The purpose of this study was to examine the effects of the cold pressor test on skin temperature, natural killer cell activity, plasma concentrations of interleukin-1 and cortisol, and the numbers of white blood cells, CD3+ cells, CD4+ cells, CD8+ cells, and CD56+ cells in the peripheral blood. In addition, the study examined whether thermal biofeedback, when presented following the cold pressor tests, would mitigate the effects of the cold pressor tests. Four male university students completed pretest psychological inventories and were pretrained during nine laboratory sessions to increase their skin temperature to 95 degrees Fahrenheit. During the experiment, blood samples were collected at 5-minute intervals and before and after the 1-minute cold pressor tests through an 18-mm catheter inserted into each subject's arm. Subjects were randomly assigned to a matched pair and to the order of experimental conditions, including baseline, the initial cold pressor test, return to baseline, the second cold pressor test, and thermal biofeedback. Each matched pair experienced the conditions in a multiple baseline fashion across subjects during the individual 1.5-hour experimental sessions. Following the experiment, subjects completed posttest psychological inventories, exit interviews, and consumer satisfaction surveys. All subjects demonstrated a decrease in skin temperature ranging from 1 to 1.4 degrees Fahrenheit during the 1-minute cold pressor tests in a multiple baseline fashion, and repeated the temperature decreases within-subjects during the second cold pressor test. Increases in natural killer cell activity ranged from 1% to 14% during the cold pressor tests. For all subjects, both cold pressor tests were associated with increased plasma concentrations of interleukin-1, ranging from 2 to 69 pg/ml. The initial cold pressor tests were associated with increases in all cell numbers in a multiple baseline fashion, but cell numbers varied during the second cold pressor tests. For all subjects, average skin temperatures during the thermal biofeedback conditions were from .3 to .9 degrees higher than during the return to baseline conditions. For all subjects, thermal biofeedback conditions were associated with from 2 to 8 (10^4 cells/ml) higher mean numbers of CD56+ cells than the return to baseline conditions. For 3 subjects, the thermal biofeedback conditions were associated with higher numbers of white blood cells, CD3+ cells, CD4+ cells, and CD8+ cells than the return to baseline conditions. Thermal biofeedback was associated with reductions of from .2 to 26 in the standard deviations of interleukin-1 values, and with a reduced range of cortisol values following the cold pressor tests. Few changes occurred in scores from pre- to posttest on the psychological tests. Subjects rated the goal of learning to relax as very important. All of the subjects stated that they would seek relaxation training for the treatment of a medical or psychological disorder if prescribed. Implications are discussed for design of research in psychoneuroimmunology, for measurement of immune system variables, and for potential clinical applications of these data.

This experiment examined the effects of EMG biofeedback and relaxation training as compared with biofeedback alone. The following.dependent variables were examined: manifest anxiety, perceived pain, perceived relaxation, EMG activity, and locus of control. Back pain patients were assigned to one of two treatment groups. Group 1 was treated with both EMG biofeedback and relaxation training. Group 2 was treated with biofeedback alone. It appears that both biofeedback combined with progressive relaxation and biofeedback training alone are effective in lowering muscle activity and perceived pain, and in increasing perceived relaxation. However, from the results of this study, it is impossible to conclude that one treatment method is more effective than the other. Suggestions for future research are discussed.

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Voluntary or involuntary muscle activation can be captured by surface electromyography (EMG), which detects muscle action potentials via sensors on the surface of the skin. The technique has been prominent in the study of physiological underpinnings of movement for over 80 years and continues to be an essential tool in scientific research. Its research topic applications include motor disorders caused by stroke, spinal cord injury, cerebral palsy, multiple sclerosis, and many others. Benefits of integrating surface EMG into healthcare have been extensively argued and supported by scientific research, but adoption in clinical settings has been frustratingly slow. The overall goal of this thesis is to advance the clinical adoption of surface EMG by developing techniques that emphasize accessibility and the needs of the end-user (i.e., clinicians). In the first chapter, this dissertation leverages theoretical and empirical literature concerning influencers of adoption, and published clinician perspectives, to determine an effective translation strategy. Developing enhanced therapeutic surface EMG techniques and complementary assessments techniques were identified as key strategic goals. In Chapter 2, I develop a new classification-based surface EMG biofeedback system designed to emphasize tailorability, flexibility, and accessibility. The system performed well during a single session in healthy participants and one individual with multiple sclerosis. In Chapter 3, tailored interventions were implemented across multiple sessions in a group of multiple sclerosis patients with severe motor impairment. Implementation was found to be feasible, and the classification record emerged as an efficient and intuitive means to monitor and assess characteristics of a training session. In Chapter 4, I develop and test an easy-to-replicate surface EMG acquisition approach, and an analysis method using simple cursor placements. The analysis method was reliable between raters and sessions in healthy male and female participants. Overall, this thesis contributes to the translation of surface EMG methods into clinical practice. / Thesis / Doctor of Science (PhD) / Surface electromyography (EMG) is the recording of electrical potentials within the muscle that drive muscle contraction, and ultimately movement. There are many surface EMG techniques that provide insightful glimpses of the processes governing movement, and they have long been used to study movement impairments caused by traumatic injuries, neurodevelopmental disorders, and neurodegenerative diseases. Use of surface EMG to inform treatment decisions and optimize therapeutic interventions may significantly improve health outcomes. However, clinicians across the various healthcare fields have been slow to take advantage of surface EMG, and it remains underutilized despite significant efforts promote its use. The goal of this thesis is to develop accessible surface EMG techniques that can be applied in therapy and assessment scenarios. Ultimately, beyond the thesis, this work is intended to advance the clinical adoption of surface EMG so that its benefits may be accessed by a greater portion of practicing clinicians and their patients.

Decreased gait symmetry has been correlated with an increased fall risk, abnormal joint loading and decreased functional outcomes. Therefore, symmetry is focused on in the rehabilitation of many patient populations. Currently, load based symmetry is collected using expensive and immobile devices that are not clinically accessible, but there is a clinical need for an objective measure of loading symmetry during daily tasks like walking. Therefore, the purpose of this dissertation was to 1) assess the validity and reliability of the loadsol® to capture ground reaction force data, 2) use the loadsol® to determine the differences in symmetry between adults with a TKA and their healthy peers and 3) explore the potential of a commercially available biofeedback system to acutely improve gait symmetry in adults. The results of this work indicate that the loadsol® is a valid and reliable method of collecting loading measures during walking in both young and older adults. TKA patients who are 12-24 months post-TKA have lower symmetry in the weight acceptance peak force, propulsive peak force and impulse when compared to their healthy peers. Finally, a case study with four asymmetric adults demonstrated that a 10-minute biofeedback intervention with the loadsol® resulted in an acute improvement in symmetry. Future work is needed to determine the potential of this intervention to improve symmetry in patient populations and to determine whether the acute response is retained following the completion of the intervention. / Doctor of Philosophy / Symmetry during walking is a valuable attribute as asymmetry has been correlated with an increased fall risk and decreased mobility. Currently, load based symmetry is collected using expensive and immobile devices that are not clinically accessible. As a result, there is a critical need for a system that can objectively measure load and loading symmetry during rehabilitation and everyday tasks in a variety of settings. A new device has been developed (loadsol®) that could potentially fill this need. Before it can be used to assess and treat patients, the loadsol® needed to be assessed for accuracy and reliability in both older and younger adults and at various speeds. Then we needed to determine if the loadsol® can be used to look at the levels of symmetry in patients who have had a knee replacement compared to their healthy peers. Finally, we tested a visual biofeedback intervention with the loadsol® to see if this intervention was able to improve symmetry. We found that the loadsol® is accurate and reliable. Patients with a knee replacement were less symmetric than their age matched peers. Finally, in a small study, the visual biofeedback intervention improved symmetry during walking in a group of people with less than 90% symmetry. Future work is needed to explore the potential of this biofeedback intervention to improve symmetry in various patient populations and to determine the extent to which patients are able to retain these improvements.

Ten college students serving as volunteer subjects were randomly assigned to one of two groups. One group received EMG biofeedback training using feedback from the frontalis muscle only, and the other group received EMG biofeedback training using feedback from several muscle sites. It was hypothesized that subjects who were given EMG biofeedback relaxation training sequentially from several muscle sites would be able to lower EMG levels at these sites to a significantly greater degree than subjects who received EMG biofeedback relaxation training using feedback from the frontalis muscle only. Both groups were given a pre-training baseline session, nine training sessions, and a post-training baseline session. Comparing the mean pre- training and post- training baseline EMG levels of each group at each muscle site using t-tests showed that there was no significant reduction of EMG muscle activity at any monitored muscle site due to either frontalis feedback training only or multiple muscle feedback training. This failure to obtain significant training effects may have resulted from using college students as subjects since they were not trying to relieve a stress related disorder and they exhibited low initial baseline EMG levels. It is suggested that future research on the generalization of EMG biofeedback training be done using a clinical population having elevated EMG levels.