Biofeedback: A Practitioner's Guide, 2nd ed.

The first edition of this book was published in 1987. Since that time, the field of applied biofeedback has taken a twisted, often confused path in mainstream medicine. Applied biofeedback began in the late 1950s with the convergence of many disciplines including psychology, physiology, biomedical engineering, and sociology. Since 1987, these disciplines have developed considerably, with advanced technologies and insights into human behavior. As a consequence, the understanding of principles in applied biofeedback is undergoing great change. This book is an attempt to document and communicate the importance of this clinical tool in today's changing health care environment. Given the wide range of disorders, clinical settings, research paradigms, and terminology used by practitioners, this is an extremely daunting task. The success of this book lies in its authors, treatment of the subject matter as an exciting, new, and evolving field with a great future rather than dwelling on an historical view of the past.

The book is divided into 12, sections that cover the entire field from the viewpoint of all of the disciplines that have been involved in the development of biofeedback. Each section contains several chapters that approach the material form different perspectives. For example, the section entitled, "Professional Issues, Considerations, and Guidelines" has chapters related to ethics, models of practice, professional communication, and personnel considerations. Perhaps due to the nature of the information, the multiple contributors tend to rely more on large tables of information rather than on terms and a list of references. The almost 900 pages of text make this book more of an encyclopedia than a readable textbook. Overall, the editor, with the assistance of contributors, has put together an overwhelming amount of information.

There are a few sections that are directly related to the use of biofeedback in a rehabilitation environment. One section, entitled "Cultivating Lower Arousal," introduces therapies aimed at achieving relaxation and control over respiration. These chapters contain a wealth of background information and suggested techniques for achieving balanced states in persons suffering from heightened states of arousal. Chapters covering headache, temporomandibular disorders, Raynaud's disease, hypertension, urinary and fecal incontinence, and fibromyalgia may be of interest to therapists in specific settings.

Perhaps the most relevant information to physical therapy can be found in the section entitled "Neuromuscular Applications." Dr David Krebs, PhD, PT, authored the chapter on neuromuscular reeducation and gait training. This well-written chapter focuses on the concept of feedback in motor control learning, with the use of electromyographic (EMG) feedback for understanding muscle activity as a prime example. Krebs goes into considerable detail about the important characteristics of the EMG signal and how these are related to practical situations. The chapter provides a detailed analysis of one clinical example related to EMG feedback training for myoelectric prosthesis control. The remaining portions of this chapter deal with the kinematic and kinetic signals that may be used to provide feedback during locomotor training.

Another chapter of interest to physical therapists is written by Eric Fogel, PT, who describes further uses of EMG biofeedback in musculoskeletal therapy. This chapter seems somewhat redundant when paired with Kreb's chapter, yet it does provide further examples of the different treatment strategies that are possible with EMG feedback. The overemphasis on EMG feedback therapy compared with other feedback modalities (eg, kinetic and kinematic signals) limits the usefulness of this chapter to those practitioners with access to EMG signal processors.

One other chapter of interest is entitled Evaluating Research in Clinical Biofeedback." This chapter discusses some questions and issues to consider when evaluating biofeedback research and when discussing therapy procedures and reported results. The author suggests ways in which clinicians and researchers can learn to communicate their ideas to each other with greater effectiveness, thus leading to improved treatment procedures. This chapter might be considered required reading for those interested in demystifying the research literature. This chapter is especially important because of the wide range of disciplines engaging in biofeedback research that may use different research techniques of varying validity.

The field of applied biofeedback has undergone some highs and lows in its almost 40-year history. The editor has been a major advocate and practitioner over these years and his experience is evident in the organization and breadth of this book. This book is written for the practitioner and therefore is a great resource for, ideas about interventions using biofeedback modalities as just one tool in the practitioner's arsenal.

The book should appeal to a variety of readers. First and foremost it would make a valuable library addition for the physical therapist who uses biofeedback as a regular strategy for cultivating physiological responses in patients. It would also be very useful for the student who wants an introduction to the field of applied biofeedback. Finally, the book should be a valuable resource for the generalists who are looking for ways to expand their arsenal of interventions and who want to supplement already effective strategies derived from biofeedback.

David A Brown, PhD, PT Rehabilitation Research and Development Center Veterans Administration Palo Alto Health Care System (153) Palo Alto,

Dr Brown is a Research Health Scientist of Physical Therapy. He conducts research and has authored several articles related to motor control deficits in persons with hemiplegia.