EMG - Biofeedback training and multidisciplinary approach was attempted on 12 patients (pts.) suffering from blephalospasm. The pts. were excluded in this report who were treated successfully only with pharmacological therapy. These pts were treated stepwise with EMG - BFT, autogenic training, desensitization treatment (DST) and / or cognitive therapy (CT) if these were not sufficiently effective. Results showed that 7 pts improved and came back in social activity, 3 were moderately improved without full social comeback, 1 was minimumly improved and 1 dropped out. 11 of 12 pts were characterized with behavior pattern of overuse of eyes and / or ophthalogical fatigue. Psychological factors were one of main causes in 10 pts. In regard to treatment modality, admission therapy was better than out - patient therapy in our clinical results. As for the number of sessions, pts treated more than 10 sessions showed better results than those who were treated between 3 and 9 sessions. In the strategy of EMC-BFT, when BFT was jointly used with cognitive approach, pts seemed more successful in the self-regulation of involuntary orbital muscle spasm than BFT solely oriented to muscle relaxation (Fig.3). Although each of single treatment modality is not sufficiently effective in blephalospasm, with joint interventions which have proper therapeutic mechanism, it becomes possible for therapists to improve various biosocio-behavioral pathological causes of refractory blephalospasm.
For the biofeedback control of blood pressure, the instantaneous blood pressure should be presented to the patient. We developed a new Method to indicate blood pressure instantaneously. In recent years it has become possible to measure the waveform of aortic blood pressure non-invasively and continuously. The waveform of aortic pressure includes much useful hemodynamic information. The pressure wave consists of forward and backward propagation waves. The backward propagation wave is reflected mainly from the junction of the arterial tree, and the time between the forward and backward waves is the double propagation time between the heart and the effective reflection point. The time between these waves can be measured by an auto-correlation method, but the measurement error of this method is too large to allow one to estimate the exact effective reflection point, because the forward and backward waves overlap each other. In this paper a new analytic method based on the cepstrum is proposed. Using our method, we can recognize on the cepstrum that the forward and backward waves of various shapes are separated clearly. There is a cross relationship between the propagation delay time and the quefrency of the cepstrum. To evaluate this method, a simulation model of the systemic circulatory system is proposed and used. In this model the arterial tree is divided into 128 segments. Each segment is represented by a four-terminal electrical network. Calculated waveforms obtained from this model are quite similar to the measured waveform from patients. Also the reflection point estimated by this method agrees with that of simulation model.
To examine the effects of mental load tasks on cardiovascular responses, three types of star maze (MT1 : normal mouse tracking, MT2 : up-down and right-left reversed mouse tracking, and MT3 : right-left only reversed mouse tracking), and a mental arithmetic were carried out using computer display and mouse. It was expected that these tasks would require different coping responses of twelve healthy subject. Heart rate, systolic and diastolic blood pressure and respiratory rate were measured during rest period (rest trial), 3 types of mouse tracking trials, and a mental arithmetic trial. Slower heart rate, higher blood pressure, faster respiration rate, and larger power spectrum of respiratory component were clearly observed in mouse tasks. On the other hand, higher blood pressure, faster respiration rate, and larger power of heart rate variability of about 0.1Hz were demonstrated in the arithmetic task. These response patterns indicated that subjects responded to the mouse tracking task using parasympathetic dominant passive-coping, and to the mental arithmetic task using sympathetic dominant active-coping. Although time and errors for drawing stars were explicitly different (MT1 < MT2 < MT3), there was no significant autonomic difference among the tracking tasks.
The role of feedback was reviewed by examining our previous experiments on biofeedback-aided voluntary heart rate (HR) control. The task of first experiment was ordinary HR increase or HR decrease during 12-days. The results of this experiment showed that the subject's awareness of the measured variables, required task, meaning of feedback, and the relationships among these was crucial in determining his or her performance. The task using the rest four experiments was a kind of tracking task where subject was required to keep one's HR or HR-like motor response in the target area as much as possible. The independent variable in those experiments was feedback delay, or time lag, between response and the presentation of feedback signal. The series of results obtained suggest that in the tasks such as HR-tracking, a mechanism similar to that of motor-learning is at work, and that even a slight delay in feedback can disturb the performance. These observations suggest when the feedback signal was fit for the required task, the performance complies with the theories of closed-loop feedback control in which case the effects of biofeedback are maximized.