A summary of 50-year history of biofeedback in Japan was described decade by decade. Development of biofeedback has been in parallel with that of surrounding technologies including computer, network, and human interface. Faced with such rapid changes in biofeedback, it was also discussed what should be done by the Japanese Society of Biofeedback Research.

  Predicting the future of biofeedback from a medical perspective, we can imagine several directions. New biological information will be available for biofeedback, and feedback tools will be more convenient. Measurement of heart rate, body temperature and skin conductance by wristwatch-size device is already used for sports training. By linking smart-glass, real time feedback will be possible in the near future. Such as motion capture, equipment will become smaller and useful.

  Several biological information that need invasion will become available. Continuous glucose monitoring (CGM) is already used for the treatment of diabetes. By insert an extremely fine cannula into the subcutaneous tissue of the abdomen, continuous monitoring of 24 hours is possible. CGM can use not only for adjustment of insulin treatment, but also for biofeedback approach.

  So many biological information will be available, and devices will progress. Medical experts will be expected evaluation and guidance based on evidence. Check the clinical meaning of biological information appropriately is very important role of medical side in next-generation biofeedback.

  Rehabilitation is a major task for the training of those with limb problems that can be trained and supported to return to their homes and workplaces by stroke or traffic.

  Virtual rehabilitation refers to the general term “VR” for the combined term of virtual reality and robotic technology.

  The advantage of virtual rehabilitation is the ability to set free VR units within a limited space of the hospital or rehabilitation room.

  In this article, we introduced virtual rehabilitation that uses a biofeedback and reported the applicability of that application.

  Heart rate variability (HRV), fluctuations of the heart rate that are characterized by normal beat-to-beat changes in cardiovascular autonomic control, has been widely used in psychophysiology and related areas for investigating autonomic nervous system activity. This article focuses on high frequency (HF) and low frequency (LF) components of HRV, and briefly reviews their autonomic neural regulatory function and cardiorespiratory resting function, as well as the therapeutic effects of HRV biofeedback (HRVBF). The analysis of HRV provides a useful tool for evaluating cardiorespiratory resting function. Therefore, the use of HRV is expected to spread to daily settings such as workplaces and schools for maintaining and improving psychophysiological adaptability. Moreover, it is anticipated that technological developments related to HRV measurement and evaluation will progress. As a result, the responsibility for the proper management of knowledge regarding HRV and HRVBF will also increase. Therefore, further HRV studies are needed to elucidate the exact mechanisms for improving the cardiorespiratory resting function.

  As a problem-solving approach, three steps are needed to spread biofeedback tools in ‘society'. The first one is to set a hypothesis how and where such tools are desirable to be used. The second is to estimate resources required for introducing and running the tools continuously. The third is to decide processes for preparation of implement. Based on these three steps, it is vital to exchange opinions with companies having the possibility to be related to the further hypothesis setting and reinforcement, to identify any stakeholders and to work on interested parties and government.

  An example of the problem-solving approach, ‘gamification' was introduced at this symposium. An application of mental health promotion related to cognitive-behavioral therapy was developed with cooperation of a major game company (Nakao et al. the 42th Annual Conference of the Japanese Society of Biofeedback, 2014). The application had been released for one year between 2016 and 2017, and the annual number of download was more than 10 thousand. At the same time, the program of the cognitive behavioral therapy was improved to be installed for full specification of the application, and to conduct the randomized trial (Shirotsuki K, et al. BioPsychoSoc Med Sep 19, 11 : 2, 2017). Such practice was adopted as one of “mibyo” projects in Kanagawa prefecture with 3-year research grant between 2015 and 2017. Through the research activity during the three years, we got four insights to indicate directions for utilization of biofeedback in an age of information and communication technology and artificial intelligence. The four directions are the implementation of wearable terminals (monitoring of health condition), utilization of life-assisted tools (assistance of daily life function), utilization of biofeedback systems in life space (personal-environment interface), and new role of biofeedback specialists (human resource development to be leaders for health management).