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Human locomotion is based on this conscious control.

Psychophysiological Disorders of the Gastrointestinal Tract

The individual carelessly pictures the destination, and begins to move. In that same moment his or her central nervous system fluidly organizes multiple components of muscular activity into a "kinetic melody," which effectively carries the individual to the goal. Hundreds and even thousands of "motor units" each motor unit comprised of many muscle fibers are recruited into one such activity or movement. A variety of diseases, injuries, and pathological conditions undermine this muscular integration, and rehabilitation of muscle pain and functional motor deficits is challenging at best.

In many cases injury destroys the sensory-motor pathway linking brain and muscle, while the muscle fibers themselves remain structurally intact, but without coordination.

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Even the healthy individual shows little precise awareness of, or control over, individual motor units in the muscles. There is no proprioceptive sensation to guide the acquisition of control of such microscopic areas of muscle function. John V. Basmajian began a program of research in the 's to test the outer limits of voluntary control over the skeletal muscles.

Basmajian utilized surface electrodes over the muscle, and visual oscilloscope and auditory feedback to the subject Basmajian, Ultimately he demonstrated that almost any subject could establish conscious control and training of a single motor unit within a muscle, within a brief time. On one occasion he monitored the muscle functions of a television interviewer. This interviewer insisted that he would learn the motor control, while simultaneously conducting the interview for television cameras.

Basmajian discouraged this bravado, yet the interviewer persisted and mastered the motor control with feedback, while carrying out the half hour interview Brown, The applications range from relieving a tension headache to rehabilitating foot drop after a stroke. Further, Basmajian's work provides convincing support for the basic biofeedback model. If an external device is able to provide the human subject with precise information about physiological processes, then the individual's control over these bodily processes can be increased.

Even those muscles or other organ functions that have been damaged by injury or disease process may be brought under some form of compensatory control, once electronic feedback is provided to the individual. The biofeedback instrument creates a functional substitute an external feedback loop , replacing the body's original internal feedback and self-regulatory process.

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One less glamorous area of clinical biofeedback practice antedates the rest of the biofeedback movement by at least two decades. In California gynecologist Arnold Kegel invented the perineometer, to assist his gynecological patients in controlling urinary leakage. The perineometer is an instrument inserted into the vagina, which measures muscle contraction and provides the patient with immediate feedback, to guide her enhanced control of urine.

The use of this device enhances self-regulation, and avoids personal embarrassment, social stigma, and costly and often ineffective surgical procedures. Kegel also introduced the now widely used Kegel exercises, but it is noteworthy that the Kegel exercises are more effective when their use is accompanied by perineometric feedback. The field of incontinence treatment also produced another contender for the earliest biofeedback device.

Hobart Mowrer, the respected psychological researcher, described the use of a bedwetting alarm in a article. This immediate feedback triggered awakening, reflex sphincter contraction, and detrusor muscle relaxation. Through a process of classical conditioning, the internal cues presented by the filling bladder take over to stimulate the same response sequence Collins, Many children rapidly learn to self-monitor and self-regulate.

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The process becomes automatic for most children, to the extent that they sleep through the night without incident. These early innovations in daytime and nighttime incontinence treatment have born fruit with dramatic personal consequences for many individuals. The United States Agency for Health Care Policy and Research published practice guidelines for adult urinary incontinence in , recommending biofeedback as the first choice of treatment Whitehead, These procedures produce a tremendous boon in personal esteem, because the individual can once again to lead an active life without shame or fear.

Further, incontinence is one of the most frequent reasons many older adults are placed prematurely in nursing home care, and effective treatment preserves the personal dignity of independent living. The work of the above pioneers in biofeedback was not alone. Reports of biofeedback applications to a variety of medical and emotional disorders proliferated rapidly in the 's and 's.

I will cite just a few of these investigations: Barry Sterman demonstrated that EEG guided training of a specific sensori-motor rhythm over the sensori-motor cortex could suppress some epileptic seizures. Bernard Engel reported operant control of cardiac arrhythmias. Chandra Patel reported on the use of both yoga and biofeedback in hypertension.

Thomas Budzynski, Johann Stoyva, and Charles Adler reported on the effects of feedback induced muscle relaxation on tension headaches.

By the field of biofeedback had established a number of effective treatment protocols, for tension headache, migraine, lower back pain, temporo-mandibular disorders, hypertension, Raynaud's syndrome, incontinence, and a number of other functional disorders. The basic instrumentation triad of the EMG, thermal feedback, and the GSR had emerged as the "workhorses" of the biofeedback clinic. The electromyograph or EMG measures the electrical potential of muscle fibers, and proved to be useful for general relaxation training, the treatment of headaches and muscular pain, and neuromuscular education.

Thermal feedback measures skin temperature, especially finger temperature, and proved useful as an indirect measure of vaso-constriction or vaso-dilation and blood flow. Thermal feedback proved useful for migraine headache, Raynaud's disease, hypertension, and general autonomic relaxation. The Galvanic Skin Response meter GSR, also referred to as a Skin Conductance or Electrodermal Activity meter measures electrical changes in the skin, associated with sympathetic nervous arousal.

A variety of additional feedback modalities proved useful for special applications: the feedback EEG electroencephalograph , measuring electrical activity on the cortex of the brain; the pneumograph, measuring respiration rate and pattern; the photo-plethysmograph, measuring heart rate and blood pulse volume; the perineometer, discussed above; and a variety of other devices Schwartz and Associates, This same time period of the 's and 's also saw the articulation of a number of concepts framing a new approach to health, wellness, and the actualization of higher human potential.

Humanistic psychology dramatically emphasized the unity of body and mind. Fritz Perls introduced a number of body awareness exercises into Gestalt therapy, as did the Reichian and other body therapy schools. Biofeedback took this emphasis on a mind-body unity to a new level and created a mind-body medicine. Engel called for a biopsychosocial model for medicine almost two decades ago, but this challenge remains unfulfilled. Wickramasekera cites a variety of interrelated mind-body techniques -- biofeedback, hypnosis, and cognitive behavior therapy -- as effective tools for addressing a variety of stress related disorders and somatization disorders.

George Whatmore and Daniel B. Kohli used EMG feedback to teach patients to relax muscle groups and developed the concept of dysponesis, misplaced effort, as a common neurophysiological factor in many functional disorders. Many individuals facing stressful situations respond by dramatically increasing efforts in the same old directions, and drawing on the same old strategies and habits.

The result is a misplaced waste of effort and energy.

The concept of dysponesis takes this problem of "doing more of the same" to a neuro-physiological level. In the face of stress the individual engages in maladaptive muscular efforts, breathing patterns, and autonomic arousal, producing only illness and fatigue. The promise of biofeedback is to increase awareness of such dysponetic habits, and to provide an avenue to new more healthful behavioral and physiological habits. Hans Selye's groundbreaking research on stress demonstrated that the human response to stress is an adaptive biological response with impact on the entire organismic system.

Cognitive attention to an approaching threat triggers an alarm and mobilization response preparing the body for emergency action. The stress response activates the limbic or emotional brain, and the hypothalamus, which then stimulate large portions of the sympathetic nervous system and the endocrine system.

The result is a flood of stress hormones including ACTH , elevated blood sugar, and hyper arousal of many internal organs and functions. The individual will notice elevated heart rate, tense musculature, rapid respiration, and a variety of intense emotional states.

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This adaptive response prepares the individual to flee or fight the threat. In ideal circumstances the threat passes and the individual can return to a more relaxed psycho-physiological state. In modern human society, however, the individual is exposed to chronically stressful work and family environments, the individual perseverates in thinking about the problems, and neither mind nor body return to the original resting state. This is the basis for many functional medical and psychiatric disorders.

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The body and mind enter a state of fatigue, exhaustion, and loss of adaptability. Many of specific components in the stress response have a temporary adaptive effect, but a debilitating effect over time.

Under stress, for example, the pituitary releases vasopressin, which contracts the walls of the arteries, raising blood pressure. Over time this vasoconstriction contributes to chronic and life threatening hypertension. The immune system also can become depleted and unable to protect one from disease. More recent research has shown that the so-called stress response is really more complex than first recognized.

The autonomic nervous system does not respond as one single unit; rather a variety of divergent patterns occur in different individuals, some for example, affecting the cardio-vascular system in various ways, others affecting the upper or lower gastrointestinal tract, and others the musculoskeletal system. Both sympathetic and parasympathetic nervous system activation patterns play a role in the multiple forms of the human stress response Gevirtz, Herbert Benson established that just as there is a human stress response , with negative effects on the body, there is also a relaxation response with a healing or restorative impact on the human physiology and mind.