Biofeedback and Neurofeedback - Adjuncts to Therapy

Capital Biofeedback:

Biofeedback and Neurofeedback as Adjuncts to Therapy

Friday, March 22, 2019

 There is a physiological basis to all of the following: stress, anxiety, decreased attention, tone/ muscle spasms, pain, body temperature, headaches.  Our bodies– fight or flight response can be set off with all of these symptoms.    

Biofeedback is a way of measuring the electrical response that happens in the brain due to stress.  With biofeedback training the therapist works to manipulate the electrical activity in the brain in order to titrate and control the body’s response to pain and stress. 

ANS and PNS – Sympathetic and parasympathetic drive – both systems run in fight or flight. 

When we are under stress we over-stress these systems and you can’t balance the two and it reduces your ability to have the resilience to perform fight or flight. 

Stress over time wears down these systems and decreases the vagal nerve response. 

 Modalities used in Neurofeedback:

Baseline Electrical Activity in brain   - measured with an ear clip.  This clip measures vagus nerve heart rate variability.   Your vagus nerve –aka Cranial Nerve X runs all throughout the body.  You need  it to have balance.  You want heart rate variability, but within a rhythm / tone

Regulatory power measures how well the body can regulate the ANS.  We want to increase that number as much as possible to change how our body responses to stress.

 Note there are 3 ways to increase our vagal responsiveness-

1.        Paced Breathing – 6 breaths/ minute – has both short term and long term affect

2.       Exercise

3.       Hearty Laughter 

 Screening tools

Heat rate variability

ANS Resposnsiveness – measures sympathetic and parasympathethic drive


Bring in a stressor and talk about it and then see if  it changes heart rate variability.  If so, you can use this same technique to regulate HR

The following Apps that can be used for paced breathing:

Breathe+ - mac users   set rate 4 sec in,  zero pause 4 sec out , 1 sec pause

Breathe2Relax  - Biofeedback of Europe with pacer – EX Air – downloadable app x 30 days. 

 Who is a Good Candidate for Biofeedback?– Anyone  who has  stress

 Therapist will see each patient  for an avg of 8-12 sessions 

 Who is Not a good candidate? – Someone with little to no cognitive function, or patients with personality disorders (trust issues)

 Neruo feedback - Looks at the firing of your brain rather than vagal nerve. 

Want maximum functioning of your brain.  Pattern of firing waves determines how you feel and how you interact with your environment.

Who?  God for those who suffer from: Pain, traumatic brain injury, stroke , headaches , migraines, ADHD, Anxiety

See gains within 8-12 sessions –

Eval Cost -  $149 for eval (1 ½ hour)

Sessions $130 for each  55 min sessions 

It can be covered under Mental Health Benefits – BCBS in-network ,  Medicare does not cover,  Can put out of network claim. 

Quantitative EEG helps to know if patient with TBI – helps to know where to focus and often receive long term training.


Inspiration Golf – Friday October 26, 2018

Inspiration Golf – Friday October 26, 2018

Inspiration Golf began in 2017 and is working on applying for non-profit status.  This organization is a partnership between pro-golfers and therapists to help individuals of various diagnoses experience freedom of activities and increase in confidence to return to leisure activities via the sport of golf. 

Why Golf?-  1. ) It is one sport where the ball does not move.  2.) The ball does not care how you swing. 

 What does Inspiration Golf have to offer?

Golf Clinic on the 2nd Saturday of every month from April – November at Lonnie Poole Golf Course.  (Demo clubs are available)

Para golfer- This is a piece of equipment that assists you with standing to hit the golf ball. 

Use of “Para golfer” is free but requires registration ahead of time.  Following registration, you will undergo a Preliminary Evaluation to assess your ability to stand, your safety and what modifications you may need to play. 


Paul Fulford’s Story:  Paul played golf his whole life prior to his CVA, 10 years ago.  He began his return to golf following his stroke after meeting a golfer with one amputated arm.  He initially took lessons from him.  After taking 2-3 months of lessons he began to play 150 yards from the green (Short Game).  The hardest thing to learn was that golf was a “different game” now.  It was no longer about the pars and the birdies.  It was now about having “fun”.  From that point her went to Adaptive Golf Clinic at Paris Island.  Now he is an active member of Inspiration Golf and recently got 2nd place in a tournament hosted by the US Adaptive Golf Alliance. 


Helpful Hints from Paul’s Wife (Sue Fulford):

After Paul’s stroke, we became a team and that team effort was very important in his returning to golf.

It helped Paul when I attended his golf lessons and wrote down the instructions that were offered.   Sue used these instructions as “reminders” when they went to practice.

Don’t be afraid if the game changes for you:  For Paul, he had to transition to 1.) Play from the “Ladies Tees”, 2.) Use Large “Martini Tees”,  3.)Use a “Flag on the cart so you can access the green with the golf cart, 4.) Use a ball retriever to get balls out of sand trap.

Remember, just like anything you start for the first time.  It doesn’t take much to get exhausted- When Paul started it took him 2 hours to play 4 holes and it was exhausting.  Take your time and most importantly, have fun!

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North Carolina Assitive Technology Program

North Carolina Assistive Technology Program (NCATP)

How can assistive technology help you?

Lynne Deese presented a variety of low, mid and high-tech devices that can be used to assist you in your daily activities.  Everything from a sock aides to an eye gaze systems.


NCATP has an office in Raleigh, NC. You can call to set up an appointment to have a  no cost tour of the facility and/or find out about technology that may be available to make your ADLs and work easier. This facility also offers equipment demonstrations, and short-term loans of equipment for home trial. 


4900 Waters Edge Drive

MSC 2804

Raleigh, NC 27606



High Technology Devices - Voice Command Devices:

Amazons Alexa and Google Home:  These devices specifically increase one’s independence for accessing environmental controls (ie. turning on the lights, unlocking doors/garage doors, turning on the fan or entertainment center)

 Nuance - Dragon Naturally Speaking: – can assist with voice to text or voice to email.

Moderate Technology Devices:  

Mouth sticks/switches, big buttons, one handed key boards are all available to trial through NCATP.

Low Technology Devices:

Sock aide, Knork(Knife/Fork), Spork (Spoon/Fork), rocker knife, weighted utensils, plate guards, extended access stick


Upcoming Event:

2018 Assistive Technology Vendor Fair

Friday, October 5, 2018

9:00am- 5:00pm

McKimmon Conference Center

1101 Gorman Street

Raleigh, NC


Tai Chi

What is tai chi?  An ancient martial art developed in China

Short for Tai Chi Chuan

  • Tai = Supreme/Without Limits
  • Chi = Ultimate/Universe
  • Chuan = Fist

Many different forms including: Yang, Chen and Sun styles

Is practiced today primarily for its health benefits:  “Meditation in motion” and “Medication in motion”

What is Tai Chi for Arthritis and Falls Prevention?
Tai chi program originally developed to help people with arthritis decrease pain
and increase activity
Program was subsequently studied and scientifically shown to decrease
participants’ risk of falling
It is recommended by the Centers for Disease Control (CDC) and National
Council on Aging (NCOA) to decrease your risk of falling

Key elements of tai chi:
Slow, smooth and continuous movements against a gentle resistance
Gentle, upright posture
Increased awareness of weight transfer
Loose and relaxed joints (“song”)
Mental quietness and serenity (“jing”)

Benefits of tai chi:
Improved balance (Decreased risk of falls)
Decreased pain from arthritis
Improved relaxation/mindfulness
Reduced blood pressure
Improved bone density
Increased muscle strength

How does tai chi improve balance?


What you should know about tai chi classes at STEPS for Recovery…

  1. Classes are small (6 people) to allow for individual attention and modifications
  2. Class is designed for individuals who have never done tai chi before
  3. If you can walk without someone else’s help, you can do this tai chi class!
  4. Most of the class is done standing, but there will be parts in sitting
  5. If you want to sit at any time, you can participate while sitting and still benefit
  6. Class will move slowly so there is time to learn if you are new to tai chi
  7. Handouts will be provided to help you practice at home; the more you practice, the more you will get out of class

The next tai chi class at STEPS for Recovery will be:
Mondays 12-1pm
June 11- August 20, 2018
$75 for 10 classes


Call (919) 535-3930 today to reserve your spot in class!



Return to Driving Following Stroke, SCI and Brain Injury

Return to Driving Following Stroke, SCI and Brain Injury

Notes from our February 23, 2018 discussion. 

The topic of driving after a stroke or brain injury is popular.  A panel discussion with several members of the community who have successfully returned to driving.  We will discuss how to initiate the process, tips on when it the right time to seek medical drivers evaluation and vehicle adaptations which can help with driving.

We will also have an opportunity for you to share your ideas for future next step meetings.

Spouses and caregivers are welcome.

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