Biofeedback combined with percutaneous electrical pudendal nerve stimulation for the treatment of low anterior rectal resection syndrome: a study protocol for a randomized controlled trial.

BACKGROUND: Low anterior resection syndrome (LARS) is a distressing condition that affects approximately 25-80% of patients following surgery for rectal cancer. LARS is characterized by debilitating bowel dysfunction symptoms, including fecal incontinence, urgent bowel movements, and increased frequency of bowel movements. Although biofeedback therapy has demonstrated effectiveness in improving postoperative rectal control, the research results have not fulfilled expectations. Recent research has highlighted that stimulating the pudendal perineal nerves has a superior impact on enhancing pelvic floor muscle function than biofeedback alone. Hence, this study aims to evaluate the efficacy of a combined approach integrating biofeedback with percutaneous electrical pudendal nerve stimulation (B-PEPNS) in patients with LARS through a randomized controlled trial (RCT). METHODS AND ANALYSIS: In this two-armed multicenter RCT, 242 participants with LARS after rectal surgery will be randomly assigned to undergo B-PEPNS (intervention group) or biofeedback (control group). Over 4 weeks, each participant will undergo 20 treatment sessions. The primary outcome will be the LARS score. The secondary outcomes will be anorectal manometry and pelvic floor muscle electromyography findings and the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire-Colorectal 29 (EORTC QLQ-CR29) scores. Data will be collected at baseline, post-intervention (1 month), and follow-up (6 months). DISCUSSION: We anticipate that this study will contribute further evidence regarding the efficacy of B-PEPNS in alleviating LARS symptoms and enhancing the quality of life for patients following rectal cancer surgery. TRIAL REGISTRATION: Chinese Clincal Trials Register ChiCTR2300078101. Registered 28 November 2023.

Evaluating the efficacy of wearable biofeedback on the outcomes of exercise interventions in people with chronic non-specific spinal pain: protocol for a systematic review and meta-analysis.

INTRODUCTION: Wearable neuromuscular and biomechanical biofeedback technology has the potential to improve patient outcomes by facilitating exercise interventions. We will conduct a systematic review to examine whether the addition of wearable biofeedback to exercise interventions improves pain, disability and quality of life beyond exercise alone for adults with chronic non-specific spinal pain. Specific effects on clinical, physiological, psychological, exercise adherence and safety outcomes will also be examined. METHODS AND ANALYSIS: A systematic search will be conducted from inception to February 2024. Full articles in the English language will be included. MEDLINE, PubMed, CINAHL, EMBASE, Web of Science, PsycINFO, AMED, SPORTDiscus, CENTRAL databases, clinical trial registries and ProQuest (PQDT) will be used to search for eligible studies. Grey literature and conference proceedings (2022-2024) will be searched for relevant reports. Randomised controlled trials using wearable neuromuscular or kinematic biofeedback devices as an adjunct to exercise interventions for the treatment of chronic spinal pain will be included in this systematic review. The comparators will be wearable biofeedback with exercise versus exercise alone, or wearable biofeedback with exercise versus placebo and exercise. Risk of bias will be assessed using Cochrane Back Review Group criteria and the quality of evidence using Grading of Recommendations Assessment, Development and Evaluation recommendations. ETHICS AND DISSEMINATION: The systematic review will be based on published studies, and therefore, does not require ethical approval. The study results will be submitted for publication in an international, open-access, peer-reviewed journal and shared through conferences and public engagement. PROSPERO REGISTRATION NUMBER: CRD42023481393.

Normative value of deep neck flexors muscle strength measurement using pressure biofeedback unit and sphygmomanometer: An observational study.

PURPOSE: To find out the normative value of deep neck flexor muscles strength using pressure biofeedback unit and sphygmomanometer. METHODS: The healthy individuals both male and female aged between 18 and 25 years were recruited by stratified random sampling method from a tertiary hospital. The procedure is performed with the patient in supine lying with the neck in a neutral position. To check strength, pressure biofeedback unit and sphygmomanometer were placed under occiput and ask the individual to do the movement is genteelly and slowly as a head nodding action (chin tuck). The performance was scored via the pressure level that patient achieves 3 repetitions for 10 s hold and interval timing for 10 s. And the pressure biofeedback unit and sphygmomanometer inflated with 40 mmHg and took three reading respectively. RESULT: Our result shows, in decreased of deep neck cervical flexor muscle Strength with age group 21 (20-22) in normal adult and underweight with age group 21 (19-23) and with BMI 21 (20.1-22.4) and 16.6 (16.1-17.6) respectively. In our study, the deep neck flexor strength of overweight adults with age group 22 (21-23) and with BMI 27.8 (25.9-29.4) is stronger is than the normal and underweight adults. CONCLUSION: The study concluded that the maximal Deep neck cervical flexor strength of overweight Adults is stronger than normal and underweight Adults. The difference is maintained in all age groups. The maximal Deep neck cervical flexor strength, for flexion is developed at neutral position of neck.

A Rapid Review on the Effectiveness and Use of Wearable Biofeedback Motion Capture Systems in Ergonomics to Mitigate Adverse Postures and Movements of the Upper Body.

Work-related diseases and disorders remain a significant global health concern, necessitating multifaceted measures for mitigation. One potential measure is work technique training utilizing augmented feedback through wearable motion capture systems. However, there exists a research gap regarding its current effectiveness in both real work environments and controlled settings, as well as its ability to reduce postural exposure and retention effects over short, medium, and long durations. A rapid review was conducted, utilizing two databases and three previous literature reviews to identify relevant studies published within the last twenty years, including recent literature up to the end of 2023. Sixteen studies met the inclusion criteria, of which 14 were of high or moderate quality. These studies were summarized descriptively, and the strength of evidence was assessed. Among the included studies, six were rated as high quality, while eight were considered moderate quality. Notably, the reporting of participation rates, blinding of assessors, and a-priori power calculations were infrequently performed. Four studies were conducted in real work environments, while ten were conducted in controlled settings. Vibration feedback was the most common feedback type utilized (n = 9), followed by auditory (n = 7) and visual feedback (n = 1). All studies employed corrective feedback initiated by the system. In controlled environments, evidence regarding the effectiveness of augmented feedback from wearable motion capture systems to reduce postural exposure ranged from strong evidence to no evidence, depending on the time elapsed after feedback administration. Conversely, for studies conducted in real work environments, the evidence ranged from very limited evidence to no evidence. Future reach needs are identified and discussed.

Revolutionizing motor dysfunction treatment: A novel closed-loop electrical stimulator guided by multiple motor tasks with predictive control.

Functional electrical stimulation (FES) has been demonstrated as a viable method for addressing motor dysfunction in individuals affected by stroke, spinal cord injury, and other etiologies. By eliciting muscle contractions to facilitate joint movements, FES plays a crucial role in fostering the restoration of motor function compromised nervous system. In response to the challenge of muscle fatigue associated with conventional FES protocols, a novel biofeedback electrical stimulator incorporating multi-motor tasks and predictive control algorithms has been developed to enable adaptive modulation of stimulation parameters. The study initially establishes a Hammerstein model for the stimulated muscle group, representing a time-varying relationship between the stimulation pulse width and the root mean square (RMS) of the surface electromyography (sEMG). An online parameter identification algorithm utilizing recursive least squares is employed to estimate the time-varying parameters of the Hammerstein model. Predictive control is then implemented through feedback corrections based on the comparison between predicted and actual outputs, guided by an optimization objective function. The integration of predictive control and roll optimization enables closed-loop control of muscle stimulation. The motor training tasks of elbow flexion and extension, wrist flexion and extension, and five-finger grasping were selected for experimental validation. The results indicate that the model parameters were accurately identified, with a RMS error of 3.83 % between actual and predicted values. Furthermore, the predictive control algorithm, based on the motor tasks, effectively adjusted the stimulus parameters to ensure that the stimulated muscle groups can achieve the desired sEMG characteristic trajectory. The biofeedback electrical stimulator that was developed has the potential to assist patients experiencing motor dysfunction in achieving the appropriate joint movements. This research provides a foundation for a novel intelligent electrical stimulation model.

Top-down brain circuits for operant bradycardia.

Heart rate (HR) can be voluntarily regulated when individuals receive real-time feedback. In a rat model of HR biofeedback, the neocortex and medial forebrain bundle were stimulated as feedback and reward, respectively. The rats reduced their HR within 30 minutes, achieving a reduction of approximately 50% after 5 days of 3-hour feedback. The reduced HR persisted for at least 10 days after training while the rats exhibited anxiolytic behavior and an elevation in blood erythrocyte count. This bradycardia was prevented by inactivating anterior cingulate cortical (ACC) neurons projecting to the ventromedial thalamic nucleus (VMT). Theta-rhythm stimulation of the ACC-to-VMT pathway replicated the bradycardia. VMT neurons projected to the dorsomedial hypothalamus (DMH) and DMH neurons projected to the nucleus ambiguus, which innervates parasympathetic neurons in the heart.

Wearable biofeedback device to assess gait features and improve gait pattern in people with parkinson's disease: a case series.

INTRODUCTION: People with Parkinson's Disease (PD) show abnormal gait patterns compromising their independence and quality of life. Among all gait alterations due to PD, reduced step length, increased cadence, and decreased ground-reaction force during the loading response and push-off phases are the most common. Wearable biofeedback technologies offer the possibility to provide correlated single or multi-modal stimuli associated with specific gait events or gait performance, hence promoting subjects' awareness of their gait disturbances. Moreover, the portability and applicability in clinical and home settings for gait rehabilitation increase the efficiency in the management of PD. The Wearable Vibrotactile Bidirectional Interface (BI) is a biofeedback device designed to extract gait features in real-time and deliver a customized vibrotactile stimulus at the waist of PD subjects synchronously with specific gait phases. The aims of this study were to measure the effect of the BI on gait parameters usually compromised by the typical bradykinetic gait and to assess its usability and safety in clinical practice. METHODS: In this case series, seven subjects (age: 70.4 ± 8.1 years; H&Y: 2.7 ± 0.3) used the BI and performed a test on a 10-meter walkway (10mWT) and a two-minute walk test (2MWT) as pre-training (Pre-trn) and post-training (Post-trn) assessments. Gait tests were executed in random order with (Bf) and without (No-Bf) the activation of the biofeedback stimulus. All subjects performed three training sessions of 40 min to familiarize themselves with the BI during walking activities. A descriptive analysis of gait parameters (i.e., gait speed, step length, cadence, walking distance, double-support phase) was carried out. The 2-sided Wilcoxon sign-test was used to assess differences between Bf and No-Bf assessments (p < 0.05). RESULTS: After training subjects improved gait speed (Pre-trn_No-Bf: 0.72(0.59,0.72) m/sec; Post-trn_Bf: 0.95(0.69,0.98) m/sec; p = 0.043) and step length (Pre-trn_No-Bf: 0.87(0.81,0.96) meters; Post-trn_Bf: 1.05(0.96,1.14) meters; p = 0.023) using the biofeedback during the 10mWT. Similarly, subjects' walking distance improved (Pre-trn_No-Bf: 97.5 (80.3,110.8) meters; Post-trn_Bf: 118.5(99.3,129.3) meters; p = 0.028) and the duration of the double-support phase decreased (Pre-trn_No-Bf: 29.7(26.8,31.7) %; Post-trn_Bf: 27.2(24.6,28.7) %; p = 0.018) during the 2MWT. An immediate effect of the BI was detected in cadence (Pre-trn_No-Bf: 108(103.8,116.7) step/min; Pre-trn_Bf: 101.4(96.3,111.4) step/min; p = 0.028) at Pre-trn, and in walking distance at Post-trn (Post-trn_No-Bf: 112.5(97.5,124.5) meters; Post-trn_Bf: 118.5(99.3,129.3) meters; p = 0.043). SUS scores were 77.5 in five subjects and 80.3 in two subjects. In terms of safety, all subjects completed the protocol without any adverse events. CONCLUSION: The BI seems to be usable and safe for PD users. Temporal gait parameters have been measured during clinical walking tests providing detailed outcomes. A short period of training with the BI suggests improvements in the gait patterns of people with PD. This research serves as preliminary support for future integration of the BI as an instrument for clinical assessment and rehabilitation in people with PD, both in hospital and remote environments. TRIAL REGISTRATION: The study protocol was registered (DGDMF.VI/P/I.5.i.m.2/2019/1297) and approved by the General Directorate of Medical Devices and Pharmaceutical Service of the Italian Ministry of Health and by the ethics committee of the Lombardy region (Milan, Italy).

The ankle dorsiflexion kinetics demand to increase swing phase foot-ground clearance: implications for assistive device design and energy demands.

BACKGROUND: The ankle is usually highly effective in modulating the swing foot's trajectory to ensure safe ground clearance but there are few reports of ankle kinetics and mechanical energy exchange during the gait cycle swing phase. Previous work has investigated ankle swing mechanics during normal walking but with developments in devices providing dorsiflexion assistance, it is now essential to understand the minimal kinetic requirements for increasing ankle dorsiflexion, particularly for devices employing energy harvesting or utilizing lighter and lower power energy sources or actuators. METHODS: Using a real-time treadmill-walking biofeedback technique, swing phase ankle dorsiflexion was experimentally controlled to increase foot-ground clearance by 4 cm achieved via increased ankle dorsiflexion. Swing phase ankle moments and dorsiflexor muscle forces were estimated using AnyBody modeling system. It was hypothesized that increasing foot-ground clearance by 4 cm, employing only the ankle joint, would require significantly higher dorsiflexion moments and muscle forces than a normal walking control condition. RESULTS: Results did not confirm significantly increased ankle moments with augmented dorsiflexion, with 0.02 N.m/kg at toe-off reducing to zero by the end of swing. Tibialis Anterior muscle force incremented significantly from 2 to 4 N/kg after toe-off, due to coactivation with the Soleus. To ensure an additional 4 cm mid swing foot-ground clearance, an estimated additional 0.003 Joules/kg is required to be released immediately after toe-off. CONCLUSION: This study highlights the interplay between ankle moments, muscle forces, and energy demands during swing phase ankle dorsiflexion, offering insights for the design of ankle assistive technologies. External devices do not need to deliver significantly greater ankle moments to increase ankle dorsiflexion but, they should offer higher mechanical power to provide rapid bursts of energy to facilitate quick dorsiflexion transitions before reaching Minimum Foot Clearance event. Additionally, for ankle-related bio-inspired devices incorporating artificial muscles or humanoid robots that aim to replicate natural ankle biomechanics, the inclusion of supplementary Tibialis Anterior forces is crucial due to Tibialis Anterior and Soleus co-activation. These design strategies ensures that ankle assistive technologies are both effective and aligned with the biomechanical realities of human movement.

Practice effects of a breathing technique on pilots' cognitive and stress associated heart rate variability during flight operations.

Commercial pilots endure multiple stressors in their daily and occupational lives which are detrimental to psychological well-being and cognitive functioning. The Quick coherence technique (QCT) is an effective intervention tool to improve stress resilience and psychophysiological balance based on a five-minute paced breathing exercise with heart rate variability (HRV) biofeedback. The current research reports on the application of QCT training within an international airline to improve commercial pilots' psychological health and support cognitive functions. Forty-four commercial pilots volunteered in a one-month training programme to practise self-regulated QCT in day-to-day life and flight operations. Pilots' stress index, HRV time-domain and frequency-domain parameters were collected to examine the influence of QCT practice on the stress resilience process. The results demonstrated that the QCT improved psychophysiological indicators associated with stress resilience and cognitive functions, in both day-to-day life and flight operation settings. HRV fluctuations, as measured through changes in RMSSD and LF/HF, revealed that the resilience processes were primarily controlled by the sympathetic nervous system activities that are important in promoting pilots' energy mobilization and cognitive functions, thus QCT has huge potential in facilitating flight performance and aviation safety. These findings provide scientific evidence for implementing QCT as an effective mental support programme and controlled rest strategy to improve pilots' psychological health, stress management, and operational performance.

Effect of virtual reality-based biofeedback for depressive and anxiety symptoms: Randomized controlled study.

BACKGROUND: The use of virtual reality (VR)-based biofeedback (BF), a relatively new intervention, is a non-pharmacological treatment of depressive and anxiety symptoms. However, studies on VR-based BF are lacking and inconclusive. METHODS: A total of 131 adults were recruited from the community. Participants who scored ≥10 on the Patient Health Questionnaire-9 (PHQ-9) or ≥9 on the Panic Disorder Severity Scale (PDSS) were included in the group with depressive or anxiety symptoms (DAS group), and others as the healthy control group (HC group). Participants from the DAS group were randomly assigned to VR-based or conventional BF intervention. All individuals visited at three times (weeks 0, 2, and 4), and completed the Montgomery-Asberg Depression Rating Scale (MADRS), the State-Trait Anxiety Inventory (STAI), and a visual analog scale (VAS) before and after the intervention, and PHQ-9 at the beginning and final visit. RESULTS: The analysis included a total of 118 participants (DAS/VR: 40, DAS/BF: 38, HC/VR: 40). There was no significant difference in demographic variables among the three groups. After the intervention, the DAS/VR group exhibited significant decreases in MADRS (70.0 %), PHQ-9 (64.1 %), STAI (29.5 %), and VAS (61.7 %) scores compared to the baseline (p <0.001). There were no significant differences between the effects of VR-based BF and conventional BF with a therapist. The HC group also showed significant decreases in the measures of depression and anxiety after receiving VR-based BF. CONCLUSION: VR-based BF was effective in reducing depressive and anxiety symptoms, even for subthreshold depression and anxiety symptoms in the HC group.

Management of the child with refractory constipation.

BACKGROUND: Caring for children with constipation refractory to conventional treatment can be challenging and management practices vary widely. AIMS: To review recent advances in the evaluation and treatment of children with refractory constipation and to propose an algorithm that incorporates the latest evidence and our institutional experience. METHODS: We performed a literature review on diagnostic tests and treatment options for children with refractory constipation. RESULTS: Evaluation of a child with refractory constipation seeks to better understand factors contributing to an individual child's presentation. Anorectal manometry evaluating for a rectal evacuation disorder and colonic manometry evaluating for colonic dysmotility can guide subsequent treatment. For the child who has not responded to conventional treatment, a trial of newer medications like linaclotide can be helpful. Transanal irrigation offers a safe and effective alternative for families able to administer daily rectal treatment. Despite mixed evidence in children, pelvic floor biofeedback therapy can help some children with pelvic floor dyssynergia. For younger children unable to cooperate with pelvic floor therapy, or older children with refractory symptoms, internal anal sphincter botulinum toxin injection can be beneficial. Antegrade continence enema treatment can be effective for children with either normal colonic motility or segmental dysmotility. Sacral nerve stimulation is generally reserved for symptoms that persist despite antegrade continence enemas, particularly if faecal incontinence is prominent. In more severe cases, temporary or permanent colonic diversion and segmental colonic resection may be needed. CONCLUSIONS: Recent advances offer hope for children with refractory constipation.

Urotherapy and biofeedback resistant dysfunctional voiding: How to deal with?

OBJECTIVES: To analyze the management strategies in the children who had treatment-resistant dysfunctional voiding (DV). METHODS: Among 75 children with DV who underwent pelvic floor biofeedback therapy (BF) between 2013 and 2020, 16 patients (14 girls, 87.5%) with a mean age of 9.81 ± 2.53 years that showed incomplete clinical response following urotherapy and initial BF sessions were retrospectively reviewed. The demographic and clinical characteristics, DVSS, and uroflowmetry parameters were recorded before and after the initial BF sessions. Subsequent treatments after initial BF and clinical responses of patients were noted. RESULTS: Clinical success was observed in one patient by addition of an anticholinergic and in three patients with combination of salvage BF sessions and anticholinergics, whom had predominant overactive bladder (OAB) symptoms. The success rate of TENS alone and in combination with other treatment modalities was 88.8% (8/9 patients). In addition, salvage BF sessions (range 2 to 3) enabled clinical success in five (50%) of 10 cases as a combination with anticholinergics or TENS. In case of incomplete emptying without OAB, adequate clinical response to Botulinum-A was observed during an average follow-up of 29 months in two boys who did not respond to alpha-blockers, even though one required repeat injection after 10 months. The total clinical success rate was 87.5% (14/16 patients) after a median follow-up of 24 months. VV-EBC and Qmax increased by a mean of 30.89% and 7.13 mL/min, respectively, whereas DVSS decreased by a mean of 8.88 points and PVR-EBC decreased by a median of 19.04%. CONCLUSIONS: Our findings showed that clinical success in resistant DV was achieved by various combination treatments in the majority of children. However, a small group may still have persistent, bothersome symptoms despite multiple treatment modalities.

Electromyographic biofeedback training in a cerebral palsy patient undergoing pronator teres rerouting and brachioradialis to extensor carpi radialis brevis tendon transfer surgery: A case report.

Several surgical procedures are used to treat dynamic pronation position of the forearm and flexion deformity of the wrist in cerebral palsy. Postoperative results of pronator teres rerouting were explored, while specially designed postoperative physiotherapy and its outcomes were limited. Herein, we present a case in whom the outcomes of electromyographic biofeedback (EMG-BF) training were assessed after pronator teres rerouting and brachioradialis tendon to extensor carpi radialis brevis tendon transfer combined with derotation osteotomy. The peak value increased, while the resting value decreased for the muscles after the intervention. Range of motion, hand function, manual ability, functional independence, and quality of life levels were improved. In conclusion, EMG biofeedback training may have a positive effect on neuromuscular control of pronator teres and brachioradialis. Free use of the upper extremity and improved manual ability positively affect the activity and quality of life of the patients.

Autonomic and cognitive control in memory: Investigating the psychophysiological link using heart rate variability biofeedback.

Vagally mediated heart rate variability (vmHRV) at resting state has been associated to cognitive functions dependent on cognitive control, such as memory. However, little is known about the phasic interaction between cognitive and autonomic control. In a pre-registered within-between-subject designed experiment, the potential of vmHRV biofeedback to simultaneously stimulate vmHRV during memory processing and cognitive control over long-term memory was tested, along with investigating psychophysiological association. 71 young healthy adults completed (twice) a false memory task in virtual reality. Immediately before memory encoding and retrieval, participants practiced either vmHRV biofeedback or a control breathing exercise. Cognitive control over long-term memory was assessed as the confidence toward false memories and the capability to discriminate them from true memories. Resting-state vmHRV before each test and phasic vmHRV during memory encoding and retrieval were measured as the root mean square differences (RMSSD) in the heart period. vmHRV biofeedback had neither an immediate effect on measures of cognitive control over long-term memory nor on phasic RMSSD. Moreover, neither resting-state nor phasic vmHRV correlated to the cognitive scores. Consequently, the utility of HRV biofeedback as a psychophysiological stimulation tool and a link between vmHRV and cognitive control over long-term memory could not be verified. Exploratory analyses revealed that baseline shift in parasympathetic activity confounded the psychophysiological association. Future directions are provided that could shed light on the relationship between cognition and vmHRV.

The effectiveness of core stabilization exercise using ultrasound biofeedback on motor function, balance control, gait speed and activities of daily living in stroke patients.

BACKGROUND: Patients with hemiparetic stroke experience diminished motor function, dynamic balance, and gait speed, which influence their activities of daily living (ADL). OBJECTIVE: This study aimed to determine the therapeutic effects of ultrasound biofeedback core exercise (UBCE) on Fugl-Meyer assessment (FMA), Time up and go (TUG), 10-meter walking test (10MWT) and functional independent measure (FIM) in participants with stroke. METHODS: Twenty-four stroke survivors consistently underwent UBCE or abdominal draw-in maneuver (ADIM) for 30 min/session, 3 days a week for 4 weeks. Clinical outcome measurements - the FMA, TUG, 10MWT, and FIM - were observed pre-and post-intervention. RESULTS: We detected significant changes in the FMA-lower extremities, TUG, 10MWT, and FIM scores between the UBCE and ADIM groups. UBCE and ADIM showed significant improvements in FMA-lower extremities, TUG, 10MWT, and FIM scores. However, UBCE showed more favorable results than ADIM in patients with stroke. CONCLUSIONS: Our research provides novel therapeutic suggestion of neurorehabilitation in stroke patients.

[Rehabilitation in bilateral vestibulopathy: trends and perspectives]. / Reabilitatsiya patsientov s dvustoronnei vestibulopatiei: tendentsii i perspektivy razvitiya.

A review of the literature on rehabilitation methods for bilateral vestibulopathy is presented using RSCI, Scopus and PubMed databases. The principles and effectiveness of physical vestibular rehabilitation, vestibular implants, galvanic vestibular stimulation, and biofeedback-based sensory substitution and augmentation systems are described. The advantages and disadvantages of each method and perspectives for their improvement are presented.

"Brain-IT": Exergame training with biofeedback breathing in neurocognitive disorders.

INTRODUCTION: The combination of exergame-based motor-cognitive training with resonance breathing guided by heart-rate variability biofeedback (HRV-BF) targets various relevant mechanisms of action to alleviate the pathological state in mild neurocognitive disorders (mNCD). METHODS: This randomized controlled trial (RCT) investigated the effectiveness of adding this novel intervention approach to usual care in mNCD. The individualized intervention was delivered via the "Brain-IT" training concept, which was iteratively co-designed, tested, and refined with patient and public involvement. RESULTS: We observed statistically significant effects with large effect sizes for global cognitive performance, immediate verbal recall, and delayed verbal recall in favor of the intervention group. Fifty-five percent of participants showed a clinically relevant improvement in response to training. DISCUSSION: Confirmatory RCTs are warranted to investigate whether the observed improvements in cognitive performance translate to affecting the rates of progression to or onset of dementia and test the implementation of the training in clinical practice. HIGHLIGHTS: We proposed a novel intervention approach for mild neurocognitive disorders. It combines exergame-based training with biofeedback-guided resonance breathing. Our results confirm the effectiveness of this approach. Fifty-five percent of participants showed a clinically relevant improvement in response to training.

The immediate efficacy of the spinomed orthosis and biofeedback posture orthosis on balance and gait in older people with thoracic hyperkyphosis.

BACKGROUND: Increased kyphosis is a common condition among older people that may, directly or indirectly, be a risk factor for poor balance and gait. Spinomed and Biofeedback Posture Trainer (BPT) orthoses is an effective treatment approach for hyperkyphosis. This study aimed to compare the immediate effects of the Spinomed and BPT orthoses on balance and gait in the older population. METHODS: A total of 52 volunteer older people with hyperkyphosis (kyphosis angle>40°) participated in this study and were randomly allocated into two groups, to either the Spinomed orthosis (n = 26, mean age = 65.50 ± 5.50) or the BPT (n = 26, mean age = 65.38 ± 5.69) orthosis. All participants were asked to wear the orthoses for 1.5 h to get used to them. Balance parameters, which are Postural Stability Test (PST), Limits of Stability (LOS), and Clinical Test of Sensory Integration for Balance (m-CTSIB) were assessed using the Biodex Balance System, while walking parameters were assessed using the G-Walk with and without orthosis. RESULTS: The Spinomed had a positive effect on balance parameters (p < 0.05) except for the closed eyes firm surface and the opened eyes foam surface conditions of the m-CTSIB (p > 0.05). BPT had a significant impact on the PST score, LOS, and the closed eyes firm surface condition of the m-CTSIB (p < 0.001). Spinomed had a significant effect on cadence, speed, gait cycle duration, elaborated steps, and symmetry index of pelvic angles (p < 0.05), while the BPT had a significant effect only on step length and rotation symmetry index. No significant difference was detected between the two types of orthoses in the balance and gait parameters (p > 0.05). CONCLUSIONS: Spinomed and BPT were both effective in improving balance performance, with similar improvements demonstrated by both orthoses. Additionally, Spinomed may provide significant improvements in cadence, speed, gait cycle duration, elaborated steps, and all symmetry indexes of pelvic angles in the short term.

The effect of a biofeedback-based virtual reality game on pain, fear and anxiety levels during port catheter needle insertion in pediatric oncology patients: A randomized controlled study.

PURPOSE: It is essential to control pain, fear, and anxiety related to medical procedures to improve the well-being of the child and family trying to cope with the disease process. This study investigated the impact of the biofeedback-based virtual reality game (BioVirtualPed) on pain, fear, and anxiety levels during port needle insertion in pediatric oncology patients (POPs). METHODS: This randomized controlled study was conducted at a hospital between August and December 2023 involving 62 POPs aged 6-12 and their mothers. The intervention group wore a virtual reality headset and a respiratory sensor during the procedure. Data were collected using the Descriptive Information Form, Wong-Baker Pain Assessment Scale, Child Fear Scale, Children's State Anxiety, Satisfaction Scoring-Visual Analog Scale, and ADXL354 Sensor. Statistical analysis was performed using IBM SPSS for Windows Version 24.0. RESULTS: The intervention group showed lower mean pain scores than the control group (p < 0.001). There was no difference in pre-procedure fear and anxiety scores between groups (p > 0.05 and p > 0.05, respectively). Post-procedure fear and anxiety scores were lower in the intervention group (p < 0.001 and p < 0.001, respectively). The intervention group's mean respiratory rates were lower (p < 0.001), and their satisfaction scores were higher (p < 0.001). Agreements between POPs and mothers on pain, fear, and anxiety scores were good and excellent across groups (p < 0.001). CONCLUSIONS: The BioVirtualPed reduced procedure-related pain, anxiety, and fear, increased care satisfaction, and had a positive effect on the mean respiratory rate, hence it shows promising results, but these findings need further comfirmation.

Nonpharmacologic Treatment of Chronic Constipation.

Functional constipation is a common clinical diagnosis that affects approximately 14% of the world's population. Non-pharmacological therapies often represent the initial steps in management and may include lifestyle adjustments or changes such as physical activity and diet. Pharmacological options have been used when the non-pharmacological approach has been ineffective. Biofeedback therapy, surgery, sacral nerve stimulation, botulinum toxin injection, and vibrating capsules can be considered in scenarios where the laxatives are ineffective. Biofeedback therapy is highly effective and safe in treating dyssynergic defecation, which affects more than half of patients with chronic constipation. This paper overviews non-pharmacological therapies for functional constipation.