. This may offer the opportunity for clinical techniques to more closely reflect the circumstances under which those techniques will be required. [ABSTRACT FROM AUTHOR]

Our aim in this study was to test the effect of 10 sessions of biofeedback (BFB) on physiological, psychological, and cognitive functioning of international tennis players. In this randomized controlled trial, we recruited 16 international tennis players (11 male, 5 female; M age = 17.31, SD = 0.87 years), who were randomly assigned to either an intervention group (IG; n = 8) or a control group (CG; n = 8). Those in the IG received 10 multimodal BFB sessions over four weeks, while those in the CG received no intervention. We assessed physiological, psychological, and cognitive parameters before and after the intervention and found a positive effect for skin temperature, state anxiety, and cognitive performance in the IG versus the CG. We provide preliminary data that 10 sessions of multimodal BFB improved cognitive functions and reduced anxiety symptoms in international tennis players. Future investigators should consider increasing sample size, incorporating an active CG, and studying these effects across diverse athletic disciplines. [ABSTRACT FROM AUTHOR]

(1) Background. Neurofeedback has been used in sports since the 1990s, frequently showing positive outcomes in enhancing athletic performance. This systematic review provides an updated analysis of neurofeedback training in sports, evaluating reaction time, cognitive performance, and emotional regulation to address literature gaps and suggest future research directions. (2) Methods. A systematic search was conducted using PubMed, Scopus, Science Direct, and Web of Science databases for articles published from January 2016 to April 2023. The search included only original articles written in English, resulting in 24 studies meeting the inclusion criteria. (3) Results. The reviewed studies cover a wide range of sports, including golf, basketball, swimming, rifle shooting, football, volleyball, athletics, judo, ice hockey, triathlon, handball, fencing, taekwondo, and darts. They involved athletes of varying experience levels (beginners, professionals, and experts) and utilized neurofeedback training targeting different frequency bands (alpha, beta, theta, and SMR), either individually or in mixed protocols. Findings show improvements in sports and cognitive performance, emotional regulation, and anxiety management. (4) Conclusions. This systematic review supports the effectiveness of neurofeedback in enhancing sports and cognitive performance across various disciplines and experience levels. Notable improvements were observed in technical skills, physical performance parameters, scoring, attention, concentration, reaction time, short-term and working memory, self-regulation, and cognitive anxiety. Future research should standardize protocols, include more diverse samples, and explore long-term effects to further validate these findings. [ABSTRACT FROM AUTHOR]

So far, there have been no high-quality studies examining the efficacy of outpatient biofeedback devices in cases of prescribed partial weight-bearing, such as after surgery on the lower limbs. This study aimed to assess whether a biofeedback device is more effective than using a personal scale. Two groups of healthy individuals wearing an insole orthosis were trained to achieve partial loading in a three-point gait within a target zone of 15–30 kg during overground walking and going up and down stairs. The treatment group (20 women and 22 men) received continuous biofeedback, while the control group (26 women and 16 men) received no information. Findings were compared in a randomized controlled trial. Compliance with partial loading without biofeedback was poor; on level ground and stairs, only one in two steps fell within the target area, and overloading occurred on at least one in three steps. The treatment group reduced the percentage of steps taken in the overload zone to ≤8.4% (p < 0.001 across all three courses) and achieved more than two-thirds of their steps within the target zone (p < 0.001 on level ground, p = 0.008 upstairs, and p = 0.028 downstairs). In contrast, the control group did not demonstrate any significant differences in the target zone (p = 0.571 on level ground, p = 0.332 upstairs, and p = 0.392 downstairs). In terms of maintaining partial load, outpatient biofeedback systems outperform bathroom scales. [ABSTRACT FROM AUTHOR]

In its chronic and non-specific form, low back pain is experienced by a large percentage of the population; its persistence impacts the quality of life and increases costs to the health care system. In recent years, the scientific literature highlights how treatment based on assessment and functional recovery is effective through IMU technology with biofeedback or exergaming as part of the tools available to assist the evaluation and treatment of these patients, who present not only with symptoms affecting the lumbar spine but often also incorrect postural attitudes. Aim: Evaluate the impact of technology, based on inertial sensors with biofeedback or exergaming, in patients with chronic non-specific low back pain. A systematic review of clinical studies obtained from PubMed, Scopus, Science Direct, and Web of Science databases from 1 January 2016 to 1 July 2024 was conducted, developing the search string based on keywords and combinations of terms with Boolean AND/OR operators; on the retrieved articles were applied inclusion and exclusion criteria. The procedure of publication selection will be represented with the PRISMA diagram, the risk of bias through the RoB scale 2, and methodological validity with the PEDro scale. Eleven articles were included, all RCTs, and most of the publications use technology with exergaming within about 1–2 months. Of the outcomes measured, improvements were reported in pain, disability, and increased function; the neuropsychological sphere related to experiencing the pathology underwent improvements. From the results obtained, the efficacy of using technology based on exergames and inertial sensors, in patients with chronic non-specific low back pain, was increased. Further clinical studies are required to achieve more uniformity in the proposed treatment to create a common guideline for health care providers. [ABSTRACT FROM AUTHOR]

Simple Summary: Cancer patients frequently encounter significant emotional and psychological challenges that can adversely affect their overall well-being and treatment outcomes. To address these challenges, we developed the Cancer Patient Empowerment Program (CancerPEP), a comprehensive, home-based intervention that incorporates physical exercise, nutritional guidance, and social support. CancerPEP builds on the success of the Prostate Cancer Patient Empowerment Program (PC-PEP), which has demonstrated positive effects on psychological well-being in prostate cancer patients. In this study, we also evaluated whether adding a Heart Rate Variability (HRV) biofeedback device could enhance the effectiveness of CancerPEP. Our findings indicate that while CancerPEP significantly reduced psychological distress and improved emotional well-being across cancer patients—including a breast cancer subgroup—at the end of the intervention (the 6-month point), the addition or lack of an HRV device did not significantly contribute to these improvements for the full sample. These results suggest that CancerPEP, similar to PC-PEP, is a valuable addition to standard cancer care, providing a holistic approach to support patients both mentally and emotionally. However, the inclusion of the HRV device may not be necessary to achieve these benefits. Background/Objectives: Psychological distress is a significant concern among cancer patients, negatively affecting their quality of life and adherence to treatment. The Cancer Patient Empowerment Program (CancerPEP) was developed as a comprehensive, home-based intervention aimed at reducing psychological distress by incorporating physical activity, dietary guidance, and social support. This study aimed to evaluate the feasibility, accrual and attrition rates, safety, and effectiveness of the CancerPEP intervention, with and without the biofeedback device, on psychological distress from baseline to 6 months, specifically focusing on the effects of group randomization and the difference between pre- and post-intervention results. Methods: This single-site, crossover randomized clinical trial included 104 cancer patients who were randomized to receive the CancerPEP intervention, with or without a Heart Rate Variability (HRV) biofeedback monitor. At 6 months, participants who did not receive the device were allowed to use one until the end of the year, while those who did receive the device were followed up to 12 months. Randomization was stratified by the presence or absence of clinically significant psychological distress and metastatic status. Psychological distress was assessed using the Kessler Psychological Distress Scale (K10) at baseline, 6 months, and 12 months. The primary endpoint was the presence of nonspecific psychological distress, as measured by the K10 scale at 6 months from the trial start, based on group randomization. A secondary exploratory analysis assessed psychological distress at baseline, 6 months, and 12 months for both groups, while controlling for group randomization and prognostic covariates. Prognostic covariates included age; comorbidities; time between diagnosis and randomization; treatment modality; relationship status; and use of prescribed medications for anxiety, depression, or both. An exploratory sub-analysis was conducted for the breast cancer subgroup, based on the sample size available after recruitment. The trial is registered at ClinicalTrials.gov (NCT05508412). Results: The provision of the HRV biofeedback monitor in conjunction with the CancerPEP intervention did not significantly affect the primary outcome in either the full sample or the breast cancer subgroup, indicating that the HRV biofeedback provision was not beneficial in this trial. No self-reported or otherwise discovered adverse events at the 6-month mark were observed. About 10% of participants were lost to follow-up in both the early and late HRV monitor provision groups. Participation in the CancerPEP program led to a significant reduction in psychological distress over time. The odds of psychological distress were significantly higher at the start of the trial than at the end of the intervention (aOR = 2.64, 95% CI: 1.53–4.56) or 6 months after the intervention (aOR = 2.94, 95% CI: 1.62–5.30). Similarly, in the breast cancer subgroup, distress was higher at the trial's start than at 6 months, i.e., after the intervention (aOR = 2.25, 95% CI: 1.24–4.08), or at the end of the trial at 12 months (aOR = 2.73, 95% CI: 1.35–5.52). Conclusions: CancerPEP significantly reduces psychological distress in cancer patients, with consistent improvements noted across various cancer types and stages, including benefits specifically for breast cancer patients. These findings build upon the success of the Prostate Cancer Patient Empowerment Program (PC-PEP), indicating that a similar comprehensive intervention can be advantageous for all cancer patients and may be further tailored to address specific needs. With its holistic approach—encompassing physical, dietary, and psychosocial support—CancerPEP shows promise as a vital component of survivorship care. Ongoing 24-month evaluations will yield critical data on its long-term benefits. Additionally, a randomized trial with a control group (usual care without intervention) for breast cancer patients is currently under way and could potentially guide the integration of CancerPEP into standard oncology care to enhance patient outcomes and quality of life. [ABSTRACT FROM AUTHOR]

Stress-related disorders constitute a fast-progressing worldwide societal problem that needs urgent attention and new solutions. Recent neuroscientific research has shown that stress-related disorders are characterized by maladaptive dynamic changes in large-scale brain networks in response to stressors, raising the possibility of modulating these networks as a promising target for intervention. Neurofeedback can be used to train individuals to endogenously modulate brain network dynamics. Once learned, this skill is transferrable to ecologically relevant scenarios outside of a laboratory or treatment facility, and individuals can be trained to explicitly apply it at the right moments as part of a just-in-time adaptive intervention in response to actual stressors in daily life. We argue that these characteristics position neurofeedback as a prime candidate for a personalized preventive neuroscience-based intervention strategy. Stress-related disorders are among the biggest global health challenges. Despite significant progress in understanding their neurocognitive basis, the promise of applying insights from fundamental research to prevention and treatment remains largely unfulfilled. We argue that neurofeedback – a method for training voluntary control over brain activity – has the potential to fill this translational gap. We provide a contemporary perspective on neurofeedback as endogenous neuromodulation that can target complex brain network dynamics, is transferable to real-world scenarios outside a laboratory or treatment facility, can be trained prospectively, and is individually adaptable. This makes neurofeedback a prime candidate for a personalized preventive neuroscience-based intervention strategy that focuses on the ecological momentary neuromodulation of stress-related brain networks in response to actual stressors in real life. [ABSTRACT FROM AUTHOR]

Introduction: Pelvic floor muscle training (PFMT) for urinary incontinence (UI) is recommended in combination with biofeedback to visualize pelvic floor muscles. The focus is on non‐invasive hand‐held ultrasound (US) measurement methods for PFMT, which can be performed at home. Recently, self‐performed US measurements in which the patient applies the US to themself have gradually spreading. This study aimed to develop an educational program for the biofeedback method using self‐performed US and to evaluate its feasibility. Methods: This study was an observational study. The ADDIE model (Analysis, Design, Development, Implementation, and Evaluation) was utilized to create an e‐learning program for women aged ≥40 years with UI. Participants self‐performed bladder US via e‐learning, using a hand‐held US device with a convex probe. The primary outcome was the number of times the bladder area was successfully extracted using an existing automatic bladder area extraction system. The secondary outcome was the total score of the technical evaluation of the self‐performed US, which was evaluated across three proficiency levels. Descriptive statistics were conducted for participant characteristics, presenting categorical variables as percentages and continuous variables as means ± SD. Results: We included 11 participants with a mean age of 56.2 years. Nine participants were able to record US videos, and two were unable to record bladder videos. Regarding the technical evaluation scores, all participants scored ≥80%; four had perfect scores. Conclusions: This study showed that transabdominal self‐performed bladder US can be performed in 81.8% of women with UI in their 40–60s by using an e‐learning program. [ABSTRACT FROM AUTHOR]

This paper explores the use of biomechanics in identifying the mechanistic causes of musculoskeletal tissue injury and degeneration. It appraises how biomechanics has been used to develop training programmes aiming to maintain or recover tissue health. Tissue health depends on the functional mechanical environment experienced by tissues during daily and rehabilitation activities. These environments are the result of the interactions between tissue motion, loading, biology, and morphology. Maintaining health of and/or repairing musculoskeletal tissues requires targeting the "ideal" in vivo tissue mechanics (i.e., loading and deformation), which may be enabled by appropriate real-time biofeedback. Recent research shows that biofeedback technologies may increase their quality and effectiveness by integrating a personalised neuromusculoskeletal modelling driven by real-time motion capture and medical imaging. Model personalisation is crucial in obtaining physically and physiologically valid predictions of tissue biomechanics. Model real-time execution is crucial and achieved by code optimisation and artificial intelligence methods. Furthermore, recent work has also shown that laboratory-based motion capture biomechanical measurements and modelling can be performed outside the laboratory with wearable sensors and artificial intelligence. The next stage is to combine these technologies into well-designed easy to use products to guide training to maintain or recover tissue health in the real-world. [ABSTRACT FROM AUTHOR]

With the advent of consumer-grade electroencephalography (EEG) and virtual reality (VR) devices, the use of human cognitive processes directly as means for user-adapted interaction in immersive virtual environments has become increasingly relevant. In this study (N = 43), we investigate electroencephalography-based neurofeedback interaction in virtual reality (VR). Particularly, we investigate this phenomenon in the context of meditation which enables the studying of cognitive processes (attention, sense of presence, meditation depth) when using an immersive interface that is adaptive based on neural responses. A prototype virtual reality environment was built that employs head-mounted display (HMD), and the neurofeedback functionality guided the user to increase the neural indices of meditation-related concentration and relaxation. The observed findings provide evidence for the effectiveness of neurofeedback functionality and VR in evoking desired types of neural activation and subjective experiences. [ABSTRACT FROM AUTHOR]

Objective Electromyography (EMG) biofeedback has been suggested as a relatively new approach to help resolve muscle disorders. This research aimed to evaluate the influence of 8 weeks of proximal pelvic muscle training and biofeedback on pain, muscle strength, and their EMG activity in individuals suffering from patellofemoral pain syndrome (PFPS). Materials & Methods This randomized clinical trial was performed on 30 young people aged 22 to 45 with PFPS. People in the intervention group (15 people) received EMG biofeedback of the abductor (gluteus medius) and external rotator (gluteus maximus) muscles along with routine physiotherapy treatments, including stretching exercises, isometric exercises of gluteal and quadriceps muscles, and conventional transcutaneous electrical nerve stimulation. In the control group (15 people), routine physiotherapy treatments were only performed on the patients. The participants of two groups were treated for 8 weeks, 3 sessions every week. Pain by a visual analog scale (VAS), maximal voluntary isometric strength (MVIC) of the abductor and external rotator muscles of the thigh with a dynamometer, and activity of these muscles, including maximum contraction, integrated EMG and onset EMG using EMG, were measured before and after the interventions. Results MVIC and EMG of the gluteus medius muscle demonstrated that the intervention group had more maximum EMG activity (P=0.043) and MVIC (P=0.003) than the control group. MVIC and the maximum EMG activity of the gluteus maximus muscle showed no significant difference between the two groups. Still, the increase in the integrated EMG of this muscle in the intervention group indicated a greater increase than in the control group (P=0.0001). Moreover, people in the intervention group had significantly less pain than the group of routine exercises alone after 8 weeks of treatment (P=0.016). Conclusion Adding 8 week biofeedback training of abductor and external rotator muscles to the routine therapeutic exercise in PFPS can lead to pain reduction, improvement of muscle strength and better performance of these muscles. This change could potentially slow down the degenerative process of the patellofemoral joint. [ABSTRACT FROM AUTHOR]

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Copyright of Acibadem Saglik Bilimleri Dergisi is the property of Acibadem University Medical School and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Biofeedback therapy is useful for treatment of functional defecation disorders but is not widely available and is labor intensive. We developed an Internet-of-Medical-Things (IoMT) device, enabling self-guided biofeedback therapy. This study assesses the safety and efficacy of self-guided biofeedback therapy using the IoMT device in comparison to standard operator-led therapy. Patients experiencing urge or seepage fecal incontinence (≥1 episode/week) were randomly assigned to either our IoMT system or to the conventional anorectal manometry-based therapy. Both interventions comprised six weekly sessions, focusing on enhancing anal strength, endurance, and coordination. The novel device facilitated self-guided therapy via visual instructions on a companion app. Primary outcomes included safety/tolerability, changes in Vaizey severity scores, and alterations in anorectal pressure profiles. Twenty-five patients (22 females, 3 males) participated, with 13 in the novel device group and 12 in the standard therapy group. Both groups showed significant reductions in symptom severity scores: IoMT device group -4.2 (95% CI: -4.06, -4.34, p = 0.018), and the standard therapy group -4.8 (95% CI: -4.31, -5.29, p = 0.028). Anal sphincter resting pressure and sustained squeeze time improved significantly in both groups, and the novel device group demonstrated an increase in maximum sphincter squeeze pressure. There were no significant differences between the therapy groups. Importantly, the experimental device was well-tolerated compared with standard therapy, with no serious adverse events observed. This study demonstrates the comparable efficacy of self-administered biofeedback using the IoMT device with traditional biofeedback therapy. The results demonstrates the potential of the IoMT device as a safe, self-guided method for FI therapy, offering convenience and effectiveness in fecal incontinence management. [ABSTRACT FROM AUTHOR]

Background: Urinary incontinence (UI) is the most prevalent pelvic floor disorder following treatment for gynaecological cancer with a distressing impact on quality-of-life in survivors. Physiotherapist-supervised pelvic floor muscle (PFM) training is recommended as the first-line intervention for UI in community-dwelling women. However, it is not known if this intervention is effective in women following treatment for gynaecological cancer, nor whether PFM training can be delivered entirely remotely. The primary aim of this study is to investigate if a telehealth-delivered PFM training program incorporating a novel biofeedback device reduces UI compared with usual care, following gynaecological cancer. Methods: This is a pragmatic, two-arm parallel-group, stratified superiority randomised controlled trial recruiting 72 participants (ACTRN12622000580774). Recruitment sites include gynaecology-oncology outpatient clinics, supplemented by advertisements through community foundations/social media/care groups. Participants must have completed primary cancer treatment at least 6 months prior or adjuvant therapy at least 3 months prior, for Stage I, II or III uterine, cervical, fallopian tube, primary peritoneal or ovarian cancer or borderline ovarian tumour, and have UI occurring at least weekly. Participants randomised to the usual care group will receive bladder and bowel advice handouts and one audio telehealth physiotherapist consultation to answer any queries about the handouts. Participants randomised to the intervention group will receive the same handouts plus eight video telehealth physiotherapist consultations for PFM training with a biofeedback device (femfit®), alongside a home-based program over 16 weeks. The primary outcome measure is a patient-reported outcome of UI frequency, amount and interference with everyday life (measured using the International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form), immediately post-intervention compared with baseline. Secondary outcomes include quality-of-life measures, bother of pelvic floor symptoms, leakage episodes, use of continence pads and global impression of change. We will also investigate if the intervention improves intra-vaginal resting and squeeze pressure in women in the intervention arm, using data from the biofeedback device. Discussion: If clinical effectiveness of telehealth-delivered physiotherapist-supervised PFM training, supplemented with home biofeedback is shown, this will allow this therapy to enter pathways of care, and provide an evidence-based option for treatment of post-cancer UI not currently available. Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR), ID 12622000580774. Registered 20 April 2022. [ABSTRACT FROM AUTHOR]

Arterial spin labelling (ASL) is the only non‐invasive technique that allows absolute quantification of perfusion and is increasingly used in brain activation studies. Contrary to the blood oxygen level‐dependent (BOLD) effect ASL measures the cerebral blood flow (CBF) directly. However, the ASL signal has a lower signal‐to‐noise ratio (SNR), than the BOLD signal, which constrains its utilization in neurofeedback studies. If successful, ASL neurofeedback can be used to aid in the rehabilitation of health conditions with impaired blood flow, for example, stroke. We provide the first ASL‐based neurofeedback study incorporating a double‐blind, sham‐controlled design. A pseudo‐continuous ASL (pCASL) approach with background suppression and 3D GRASE readout was combined with a real‐time post‐processing pipeline. The real‐time pipeline allows to monitor the ASL signal and provides real‐time feedback on the neural activity to the subject. In total 41 healthy adults (19–56 years) divided into three groups underwent a neurofeedback‐based emotion imagery training of the left anterior insula. Two groups differing only in the explicitness level of instruction received real training and a third group received sham feedback. Only those participants receiving real feedback with explicit instruction showed significantly higher absolute CBF values in the trained region during neurofeedback than participants receiving sham feedback. However, responder analyses of percent signal change values show no differences in activation between the three groups. Persisting limitations, such as the lower SNR, confounding effects of arterial transit time and partial volume effects still impact negatively the implementation of ASL neurofeedback. [ABSTRACT FROM AUTHOR]

Identifying brain activity and flow direction can help in monitoring the effectiveness of neurofeedback tasks that aim to treat cognitive deficits. The goal of this study was to compare the neuronal electrical activity of the cortex between individuals from two groups—low and high difficulty—based on a spatial analysis of electroencephalography (EEG) acquired through neurofeedback sessions. These sessions require the subjects to maintain their state of attention when executing a task. EEG data were collected during three neurofeedback sessions for each person, including theta and beta frequencies, followed by a comprehensive preprocessing. The inverse solution based on cortical current density was applied to identify brain regions related to the state of attention. Thereafter, effective connectivity between those regions was estimated using the Directed Transfer Function. The average cortical current density of the high-difficulty group demonstrated that the medial prefrontal, dorsolateral prefrontal, and temporal regions are related to the attentional state. In contrast, the low-difficulty group presented higher current density values in the central regions. Furthermore, for both theta and beta frequencies, for the high-difficulty group, flows left and entered several regions, unlike the low-difficulty group, which presented flows leaving a single region. In this study, we identified which brain regions are related to the state of attention in individuals who perform more demanding tasks (high-difficulty group). [ABSTRACT FROM AUTHOR]

Hallucinations can occur in the healthy population, are clinically relevant and frequent symptoms in many neuropsychiatric conditions, and have been shown to mark disease progression in patients with neurodegenerative disorders where antipsychotic treatment remains challenging. Here, we combine MR-robotics capable of inducing a clinically-relevant hallucination, with real-time fMRI neurofeedback (fMRI-NF) to train healthy individuals to up-regulate a fronto-parietal brain network associated with the robotically-induced hallucination. Over three days, participants learned to modulate occurrences of and transition probabilities to this network, leading to heightened sensitivity to induced hallucinations after training. Moreover, participants who became sensitive and succeeded in fMRI-NF training, showed sustained and specific neural changes after training, characterized by increased hallucination network occurrences during induction and decreased hallucination network occurrences during a matched control condition. These data demonstrate that fMRI-NF modulates specific hallucination network dynamics and highlights the potential of fMRI-NF as a novel antipsychotic treatment in neurodegenerative disorders and schizophrenia. fMRI-neurofeedback targeting a hallucination-related whole-brain network allows individuals to willfully control its temporal properties and modify proneness the hallucination induction, showing promise for investigating future therapies in disease. [ABSTRACT FROM AUTHOR]

Purpose: This study examines how ultrasound biofeedback and intensive treatment distribution affect speech sound generalization during an evidence-based treatment, Speech Motor Chaining, for children with persisting speech errors associated with childhood apraxia of speech (CAS). Method: In a 2 x 2 factorial randomized controlled trial, children ages 9-17 years meeting CAS criteria were randomized to receive (a) a distributed treatment (20 sessions twice weekly over 10 weeks) or intensive treatment (20 hr in 5 weeks, with 10 hr in Week 1) and (b) treatment with or without biofeedback. Due to the COVID pandemic, some participants were randomized to distributed/intensive telepractice treatment only. The primary outcome was percent target sounds correct on untreated phrases (i.e., generalization) at the 10-week time point. More than 50,000 narrow phonetic transcriptions were analyzed. Results: Forty-eight participants completed treatment. Intensive treatment significantly increased generalization at all time points. The effect of biofeedback was significant at 5 weeks from the start of treatment but not significant at the primary 10-week time point. However, when comparing each group immediately after their 20 hr of treatment finished, generalization was significantly greater in intensive over distributed treatment and greater in ultrasound over no-ultrasound treatment (with a significant interaction favoring intensive treatment with ultrasound). Only the advantage of intensive treatment remained significant 5 weeks after groups finished treatment. There was no significant difference between face-to-face and telepractice modalities. Conclusions: When the number of treatment hours is fixed, an intensive schedule of Speech Motor Chaining facilitated greater improvement than a distributed schedule. Ultrasound biofeedback initially accelerated learning, but the benefits may dissipate as treatment continues or after it ends. [ABSTRACT FROM AUTHOR]

Establishing a successful neurofeedback practice requires not only clinical expertise, but also strong business acumen. Many of the suggestions in this article apply to those with biofeedback and related practices as well. This article reviews tips on leveraging resources from national organizations and local economic development options. Building a compelling brand with professional logos and adhering to ethical advertising standards are essential. A robust web presence, bolstered by effective search engine optimization, enhances visibility. Tracking client inquiries and analyzing referral sources can guide strategic decisions. Additionally, managing finances prudently and optimizing time-management skills are crucial for sustained success and personal fulfillment in this specialized field. [ABSTRACT FROM AUTHOR]

This paper examines the innovative integration of acceptance and commitment therapy (ACT) principles with biofeedback methodologies, presenting a novel approach to psychophysiological therapy. This paper uses Kevin Polk's structured ACT matrix approach to elucidate how biofeedback can augment ACT processes, including acceptance, cognitive defusion, and present-moment awareness. The paper explicates practical techniques such as the "Hook Words Exercise" and "Verbal Aikido," demonstrating their application within a biofeedback-enhanced therapeutic context. This integrative approach represents a significant advancement in psychophysiological interventions, offering a comprehensive framework for deepening interoceptive awareness and fostering psychological flexibility and value-aligned living while bridging the gap between cognitive processes and physiological responses. By exemplifying assimilative integration in psychotherapy, this approach offers a promising avenue for advancing both clinical practice and research in psychophysiological interventions, potentially improving therapeutic outcomes and client engagement. [ABSTRACT FROM AUTHOR]

In 2019, our team traveled internationally to test the effectiveness of a physiological assessment and heart rate variability (HRV) biofeedback program for a group of highly accomplished Special Forces Wounded Warriors participating in an international rehabilitative adaptive event. The intent was to offer biofeedback in a remote setting for managing and measuring stress while performing highly stressful tasks. The evaluation took place 8,000 miles from the mainland United States on the island of Saipan, the site of a tremendous battle during World War II. To our knowledge, a biofeedback system of this type has never been employed in a remote setting with this population. The transport of biofeedback equipment came with unique challenges as did providing an internet-based biofeedback project in a remote setting. Although HRV and health-related data were collected by study staff, the analysis of the data is not included in this manuscript. The purpose of this article is to provide information on key factors to consider when providing biofeedback in a remote setting, including data collection and storage in a limited internet service area; safe transport of equipment; and tools for successful biofeedback training in an isolated, international setting. We hope the information in this article will guide practitioners who plan to do similar types of biofeedback studies and interventions in the future. [ABSTRACT FROM AUTHOR]

Prostate cancer is one of the most common malignancies in men, and radical prostatectomy (RP) is the primary treatment method for localized and locally advanced prostate cancer. However, due to surgical trauma, patients undergoing RP often face postoperative complications such as sexual dysfunction and urinary incontinence, leading to varying degrees of decline in quality of life. Currently, there is a lack of standardized clinical guidelines for postoperative rehabilitation in these patients. To address this issue, the present consensus was developed using evidence-based medicine approaches, including a thorough review and evaluation of relevant literature, quality grading, and evidence synthesis. An initial draft was created and subsequently refined through expert meetings, discussions and Delphi surveys. This process involved three rounds of consultations with 29 experts from 24 different hospitals across various specialties, including urology, oncology, rehabilitation medicine, nutrition and psychology. The results were systematically summarized under the guidance of the Committee of Integrated Rehabilitation for Urogenital Tumors, Chinese AntiCancer Association, culminating in the formulation of the “Chinese expert consensus on perioperative integrated rehabilitation for radical prostatectomy (2024 edition)”. This consensus aimed to provide standardized integrated rehabilitation recommendations for patients undergoing RP, with the goals of improving postoperative recovery efficiency and reducing the impact of both short- and long-term complications on survival and quality of life. The consensus has been registered on Practice guideline REgistration for transPAREncy (PREPARE) with the registration number PREPARE-2024CN666. The consensus covers several key areas, including comprehensive perioperative assessment, application of the Enhanced Recovery After Surgery (ERAS) principles, management and treatment of common postoperative complications, and psychological and social support for patients. Regarding perioperative assessment, the consensus emphasizes a thorough evaluation of patients’ physical and psychological conditions before surgery, including nutritional status, pelvic floor function and psychological state, to develop individualized rehabilitation plans and optimize preoperative preparation, thereby laying a solid foundation for postoperative recovery. The application of ERAS principles includes reducing preoperative fasting and fluid restrictions, improving perioperative management, providing preoperative education, and implementing psychological interventions, all of which effectively reduce the incidence of postoperative complications and accelerate recovery. For common postoperative complications such as urinary incontinence and sexual dysfunction, the consensus recommends various rehabilitation measures, including pelvic floor muscle training (PFMT) and biofeedback therapy, to alleviate symptoms and improve quality of life. Additionally, the consensus underscores the importance of psychological and social support, advising comprehensive support for patients in the postoperative period. The publication of this consensus provides clinical practitioners with standardized guidelines for postoperative rehabilitation, which can enhance the recovery efficiency of patients undergoing RP, reduce the incidence of complications, and significantly improve the quality of life. As more clinical studies are conducted in the future, the content of this consensus will be continuously validated and refined, offering more comprehensive and personalized rehabilitation guidance for prostate cancer patients. [ABSTRACT FROM AUTHOR]

Disruptive behavior disorders [including conduct disorder (CD) and oppositional defiant disorder (ODD)] are common childhood and adolescent psychiatric conditions often linked to altered arousal. The recommended first-line treatment is multi-modal therapy and includes psychosocial and behavioral interventions. Their modest effect sizes along with clinically and biologically heterogeneous phenotypes emphasize the need for innovative personalized treatment targeting impaired functions such as arousal dysregulation. A total of 37 children aged 8–14 years diagnosed with ODD/CD were randomized to 20 sessions of individualized arousal biofeedback using skin conductance levels (SCL-BF) or active treatment as usual (TAU) including psychoeducation and cognitive–behavioral elements. The primary outcome was the change in parents´ ratings of aggressive behavior measured by the Modified Overt Aggression Scale. Secondary outcome measures were subscales from the Child Behavior Checklist, the Inventory of Callous-Unemotional traits, and the Reactive-Proactive Aggression Questionnaire. The SCL-BF treatment was neither superior nor inferior to the active TAU. Both groups showed reduced aggression after treatment with small effects for the primary outcome and large effects for some secondary outcomes. Importantly, successful learning of SCL self-regulation was related to reduced aggression at post-assessment. Individualized SCL-BF was not inferior to active TAU for any treatment outcome with improvements in aggression. Further, participants were on average able to self-regulate their SCL, and those who best learned self-regulation showed the highest clinical improvement, pointing to specificity of SCL-BF regulation for improving aggression. Further studies with larger samples and improved methods, for example by developing BF for mobile use in ecologically more valid settings are warranted. [ABSTRACT FROM AUTHOR]

Introduction Emerging research has provided tentative support for the use of heart rate variability biofeedback (HRVB) as a treatment for several psychological disorders, with meta-analyses providing compelling evidence for HRVB as a promising treatment for anxiety, depression, and PTSD. Given the prevalence of PTSD in military veterans and the comparatively lower benefit and higher attrition rate of traditional psychological treatment for PTSD relative to civilian counterparts, it is important to examine complementary and alternative treatment approaches such as HRVB in this population. Although studies of HRVB for PTSD have been conducted with military veterans, they have involved relatively small sample sizes, limiting interpretation. To address this, the current article presents a comprehensive meta-analysis, consolidating existing literature to more accurately evaluate the efficacy of HRVB in reducing PTSD symptoms within military populations. Materials and Methods This meta-analysis was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, and our protocol was registered with PROSPERO to increase review transparency. A literature search of HRVB interventions was conducted using PubMed, PsycINFO, Military Database, PTSDPubs, and EBSCO's Psychological and Behavioral Sciences Collection. Results Five studies met eligibility criteria, providing a combined sample size of 95 military services members. For all studies, effect sizes were negative, indicating a reduction in PTSD symptoms. Effect sizes ranged from −1.614 to −0.414, resulting in an overall moderate to large mean effect for HRVB (Hedges's g  = −0.557; 95% confidence interval = −0.818 to −0.296; P  < .001). Additionally, cumulative attrition was 5.8%, significantly lower than commonly reported rates for evidence-based treatments (16%–36%). Conclusions The present study is the first meta-analysis to examine HRVB as a treatment for military service members with PTSD. Results indicate that HRVB may be a viable treatment approach to reduce PTSD symptomatology. Low attrition rates, ease of accessibility, and favorable participant outlook serve as additional benefits for the use of HRVB. [ABSTRACT FROM AUTHOR]