The effect of frontal EMG biofeedback training on the behavior of children with activity-level problems

Electromyographic study of motor learning for a voice production task

PURPOSE

This study's broad objective was to examine the effectiveness of surface electromyographic (EMG) biofeedback for motor learning in the voice production domain. The specific objective was to examine whether concurrent or terminal biofeedback would facilitate learning for a relaxed laryngeal musculature task during spoken reading.

METHOD

Twenty-two healthy adult speakers were randomly assigned to 1 of 2 groups. One group received real-time EMG waveform displays of muscle activation from bilateral thyrohyoid sites during reading trials (concurrent feedback group). The other group received static terminal EMG waveform displays about activation levels for the same sites on completion of successive trials (terminal feedback group). All participants were instructed to minimize EMG amplitudes from the thyrohyoid sites during phonation in an oral reading task. Signals were also collected from control, orofacial sites, but participants received neither instructions nor feedback for those sites.

RESULTS

The pooled data (2 feedback groups x 2 electrode sites) showed that, overall, muscle activation levels did decrease across baseline, training, and no-feedback test phases. However, no clear evidence was seen of reliable changes in the targeted laryngeal muscle activation levels across the phases, for either the concurrent or the terminal feedback groups. Paradoxically, and entirely unanticipated, reliable decreases were seen in muscle activation for the orofacial, no-feedback control sites. Those decreases were equivalent across concurrent and terminal feedback groups.

CONCLUSIONS

The unanticipated findings indicate that the provision of biofeedback for a target muscle group facilitated incidental learning in another, untargeted muscle group. Discussion focuses on the possible role of locus of attention in motor learning. Building on literature from other domains, the hypothesis is advanced that attention to muscular contractile force during training trials may suppress intentional learning for attended target sites but may benefit incidental learning for nearby, unattended sites.

The role of complementary and alternative medicine in attention-deficit hyperactivity disorder

The use of complementary and alternative medicine (CAM) in pediatrics has become widespread. Parents of young children with developmental and behavioral problems such as attention-deficit hyperactivity disorder (ADHD) are particularly drawn to CAM interventions to avoid or decrease use of psychotropic medications. This paper reviews the epidemiology of CAM use for ADHD, describes a conceptual model of CAM, discusses a variety of commonly used therapies for ADHD, and introduces a systematic, pragmatic approach to discussing CAM therapy use with parents.

Biofeedback as a treatment for childhood hyperactivity: a critical review of the literature

Hyperactivity is a significant problem for which no causal theories have been unequivocally substantiated and one in which treatment approaches have met with limited success. Recent research in behavioral medicine has brought biofeedback into use as a treatment for disorders that are mediated by physiologic functioning, with hyperactivity as one such disorder. 36 studies are reviewed in which biofeedback was used as a treatment for hyperactivity. This review indicated that biofeedback treatments alone have not been effectively evaluated, and methodological problems with the current studies severely limit generalizations that may be made to hyperactive populations. Biofeedback in conjunction with other techniques appears to have promise for reducing some of the behavioral symptoms of the hyperactivity syndrome. Directions for further research are presented.

Teaching parents to conduct behavioral relaxation training with their hyperactive children

Three boys meeting multiple criteria for hyperactivity received Behavioral Relaxation Training (BRT) in their homes from their parents, under the supervision of the experimenter. BRT involved modeling, prompting, token reinforcement, and praise, for ten overt relaxed behaviors. All children learned to relax to a criterion of at least 80% on the Behavioral Relaxation Scale (BRS), an objective measure of relaxation. Frontalis EMG levels were correlated with BRS scores for two children. Proficiency was maintained at one and three-month follow-ups. All children were removed from medication by follow-up. Parent ratings of hyperactive behavior on two standardized questionnaires showed improvements from baseline to follow-up. Teacher ratings of problem behavior were less consistently positive. The concept of relaxation as a skill rather than a state, and its implications as an alternative to medication therapy, are discussed.

Behavioral relaxation training with hyperactive children

Three boys meeting multiple criteria of hyperactivity were trained to emit ten specific relaxed behaviors by means of Behavioral Relaxation Training (BRT). Dependent measures included the Behavioral Relaxation Scale (BRS), frontalis electromyogram (EMG), the Conners Parent Symptom Questionnaire, and self-report. A multiple-probe design across subjects was employed, plus a reversal between recliner and beanbag chair for each subject. BRT was effective in producing high levels of relaxed behaviors and low EMG levels in the office setting, particularly in conjunction with the beanbag chair, with some reduction of hyperactivity scores on the Conners. Subsequent training in each child's home by his mother was accompanied by further reductions in parent-reported symptoms and low EMG levels, which were maintained at a 1-month follow-up.

Is group progressive relaxation training as effective with hyperactive children as individual EMG biofeedback treatment?

This study examined whether group progressive relaxation training was as effective as individual EMG biofeedback training in facilitating the academic achievement and self-control of 45 hyperactive elementary school children. Academic achievement was assessed with the Gates-MacGinities Reading Tests, and self-control was measured with the Nowicki-Strickland and the Teacher Rating scales. Eight sessions were scheduled at weekly intervals. Progressive relaxation was conducted in groups of seven or eight and was induced with a commercial audiocassette program. EMG training augmented frontalis biofeedback with those taped exercises. A placebo group listened to taped children's stories. Multivariate analysis of variance indicated no significant differences among the three contrast groups when all dependent variables were considered together. However, univariate F values and discriminant analysis disclosed locus of control to be significantly more internal for the progressive relaxation condition. Also, differences between the two relaxation and the placebo groups, though not statistically significant, were all in the expected direction. While the relative efficacy of group progressive relaxation could not be established conclusively, the data appeared sufficiently positive to warrant further investigation of this cost-effective prospective intervention.

Predictors of success in the EMG biofeedback training of hyperactive male children

EMG biofeedback training is continuing to evolve as a promising treatment of hyperactivity. But while research on its application suggests that this technique induces significantly lower EMG levels in experimental samples as a whole, it also discloses that some children evidence but limited reductions. Most likely, this variability is introduced by differences in subject attributes. This study assessed that prospect by examining whether four common subject characteristics correlated with the extent of decrease in EMG level achieved by 59 hyperactive school-aged boys. Those variables were pretreatment EMG level, age degree of hyperactivity, and locus of control. Number of applications or training sessions was included as the fifth predictor. A multiple regression analysis determined that only locus of control was predictive of success in EMG training; however, it accounted for 72% of the variance. Implications of these findings are discussed.