Physiological changes after biofeedback and relaxation training for multiple-pain tension-headache patients

This paper is concerned with the psychophysiology of "muscle-contraction" headaches in a group of Compensation patients suffering from multiple pain problems in addition to headaches. A total of 55 of these patients were divided into 4 groups which received frontalis EMG biofeedback, relaxation training, combined biofeedback-relaxation training, or no treatment. Differences were observed among the 3 experimental treatments and the control group with respect to headache changes, but there were no differences among groups with respect to the changes observed in four underlying physiological responses as a function of time or practice. While the subjects who showed the largest changes in headache characteristics were those who exhibited the largest decreases in frontalis EMG, these were also the subjects whose initial frontalis EMG levels were the highest. It is concluded that, in keeping with a growing literature, the link between frontalis EMG and "muscle-contraction" headaches is a tenuous one and that the changes brought about in headache symptomatology through biofeedback or relaxation training are most likely attributable to a generalization of feelings of mastery over the environment or of self-efficacy brought about in the subjects through apparent success at the task.     

The relationship between frontalis muscle activity and self-reports of headache pain

The relationship between levels of frontalis muscle activity and self-reports of pain was evaluated in two studies. In Study I frontalis muscle activity and self-reports of pain collected during biofeedback treatment of muscular contraction headache clients were correlated. In Study II frontalis EMG activity was increased and decreased using biofeedback techniques while concurrent reports of headache pain were recorded. The results of Study I indicated a significant relationship between EMG activity and reported headache pain for only two of the five subjects studied. The biofeedback procedures in Study II were associated with reliable increases and decreases in EMG activity. Concordance between EMG and pain reports occurred only during the EMG increase condition. Overall correlations were significant for one of the 2 subjects. The results suggest that EMG activity may not be sufficient to account for pain reports in all chronic headache clients, and variables other than EMG activity may be influencing reports of pain in some patients.     

An examination of methods for producing relaxation during short-term laboratory sessions

Reductions in psychological and physiological correlates of tension produced by various muscle relaxation training techniques were examined during a short-term laboratory session. Two studies are described involving a combined total of one hundred subjects receiving either abbreviated progressive relaxation, visual, auditory, or tactile electromyographic (EMG) biofeedback procedures. The Anxiety Differential was administered before and after the laboratory session. Heart rate, respiratory rate, skin conductance, systolic blood pressure, and frontalis and dominant forearm extensor EMG measures were obtained before, during, and after administration of relaxation training. Results indicated feedback in the tactile modality to produce overall reductions in tension comparable to those produced by progressive relaxation. Overall reductions in tension displayed by both progressive relaxation and tactile feedback were generally greater than reductions shown by visual or auditory feedback procedures. Interpretations suggest that certain forms of EMG feedback may offer an alternative to progressive relaxation techniques for producing short-term reductions in tension. Feedback modality is further indicated as a potentially important variable during relaxation training using the EMG feedback technique.     

Electrode placement,EMG feedback,and relaxation for tension headaches

Fifteen tension headache subjects were allocated to one of three groups: direct EMG feedback (from a site corresponding to the source of pain), indirect EMG feedback (from a site not corresponding to the source of the pain) and relaxation instructions. There were two base-line, six treatment and one post-treatment sessions. No significant differences were found between base-line and post-treatment EMG levels, for any of the groups; however, some significant reductions in levels were obtained within sessions. EMG levels recorded during headache attacks did not differ significantly from levels recorded during base-line. Frequency and intensity of headaches were significantly reduced, particularly in the relaxation group. At follow-up this improvement was maintained for subjects with forehead pain, but differences between the groups had disappeared.     

Comparative effectiveness of patterned biofeedback vs meditation training on EMG and skin temperature changes

This study examined whether a low arousal, relaxation pattern of frontalis EMG decreases and peripheral skin temperature increases could be attained more effectively through biofeedback or meditation training. Thirty female subjects, ranging in age from 21 to 59, were randomly assigned to one of three groups: patterned biofeedback, clinically standardized meditation or control. Prior to training, subjects were administered the EPI. Each subject was seen weekly for seven sessions. Subjective experiences and time spent practising at home were also recorded. Repeated measures ANCOVA's performed on the EMG and skin temperature means indicated that the meditation group showed significantly lower EMG levels at the end of treatment than the control group. No group had significant temperature increases nor were there any significant differences in practice time. The biofeedback group had difficulty in patterning the two feedback signals simultaneously. Extraverts in the control group had the highest EMG levels. The most positive subjective reports came from subjects in the meditation group. Meditation offers a viable alternative as a relaxation procedure, requiring little time to learn and devoid of any performance criteria levels.     

Modulation of motor variability related to experimental muscle pain during elbow-flexion contractions

Experimental muscle pain typically reorganizes the motor control. The pain effects may decrease when the three-dimensional force components are voluntarily adjusted, but it is not known if this could have negative consequences on other structures of the motor system. The present study assessed the effects of acute pain on the force variability during sustained elbow flexion when controlling task-related (one-dimensional) and all (three-dimensional) contraction force components via visual feedback. Experimental muscle pain was induced by bolus injection of hypertonic saline into m. biceps brachii, and isotonic saline was used as control. Twelve subjects performed sustained elbow flexion at different levels of the maximal voluntary contraction (5–30% MVC) before, during, and after the injections. Three-dimensional force components were measured simultaneously with surface electromyography (EMG) from elbow flexors and auxiliary muscles. Results showed that force variability was increased during pain compared to baseline for contractions using one-dimensional feedback (P < .05), but no significant differences were found for three-dimensional feedback. During painful contractions (1) EMG activity from m. trapezius was increased during contractions using both one-dimensional and three-dimensional feedback (P < .05), and (2) the complexity of EMG from m. triceps brachii and m. deltoid was higher for the three-dimensional feedback (P < .05). In conclusion, the three-dimensional feedback reduced the pain-related functional distortion at the cost of a more complex control of synergistic muscles.     

Site-specific muscle hyper-reactivity in musicians with occupational upper limb pain.

Fourteen musicians who reported a history of pain in the upper limb associated with the playing of their instruments were compared with a sample of pain-free musicians, matched for age, sex and musical instrument. Four tasks were presented in random order and included neutral, general stressor, personal stressor and pain stressor tasks. Ratings of stressfulness and recordings of skin conductance level confirmed the effectiveness of the experimental manipulations for both subject groups. No differences were found between groups or tasks for frontalis surface electromyograph (EMG) activity. Evidence was found, however, of EMG elevation in flexor and trapezius muscles on the pain side for the pain subjects, in response to the task involving recall of a pain experience. This elevation was not found for the pain-free controls or for other stressor tasks, although some elevation in response to the pain stressor task was found for pain subjects in the trapezius muscles of the non-pain side. The duration of return to baseline of EMG following the pain stressor task was found to be extended in pain subjects for the trapezius, but not for the flexor muscles of the pain side. The findings suggest that site-specific muscle hyper-reactivity may play a role in the development and maintenance of occupational upper limb pain in musicians.     

Reorganised anticipatory postural adjustments due to experimental lower extremity muscle pain

Automated movements adjusting postural control may be hampered during musculoskeletal pain leaving a risk of incomplete control of balance. This study investigated the effect of experimental muscle pain on anticipatory postural adjustments by reaction task movements. While standing, nine healthy males performed two reaction time tasks (shoulder flexion of dominant side and bilateral heel lift) before, during and after experimental muscle pain. On two different days experimental pain was induced in the m. vastus medialis (VM) or the m. tibialis anterior (TA) of the dominant side by injections of hypertonic saline (1 ml, 5.8%). Isotonic saline (1 ml, 0.9%) was used as control injection. Electromyography (EMG) was recorded from 13 muscles. EMG onset, EMG amplitude, and kinematic parameters (shoulder and ankle joint) were extracted. During shoulder flexion and VM pain the onset of the ipsilateral biceps femoris was significantly faster than baseline and post injection sessions. During heels lift in the VM and TA pain conditions the onset of the contralateral TA was significantly faster than baseline and post injection sessions in bilateral side. VM pain significantly reduced m. quadriceps femoris activity and TA pain significantly reduced ipsilateral VM activity and TA activity during bilateral heel lift. The EMG reaction time was delayed in bilateral soleus muscles during heels lift with VM and TA pain. The faster onset of postural muscle activity during anticipatory postural adjustments may suggest a compensatory function to maintain postural control whereas the reduced postural muscle activity during APAs may indicate a pain adaptation strategy to avoid secondary damage.     

Task performance and electromyopotential as functions of task difficulty and EMG feedback

The dearth of empirical research in the application of biofeedback is discussed. Exp. 1 assessed relationships among biofeedback EMG training, EMG levels, cognitive task performance, and task difficulty. 72 subjects (male or female college students) were administered 1 trial on an iconic memory task with either EMG audio feedback, sham EMG audio feedback, or no feedback. Three levels of task difficulty were used. One 20-min. training session significantly lowered EMG responses, and task performance was inversely related to task difficulty. No relationship between EMG level and task performance was observed. Exp. 2 investigated the effect of increased EMG responses on cognitive task performance for one level of difficulty. One biofeedback training session did not significantly increase frontalis EMG, and there was no relationship between increased EMG and task performance.     

BIOFEEDBACK AND RATIONAL-EMOTIVE THERAPY IN THE MANAGEMENT OF MIGRAINE HEADACHE

Twenty-four migraine patients were randomly assigned to one of four conditions: (a) self-monitoring of headache activity (waiting list), (b) frontalis EMG biofeedback, (c) digit temperature biofeedback, and (d) digit temperature biofeedback plus Rational-Emotive Therapy (RET). Bidirectional control over the target physiological response was assessed through a reversal design in each session. Following at least a four-week baseline, the three biofeedback groups received 8 to 10, 30-minute sessions of bidirectional biofeedback training, scheduled twice a week. Subjects in the combined digit temperature biofeedback plus RET group received three 40-minute sessions of RET as an addition to the third, fifth, and seventh biofeedback sessions. Records of daily home practice were kept throughout treatment and three-month followup. Subjects on the waiting list monitored headaches for at least five months, corresponding to “baseline”, “treatment”, and three-month followup. Digit temperature biofeedback alone and in conjunction with RET did not prove to be more effective than the control conditions. All the EMG subjects reduced headache activity to two-thirds or less of the baseline level by the third month of followup. Bidirectional digit temperature performance did not improve with training, was demonstrated in only 33% of the biofeedback sessions, was not maintained over time, and was unrelated to improvement in headache activity. EMG subjects reported biofeedback performance to be an easier task and met the performance criterion on 85% of the sessions. The frequency of home practice contributed over 55% of the variance in retrospective estimates of headache improvement but was not related to changes in daily records of headache activity.     

Physiological responses of obese subjects to external stimuli

Physiological arousal was measured in 11 obese and 11 normal-weight subjects during presentation of emotive, food, and neutral stimuli. No differential arousal (heart rate, temperature, GSR, and EMG on frontalis muscle) between the groups was obtained for any of the three types of stimuli. Discrepancies between the present findings and earlier results are discussed.     

Cumulative integrated electromyographic activity of selected speech-related muscle groups of nonstutterers during massed oral readings

The electromyographic (EMG) integrated amplitude of masseter and laryngeal muscle groups were analyzed during five massed oral readings of 16 nonstuttering adult subjects. Reduction in dysfluencies were observed over the five trials as was a reduction in reading time across trials. Significant decreases in EMG activity across trials were found for the laryngeal, but not the masseter, EMG activity. This suggests that changes in vocal behavior thought to accompany adaptation are reflected in decreases in EMG activity of select speech-related muscle groups.     

Role of the feedback signal in electromyograph biofeedback: the relevance of attention

This article describes two experiments designed to examine the hypothesis that the critical role of the feedback signal in frontalis electromyograph (EMG) biofeedback is an attentional one. In both experiments, high- and low-absorption subjects were assigned to either a biofeedback condition, a no-feedback condition, or an attentional demand condition in which external stimuli, related to relaxation, were presented as an attentional focus. The two experiments differed essentially in the type of attentional demand condition that was employed and varied the compelling nature of the demand on subjects for an external attentional focus. The pattern of results was consistent with the attentional hypothesis. For low-absorption subjects, performance in the biofeedback and attentional demand conditions was equivalent and appreciably greater than in the no-feedback condition. For high-absorption subjects, an interference effect of biofeedback was observed, but data indicated a similar interference effect on the performance of subjects when the attentional demand condition was most compelling. The pattern of results obtained point to the special relevance of attentional processes and highlight their lack of emphasis in contemporary theoretical models of EMG biofeedback.     

Emotional responding following experimental manipulation of facial electromyographic activity

Increases in zygomatic electromyographic (EMG) responding have been reported during the imagination of positive affective scenes, and increases in corrugator EMG have been reported during negative affective scenes. Thirty female subjects were instructed to imagine three positive affective scenes and three negative affective scenes. During the initial imagination of each scene, the subject was told simply to imagine the situation. The subject then imagined the situation again and was instructed to enhance the muscle tension in one of two muscle groups (the zygomatic muscles for positive scenes and the corrugator muscle for negative scenes). The subject then imagined the scence a third time and was instructed to suppress the muscle tension in the same muscle group. The order of administration of enhancement and suppression trials was randomized for each scene. Subjects were given several trials to practice controlling both zygomatic and corrugator EMG. Feedback was available during the practice trials and during the enhancement and suppression trials of the experiment. Continuous monitoring of both zygomatic and corrugator EMG during the study indicated that subjects were successful in altering muscle tension in accord with the experimental instructions, and videotapes of subjects' faces indicated no overt changes in facial responding during imagination of the scenes. Subjects' ratings of emotional responding during each scene indicated that subjects experienced less enjoyment and more distress during positive affective trials in which they suppressed zygomatic EMG activity. The results are discussed in terms of the facial feedback hypothesis.     

The treatment of nocturnal bruxism using contingent EMG feedback with an arousal task

Nocturnal electromyographic (EMG) recordings of masseter muscle activity were performed before and after treatment on 10 heavy bruxism subjects. Treatment consisted of giving the subjects an auditory feedback signal during sleep which occurred when they clenched with moderate force. Each subject additionally had to perform an arousal task every time the signal occurred. Nine of 10 subjects demonstrated a significantly decreased EMG activity using a contingent auditory feedback signal, combining it with an arousal task.     

Facial EMG reactions to facial expressions: A case of facial emotional contagion?

The purpose of this study is to explore whether subjects exposed to stimuli of facial expressions respond with facial electromyographic (EMG) reactions consistent with the hypothesis that facial expressions are contagious. This study further examines whether males and females differ in facial EMG intensity. Two experiments demonstrated that subjects responded with facial EMG activity over the corrugator supercilii, the zygomatic major , the lateral frontalis , the depressor supercilii , and the levator labii muscle regions to stimuli of sad, angry, fearful, surprised, disgusted and happy faces, that, to large extent, were consistent with the hypothesis that facial expressions are contagious. Aspects of gender differences reported in earlier studies were found, indicating a tendency for females to respond with more pronounced facial EMG intensity.     

Electromyographic and vasomotor activity in tension, migraine, and combined headache patients: The influence of postural variation

Electromyographic (EMG) and temporal artery vasomotor activity was evaluated in three groups of headache patients (tension, migraine and combined) and nonheadache control subjects while in reclining, sitting and standing positions. Analysis of the EMG data revealed that at all measurement sites (bilateral frontalis, bilateral trapezius) the three headache groups demonstrated significantly higher levels than the nonheadache group but did not differ from each other. A secondary analysis of the trapezius EMG data revealed that a large percentage of headache patients had “normal” EMG levels in the reclining position but showed abnormalities in the sitting and standing positions. Analysis of the left temporal artery vasomotor activity revealed that all three headache groups vasoconstricted to a significantly greater extent than the nonheadache group in the sitting and standing positions. However, a diagnosis by position interaction was found for the right temporal artery with the migraine group demonstrating a unique pattern of activity.     

The treatment of tension headache—I. Muscular abnormality and biofeedback

The specificity and efficacy of a short EMG biofeedback treatment were assessed in a selected group of chronic tension-headache cases—those having significantly elevated levels of muscle tension. The effects of training patients to raise/maintain EMG levels were compared to those obtained from patients who were trained to lower tension levels. The results showed little evidence of increased self-control of the muscle despite successful EMG control during six bio-feedback sessions. A progressive and significant reduction in resting level was found only in the groups trained to reduce EMG levels. The treatment proved ineffectual in reducing headache. The implications of the dissociation of muscle tension and headache are discussed both with respect to current views of tension headaches and the role of biofeedback in their treatment.     

Sensory feedback in the learning of a novel motor task

The role of different forms of feedback is examined in learning a novel motor task. Five groups of ten subjects had to learn the voluntary control of the abduction of the big toe, each under a different feedback condition (proprioceptive feedback, visual feedback, EMG feedback, tactile feedback, force feedback). The task was selected for two reasons. First, in most motor learning studies subjects have to perform simple movements which present hardly any learning problem. Second, studying the learning of a new movement an provide useful information for neuromuscular reeducation, where patients often also have to learn movements for which no control strategy exists. The results show that artificial sensory feedback (EMG feedback, force feedback) is more powerful than "natural" (proprioceptive, visual, and tactile) feedback. The implications of these results for neuromuscular reeducation are discussed.