A Day’s Session Notes of a Neurotherapy Center of Washington
Therapist Using sEMG, General Biofeedback, and EEG Neurotherapy
Emily Perlman, MS
The following material is a collection of annotated chart notes taken from typical events in a daily treatment schedule of a therapist experienced in surface electromyography (sEMG), stress-reduction biofeedback (for overarousal of the autonomic nervous system), and EEG neurofeedback treatments at the NCW. While the material is factual, details and identification have been altered to protect identities. Most case descriptions are composite in nature to protect identities, but are illustrative of the problems treated, clinical experience, and outcomes.
Reasons for treatment include: Depression, Insomnia, Fatigue, Dizziness, Anxiety, Pain, Headache, Fibromyalgia
Abbreviations: Tx – treatment; Sx – symptoms; Pt – patient; MVA – motor vehicle accident; TBI – traumatic brain injury; PTSD – post-traumatic stress disorder; FMS – fibromyalgia syndrome, r/o –rule out; c/o – complains of. sEMG –surface electromyography. [sEMG - Using dedicated software, electrical activity each of a pair of muscles is painlessly displayed on a computer, and the relative level of activity is computed automatically. Pain is caused by muscle imbalances that are, at least 20% different in electrical activity between the left and right muscles of a pair. The treatment of these imbalances requires practicing individualized exercises at home. The imbalances are rechecked, usually weekly, after the exercises are done. The exercises, if done faithfully and correctly, produce some correction so that other imbalances can be addressed.]
1 - LNT - Background: Early 50s female, referred by physician and web site for help with FMS, insomnia, headache and fatigue. History of PTSD & TBI from past physical/emotional trauma.
1st session – Pt c/o increased pain and stiffness. Pt has been taught military-type posture. Noticed she hyper-extended back when seated and standing. Did postural re-training and worked on improving awareness of muscles in mid-back. No pain in lower trapezius after appointment.
3rd session – severe back pain, educated on autonomic nervous system and its role in pain and stress reactivity. Introduced diaphragmatic breathing and a pain management technique. Pain in back went from 5/10 to 0. Pt said felt like her old self of 10 years ago.
6th session – Pt states is using breathing techniques regularly to decrease stress reaction and reduce pain. Noticed clenches neck often without awareness (probably subconscious reaction to past abuse). Was able to release with visual and verbal feedback.
16th session – Pt carries heavy pocketbook. Pulls it when she is inside while she bends and twists her body. Pt also wears high heels daily. Explained proper body mechanics and suggested dolly for purse and smaller heels for feet. Pt was also tensing face a lot and having difficulty remembering to relax jaw and neck. Decided to use barrettes as reminders because they would be close to the face. (Note: Pt did start wearing flat heels 3 weeks later!)
35th session – Pain medications decreased, using breathing techniques to better manage muscle tension and stress. Doing stretching program. Still clenches muscles when dealing with emotional issues with psychiatrist. Difficulty pacing self and/or asking for help (ie: lifting of heavy boxes at home).
2 - KK - Background: 31-year-old female with FMS manifesting in neck, back, and hip pain. Referred by physician.
Session #4: Did not complete even 3 days of assigned supraspinatus re-training, still imbalanced. Appointments inconsistent, completion of exercises intermittent. Having difficulty fitting home exercises into her day. Working at computer many hours at a time. Improper posture continually aggravates muscles.
Session #6: Introduced to heart rate variability training, which involves breath work. Pt c/o being uncomfortable with focusing on breathing, switched to noticing sensations and progressive relaxation. Elbow pain disappeared, back pain lessened.
Update: Pt discharged self from Tx after session #6. Not integrating any learning into daily routine.
3 - TC - Background: 43-year-old male with FMS following TBI. Works in a job that involves a lot of physical hazard. Referred by physician for depression, neck pain, poor memory, concentration, energy, and sleep. Has struggled since early teens following a severe beating. Has since had several injuries related to work, one involving loss of conciousness. Because of severe pain, physician referred for sEMG biofeedback.
Session #6: After EEG stim, felt “really great”, “giddy at first”, overall mood much better, good energy. Memory improving – not going blank in the middle of a sentence, clarity much better.
Session #7: EEG stim tx: Drinking red bull to stay up at night for work. Cautioned about repercussions on sleep habits.
Update after 15 sessions: EEG stim - Minimal racing thoughts, sleep, energy and mood good. Recovery time much better from illness or stressful work hours.
SEMG biofeedback: Started after 5 EEG stim treatment.
Evaluation showed muscle imbalances in shoulders and arms. Focus was on postural re-training. Carried a lot of heavy equip on belt, weight affecting hip and lower trapezius. Pain levels decreased when took these extras off belt. Improvement was intermittent, but pt reported the postural work and switch in carrying habits helped decrease pain and increase endurance after 3 sEMG Txs.
4 - JH - Background: Communications position, walks all day, stands a lot and drives a truck in the field. The truck seat is not suited to her frame and finds it physically stressful to drive. Carries walkie-talkie, phone, clipboard, cup of coffee all day long. Complaints are of shoulder, neck and back pain.
Session #2: EMG - Pt reports no pain, just some shoulder and neck tension because she adjusted use of work related items (ie: wears walkie-talkie on a harness). Decreased her driving obligations significantly. Used information from EMG for excellent results!
5 – CX - Background: Male , 40s, referred by physician for myofascial pain. Physical job required walking with heavy case. Rear-ended two years earlier, claims physical therapy made things worse. Chief complaint of neck pain post-whiplash.
Session #1 - sEMG: Apparent that job set up contributing greatly to neck pain. Not possible to carry case on wheels due to terrain. Recommended switching case between shoulders every half hour. Suggested setting watch timer to remind. Assessment with sEMG revealed neck agitation with hyper-reactivity in neck with shoulder movements. Simulated job situation while trying to calm neck. Was able to calm neck completely with visual and verbal feedback.
Session #2: No change in pain even with techniques in place. Had massage therapist do quick eval. Revealed neck muscles being locked up. Stretches were given as well as recommendation to see massage therapist for manual intervention.
