Peu différenciées à la naissance, les émotions deviendraient intelligibles en étant élevées à la conscience par le développement d’une sensibilité aux sensations internes accompagnant l’émotion, sa représentation et sa symbolisation (Gergely & Watson, 1996). La théorie du miroir affectif-parental du biofeedback social de Gergely & Watson (1996), poussée plus loin par Fonagy, Gergely, Jurist et Target (2002), explique comment une interaction de biofeedback social complexe, innée, et probablement implicite, s’établit entre parent et nouveau-né pour aider ce dernier à différencier les somatosensations accompagnant l’expérience d’une émotion, au travers d’un comportement parental de miroir. Le but de cette thèse est de réviser cette théorie, et plus particulièrement l’hypothèse du miroir « marqué » (markedness), qui serait nécessaire pour dissocier le miroir parental du parent, et permettre l’appropriation de son contenu informationnel par l’enfant. Ce processus de sensibilisation est conçu comme partie intégrante du travail de symbolisation des émotions chez les enfants autant que chez les adultes. Cependant, le miroir marqué se manifestant par une expression exagérée ou « voix de bébé » (motherese) nécessiterait l’utilisation par le thérapeute d’une « voix de patient » (therapese) (Fonagy, 2010) pour être appliqué à la psychothérapie adulte, une proposition difficile à soutenir. La révision examine comment la sensibilisation d’une émotion est accomplie : par un mécanisme d’internalisation nécessitant un miroir « marqué » ou par un mécanisme de détection de la contingence de l’enfant. Elle démontre que le détecteur de contingence du nouveau-né (d’un fonctionnement semblable au système d’entraînement par biofeedback pour adultes) est le médiateur des fonctions de sensibilisation, de représentation, et de symbolisation de la ii sensation d’une émotion par ses processus de détection de la covariance-invariance, de la maximisation, et du contrôle contingent du miroir parental. Ces processus permettent à l’émotion de devenir consciente, que le miroir parental soit ‘marqué’ ou non. Le modèle révisé devient donc applicable à la thérapie des adultes. Une vignette clinique analysée à l’aide de la perspective du Boston Change Process Study Group sur le changement est utilisée pour contraster et illustrer les processus de sensibilisation et de symbolisation des émotions, et leur application à la psychothérapie adulte. Cette thèse considère les implications cliniques du nouveau modèle, et elle spécule sur les conséquences de difficultés parentales vis-à-vis de la disponibilité requise par les besoins de biofeedback social du nouveau-né, et sur les conséquences de traumatismes déconnectant des émotions déjà sensibilisées de leurs représentations. Finalement, elle suggère que le miroir sensible des émotions en thérapie puisse remédier à ces deux sortes de difficultés, et que le modèle puisse être utilisé concurremment à d’autres modèles du changement, en facilitant la génération d’états internes ressentis et symbolisés pouvant être utilisés pour communiquer avec soi-même et les autres pour la réparation de difficultés émotionnelles et relationnelles chez les enfants et les adultes. / Undifferentiated at birth, emotions would become intelligible by being raised to consciousness through the development of sensitivity to the inner sensations accompanying the emotion, their representation and symbolization (Gergely & Watson, 1996). The social biofeedback theory of parental affect-mirroring of Gergely and Watson (1996), furthered by Fonagy, Gergely, Jurist and Target (2002), explains how these somatosensory signals are so important that a complex, probably implicit, and possibly innate social biofeedback interaction exists between caregiver and infant, where the latter learns to differentiate between emotions through the parent’s mirroring of his emotion expression. The aim of this thesis is to revise this theory, and more precisely the ‘markedness’ hypothesis, which would be necessary to dissociate the parental mirroring from the parent and allow appropriation of its informational content as pertaining to the infant. The process of sensitization to these sensations is conceived to be integral to the symbolization of emotions in children and adults. However, ‘motherese’, the singsong prosody of markedness hypothesized to be necessary to foster successful social biofeedback interactions between caregivers and infants, requires that therapists use ‘therapese’ in the clinical setting (Fonagy, 2010), a proposition difficult to reconcile with the therapy of adults. The revision investigates whether the sensitization and symbolization of an emotion is accomplished through an internalization mechanism requiring the ‘markedness’ hypothesis, or solely through social biofeedback mechanisms based on infant contingency detection. It demonstrates that the infant’s contingency detector (similarly to biofeedback training in adults) mediates the iv functions of sensitization, representation, and symbolization of an emotion through its processes of covariance-invariance detection, maximization, and the contingent control of the parental mirroring. It allows the emotion to be raised to consciousness, with the help of the parental mirror, whether it is ‘marked’ or not. The revised model thus becomes applicable to the therapy of adults. A clinical vignette analyzed with the Boston Change Process Study Group’s perspective on change is used to contrast and illustrate the processes of sensitization and representations of emotions, and their application in adult psychotherapy. The thesis considers the clinical implications of the new model and speculates on the consequences of parental difficulties with surrendering to the social biofeedback needs of the infant, and on the consequences of emotional trauma disconnecting sensitive emotion sensations from their representations. Finally, it suggest that both kinds of difficulties can be repaired through sensitive mirroring of emotions in therapy, and that the model might be used concurrently with other models of change, by facilitating the generation of felt and symbolized inner states that can be used for self and other communication in the repair of emotional and relational difficulties in children and adults.

The intent of the following research is to utilize task-specific, constraint-induced therapies and apply towards dynamic training for symmetrical balance. Modifications to an elliptical trainer were made to both measure weight distributions during dynamic stance as well as provide kinetic biofeedback through a man-machine interface. Following a review of the background, which includes research from several decades that are seminal to current studies, a design review is discussed to cover the design of the modified elliptical (Chapter 2). An initial study was conducted in a healthy sample population in order to determine the best visual biofeedback representation by comparing different man-machine interfaces (Chapter 3). Index of gait symmetry measures indicated that one display interface optimized participant performance during activity with the modified elliptical trainer. A second study was designed to determine the effects of manipulating the gain of the signal to encourage increased distribution towards the non-dominant weight bearing limb. The purpose of the second study was to better understand the threshold value of gain manipulation in a healthy sample set. Results analyzing percentage error as a measure of performance show that a range between 5-10% allows for a suitable threshold value to be applied for participants who have suffered a stroke. A final study was conducted to apply results/knowledge from the previous two studies to a stroke cohort to determine short-term carryover following training with the modified elliptical trainer. Data taken from force measurements on the elliptical trainer suggest that there was carryover with decreased error from pre to post training. For one participant GaitRite® data show a significant difference from pre to post measurements in single limb support. The results of the research suggest that visual biofeedback can improve symmetrical performance during dynamic patterns. For a better understanding of visual biofeedback delivery, one display representation proved to be beneficial compared to the others which resulted in improved performance. Results show that healthy human participants can minimize error with visual biofeedback and continue minimizing error until a threshold value of 10%. Finally, results have shown promise towards applying such a system for kinetic gait rehabilitation.

Title: The importance of myofeedback rehabilitation in faecal incontinence Introduction: Faecal incontinence is a serious symptom significantly worsening quality of life. Following results of international studies myofeedback has been considered an effective option of conservative treatment of this disease. Despite that it has so far been used at just a few centres in the Czech Republic. Purpose: The main purpose of this thesis was to assess the relevance of myofeedback as part of recovery therapy. Other objectives included assessment of use of a vaginal electrode instead of an anal one and comparison of the result correlations between examination by anal manometry, surface EMG and subjective improvement of continence for the patients. Methods: The research project included 8 females. The objective method of assessment of effects of the treatment involved examination of pelvis bottom muscles with the help of anorectal manometry and surface EMG. Success of the therapy was evaluated through the St Marks incontinence score and by the test population themselves filling out a quality of life questionnaire. Results: In the course of three-month recovery most patients experienced improvement of subjective as well as objective parameters. The results of the study are comparable to results of international...

by Emil, Chiu Hong Man. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1993. / Includes bibliographical references (leaves 108-118). / Acknowledgment --- p.6 / List of Abbreviations --- p.7 / Summary --- p.8 / Chapter Chapter 1 --- Childhood Asthma - An Overview --- p.10 / Chapter 1.1 --- Definition of childhood asthma --- p.10 / Chapter 1.2 --- Basic Pathophysiology of Asthma --- p.11 / Chapter 1.2.1 --- Airway obstruction --- p.11 / Chapter 1.2.2 --- Airway inflammation --- p.11 / Chapter 1.2.3 --- Bronchial hyperresponsiveness --- p.12 / Chapter 1.2.4 --- Trigger factors of asthma --- p.12 / Chapter 1.3 --- Measurement of the severity of asthma --- p.14 / Chapter 1.3.1 --- Obj ective measures of lung function --- p.14 / Chapter 1.3.2 --- Measures of bronchial hyperresponsiveness --- p.15 / Chapter 1.3.3 --- Clinical measures --- p.16 / Chapter 1.4 --- Epidemiology --- p.16 / Chapter 1.5 --- Treatment of asthma --- p.19 / Chapter 1.5.1 --- Pharmacological treatment --- p.19 / Chapter 1.5.2 --- Non-pharmacological treatment --- p.20 / Chapter 1.5.3 --- Behavioral Intervention --- p.24 / Chapter 1.5.4 --- Summary of treatment of asthma --- p.28 / Chapter Chapter 2 --- Change in Lung Mechanic During Asthmatic Attack --- p.29 / Chapter 2.1 --- Asthmatic Attack --- p.29 / Chapter 2.2 --- Hyperinflation of the lungs during asthmatic attack --- p.30 / Chapter 2.3 --- Effect of hyperinflation on respiratory muscle function --- p.32 / Chapter Chapter 3 --- Biofeedback Intervention --- p.36 / Chapter 3.1 --- Background --- p.36 / Chapter 3.2 --- Definition of biofeedback --- p.36 / Chapter 3.3 --- Biofeedback as an adjunctive treatment to asthma --- p.37 / Chapter 3.3.1 --- Direct airways biofeedback --- p.38 / Chapter 3.3.2 --- Muscle EMG biofeedback --- p.41 / Chapter 3.4 --- Justification of study --- p.45 / Chapter Chapter 4 --- Material and Methods --- p.47 / Chapter 4.1 --- Study design and patients recruitment --- p.47 / Chapter 4.2 --- Equipment and measurement --- p.49 / Chapter 4.2.1 --- Biofeedback unit and the computer system --- p.49 / Chapter 4.2.2 --- Mini Wright flow meter --- p.50 / Chapter 4.2.3 --- Clinical measures --- p.50 / Chapter 4.2.4 --- Bronchial provocation test --- p.51 / Chapter 4.3 --- Biofeedback training --- p.53 / Chapter 4.3.1 --- Preparation of the patient --- p.53 / Chapter 4.3.2 --- Training Procedures --- p.54 / Chapter 4.3.3 --- Criteria for successful training --- p.55 / Chapter 4.4 --- Statistical methods --- p.56 / Chapter Chapter 5 --- Results --- p.58 / Chapter 5.1 --- Immediate training effects --- p.58 / Chapter 5.1.1 --- Comparison between the successful group and the fail group --- p.59 / Chapter 5.1.2 --- Combining successful and fail groups as the training group --- p.63 / Chapter 5.2 --- One year follow-up --- p.65 / Chapter 5.2.1 --- Social and clinical characteristics of both training and control group --- p.65 / Chapter 5.2.2 --- Clinical characteristic --- p.66 / Chapter 5.2.3 --- Attack rate --- p.66 / Chapter 5.2.4 --- The Fscore --- p.67 / Chapter 5.2.5 --- Score --- p.67 / Chapter 5.2.6 --- Mscore --- p.68 / Chapter 5.2.7 --- Bronchial hyperresponsiveness --- p.68 / Chapter 5.2.8 --- Lung functions --- p.69 / Chapter Chapter 6 --- Discussion --- p.95 / Chapter 6.1 --- Physiological effects --- p.95 / Chapter 6.1.1 --- EMG --- p.96 / Chapter 6.1.2 --- Pulse rate and skin temperature --- p.97 / Chapter 6.1.3 --- Lung functions --- p.97 / Chapter 6.2 --- Clinical outcomes --- p.100 / Chapter 6.2.1 --- Attack rate and symptom --- p.100 / Chapter 6.3 --- Clinical implication of study --- p.101 / Chapter 6.4 --- Limitation and difficulties --- p.103 / Chapter 6.5 --- Suggestions for further study --- p.104 / Chapter Chapter 7 --- Conclusions --- p.105 / References --- p.108 / Appendix1 --- p.119 / Appendix2 --- p.120 / List of Figures --- p.122 / List of Tables --- p.124

Background Anxiety experienced by individuals visiting the dental office to receive treatment is prevalent in the population. The clinical manifestation of these anxieties is considerable; it is estimated that approximately between 14 and 30 million people in the United States do not seek routine dental care due to dental anxiety. Dentists and other scientists have explored many techniques and procedures in attempts to ameliorate these anxieties and improve patient care. Biofeedback is a process that involves measuring a person's specific bodily functions such as blood pressure, heart rate, skin temperature, muscle tension, or breathing rate, and conveying the information to the patient in real-time. This raises the patient's awareness and therefore the possibility of conscious control of those functions. Evidence has shown biofeedback to be a useful modality of treatment for numerous conditions associated with anxiety. Anxiety has been shown to up-regulate the sympathetic nervous system. When the sympathetic nervous system is up-regulated, the pain threshold is decreased, and physiologic parameters of anxiety are manifested in the patient. This physiological phenomenon is well understood and demonstrates that, with anxiety, the individual will have a decreased pain threshold (i.e., greater response to noxious or painful stimuli). The purpose of the current pilot study is to investigate the use of a novel biofeedback system (RESPeRATE™) to reduce patients' pre-operative general anxiety levels and subsequently the pain associated with dental injections. Methods Eighty-one subjects participated in this randomized controlled study. Forty subjects were in the experimental group and forty-one subjects were in the control group. All subjects were asked to fill out a pre-injection survey (Dental Injection Sensitivity Survey - DISS), measuring baseline anxiety levels. Subjects in the experimental group used a biofeedback technique, while subjects in the control group were not exposed to any biofeedback. All participants then received an inferior alveolar local anesthetic injection. Subjects in both groups were then given a post-injection survey (measuring anxiety levels), and filled out a Visual Analog Scale (VAS). The VAS was designed to measure the subjects' perception of pain of the injection, the overall injection experience, and anticipatory anxiety for future injections. Results The results of the study demonstrated that there was no significant difference between the treatment group and the control group with respect to any of the pre/post-operative anxiety measures as recorded by the DISS. This study did demonstrate that with the use of the RESPeRATE™ device there was a significant difference in the overall injection experience between the experimental group and the control group (p=0.013), as measured by the VAS. A trend towards improved responses for the experimental group was noted with respect to both level of discomfort and ratings of future nervousness; these results did not reach a statically significance of p<.05. Conclusions Future studies and power calculation will be more specific towards the RESPeRATE™ in a dental setting, and lead to more accurate approximations on the number of subjects needed to determine whether the difference was due to chance or due to the treatment modality. It appears that this novel pilot study was underpowered. It would also be feasible to apply the technology to other areas in dentistry where anxiety and sympathetic up-regulation are etiologic components. Areas of future studies may include temporomandibular joint dysfunction, orofacial pain, periodontal disease, and wound healing.

Research has shown that psychotherapy patients experience increased physiological responsivity to stress which might negatively impact their experience in psychotherapy and their overall progress and outcome. The purpose of the present study was to investigate the effect of a heart rate variability biofeedback intervention on the physiological stress responsiveness and the psychotherapy outcomes of participants in psychotherapy. Forty college students attending psychotherapy at their university counseling center were divided into an experimental group and a control group. The experimental group participated in a 6-week biofeedback intervention and we assessed their physiological stress reactivity before and after implementation of the intervention, compared to a matched control group. The Trier Social Stress Test (TSST) was administered pre- and post-intervention to induce a stress reaction. It was hypothesized that psychotherapy patients involved in the biofeedback intervention would show decreased physiological stress reactivity to and faster physiological recovery from a laboratory induced stressor post-intervention compared to psychotherapy patients in the matched control group. It was also hypothesized that these participants would demonstrate larger distress reduction after implementation of the intervention. Results of the study found no significant main effect of the TSST on systolic blood pressure, heart rate, and HRV. There however was a main effect on diastolic blood pressure. The only variable that significantly differed between groups was the LF/HF ration. The results also revealed no significant change from pre-intervention baseline to post-intervention heart rate, blood pressure, and HRV, suggesting that the HRV biofeedback intervention was not effective in changing the stress response over time. Regarding levels of distress, results also revealed no statistical between group differences post-intervention, although the biofeedback group appeared to report significantly lower levels of distress post-intervention.

Stair-climbing is an important skill for promoting independence and activities of daily life and is a key component of rehabilitation therapies for physically disabled children. This thesis describes the design and evaluation of an interactive musical stairs system for children engaged in stair-climbing physical therapies. The achievement of a targeted therapeutic goal, namely, use of reciprocal steps, was significantly increased by 6% [SD=7%] (p=0.007) with the presence of audio feedback. Levels of participant enjoyment and motivation increased as well. This led to the development of an automated system, using inertial sensors to detect initial contact (IC) events each time a child makes a step, to trigger audio feedback. A semi-generic algorithm was designed that was able to detect 96% [SD=3%] of IC events during stair-climbing therapy sessions. This thesis lays the groundwork for future longitudinal research investigating the efficacy of audio feedback in stair-climbing and other rehabilitation therapies as well.

Stair-climbing is an important skill for promoting independence and activities of daily life and is a key component of rehabilitation therapies for physically disabled children. This thesis describes the design and evaluation of an interactive musical stairs system for children engaged in stair-climbing physical therapies. The achievement of a targeted therapeutic goal, namely, use of reciprocal steps, was significantly increased by 6% [SD=7%] (p=0.007) with the presence of audio feedback. Levels of participant enjoyment and motivation increased as well. This led to the development of an automated system, using inertial sensors to detect initial contact (IC) events each time a child makes a step, to trigger audio feedback. A semi-generic algorithm was designed that was able to detect 96% [SD=3%] of IC events during stair-climbing therapy sessions. This thesis lays the groundwork for future longitudinal research investigating the efficacy of audio feedback in stair-climbing and other rehabilitation therapies as well.

Det positiva sambandet mellan stress och idrottsskador är väl dokumenterat i litteraturen. Ett ökat antal psykologiska skadeförebyggande interventioner visar att det är möjligt att förebygga idrottsskador genom kognitiv beteendeträning. Användandet av biofeedback tillsammans med kognitiv beteendeträning i skadeförebyggande syfte är dock en relativt outforskad interventionsstrategi (Johnson, 2007). Syftet med studien var att undersöka om det genom interventionsbaserad kognitiv beteendeträning i kombination med biofeedbackanvändning gick att minska antalet idrottsskador för fotbollsspelare. Deltagare ifrån fyra idrottsgymnasier (16-19 år) delades in i en experimentgrupp (n=13) och en kontrollgrupp (n=14). Deltagarna fick fylla i tre enkäter (SAS, LESCA och ACSI-28) vid en förmätning. Ett MANOVA test att visade de två grupperna inte skilde sig signifikant vid förmätningen. Experimentgruppen genomgick en 9-veckors interventionsperiod bestående av 7 sessioner innehållande: somatisk avslappning, dagbok för kritiska händelser, tankestopp, emotions/problem fokuserad coping, målsättning och biofeedbackträning. Ett Mann- Whitney U test visade en tendens till signifikant skillnad mellan kontroll och experimentgrupp U (n1 = 13, n2 = 14) = 51.00, p &lt; .054, där experimentgruppen drabbades av färre idrottsskador jämfört med kontrollgruppen. Resultatet ifrån studien diskuteras främst ur ett psykologiskt perspektiv och förslag på framtida forskning inom området ges. / The positive relationship between stress and sport injury is well documented in the literature. An increasing number of prevention intervention studies shows that it is possible to prevent sport injuries through cognitive-behavioral training. However, the use of biofeedback combined with a cognitive-behavioral approach for injury prevention is a relatively unexplored methodology (Johnson, 2007). The purpose of this study was to investigate if it is possible to combine biofeedback and cognitive-behavioral training to reduce numbers of sport injuries for soccer players. Participants from four sports high schools (16-19 years old) where divided into one experiment (n=13) and one control group (n=14). Participants were asked to complete three questionnaires (SAS, LESCA and ACSI-28) in a baseline measure. A MANOVA test showed that the two groups did not differ significantly based on the questionnaires at the baseline measure. The experiment group participated in a 9 week intervention period consisting of 7 sessions including: somatic relaxation, critical incident diary, thought stopping, emotions/problem focused coping, goal setting and biofeedback training. A Mann-Whitney U test showed a tendency to a significant difference between the control and experiment group U (n1 = 13, n2 = 14) = 51.00, p &lt; .054, where the experiment group sustained fewer sport injuries compared to the control group. The result of the study is discussed foremost from a psychological perspective and proposals for future research are given.

Thesis (M.A.)--University of West Florida, 2009. / Submitted to the Dept. of Psychology. Title from title page of source document. Document formatted into pages; contains 78 pages. Includes bibliographical references.