Biofeedback headband

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An Example of a biofeedback headband.

A biofeedback headband is a self-contained biofeedback unit which is worn on the head and held in place by an elastic strap. Muscular activity (e.g. clenching) is detected via electromyography (EMG) by picking up microvolt-level muscle signals from the muscles through black conductive rubber sensor pads which contact the forehead and temples, measuring the frontalis muscle and the temporalis muscle respectively.

Claimed benefits[edit]

Biofeedback headbands are claimed to be of benefit in controlling bruxism, including sleep bruxism and awake bruxism,[medical citation needed] and temporomandibular joint dysfunction (TMD).[medical citation needed] They are also claimed to be of use in reducing tension headaches[medical citation needed] and migraines[medical citation needed]

Evidence[edit]

No widely accepted treatment protocol for bruxism and TMD exists. There are many different treatments used for bruxism, some more commonly than others. In everyday practice, bruxism and TMD are managed with psychosocial interventions (e.g. cognitive behavioral therapy, progressive muscle relaxation, yoga, hypnosis), provision of occlusal splints (mainly to protect the teeth from damage rather than any other claimed benefit) and several other therapies including medication, physiotherapy, acupuncture, botox injections, and others. Biofeedback as a treatment option is relatively new, and currently only a small percentage of people undergoing treatment for TMD and bruxism use biofeedback as a treatment modality.[medical citation needed]

Bruxism and temporomandibular joint dysfunction[edit]

One literature review concluded "devices such as miniature self contained EMG detector analyzer have potential if they are scientifically verified in large population and proven to be useful in clinics in terms of easy use. In the absence of definitive evidence, bruxism can be best managed by occlusal appliances, counseling, change in lifestyle and pharmacological interventions."[1] Referring to a biofeedback headband, the same authors state "although scientific confirmation is needed for a large population, it is considered as one of the potent devices for detecting and also for managing sleep bruxism".[1] Referring to biofeedback techniques (not a biofeedback headband) which were designed to wake the user upon detection of a bruxism event, the same authors also state "no evidence is available for the long time use of biofeedback in the management of bruxism. Further, the possible consequences of the frequent arousals, like excessive daytime sleepiness, need further attention before this technique can be applied for the safe treatment of patients with bruxism."[1] Another study concluded that biofeedback, as a technique generally, is ineffective for sleep bruxism.[2]

There are many theories surrounding the cause of TMD, and the exact etiology is unknown, but most now agree that it is likely to be caused by several factors,[3] one of which may be parafunctional activity of the masticatory and facial musculature, but there is no conclusive evidence of this cause specifically, and the importance of this as a contributing factor in relation to other possible factors is debated. In TMD, the vast majority of experts now state that no irreversible treatment should be carried out.[4] EMG biofeedback is not an irreversible treatment, and can therefore be tried with little or no risk compared to irreversible treatments.

One study investigating the possible benefits of biofeedback in TMD reported that 69% of people with TMD using biofeedback had improved symptoms compared to 35% of people with TMD using placebo biofeedback, who also reported improved symptoms.[2] The improvement in symptoms appears to be stable, with little deterioration after 2 years.[2]

Migraine and tension headache[edit]

Main articles: Tension headache and Migraine

A systematic review concluded that there is a medium to large effect size for biofeedback in migraine and tension headaches in adults, and this appears to be stable at 14 months.[5]

History[edit]

The first biofeedback headband was invented by Lee Weinstein, in 1998, and patented in September, 2000.[6] Advances were made in the following year and patented in August, 2001.[7] The first headband commercially available for use in the reduction or elimination of bruxism was introduced by BruxCare at the Yankee Dental Congress in Boston, in February 2001. These early units had reliability problems and were re-designed by Holistic Technologies in 2007. The currently available model is sold under the trade name SleepGuard. All of these units use an audio tone as the biofeedback.

Prior to the development of the biofeedback headband, biofeedback electronics was typically housed in table-top instruments which connected to a person through a set of wires connected to electrodes which are adhesively connected to the skin. Sleep labs which offer biofeedback or EMG measurement typically use such table-top EMG measurement and biofeedback equipment.

The original models, introduced in 2001, employed rechargeable batteries which lasted about three days before needing to be recharged. The lithium ion batteries used in those original units unfortunately suffered from a problem that if a unit was allowed to totally discharge (for instance, by being left in a drawer without use for a month or two), the batteries would no longer hold a charge.

In the following years, there were a series of improvements to the design, reducing power consumption, and eventually the rechargeable units were replaced with units which run on inexpensive disposable batteries. Modern units such as the SleepGuard biofeedback headband can typically be used for more than 35 nights on a single set of batteries.

Advantages over tabletop biofeedback[edit]

Biofeedback headbands have several advantages over tabletop biofeedback machines. Since a biofeedback headband is self-contained and does not require the use of adhesive sensors or a wiring harness, many people find it easier to sleep using a biofeedback headband than using a table-top bedside biofeedback unit. Acoustic feedback from biofeedback headbands is either a forehead-contacting sound transducer or an earphone, both of which have less potential to disturb a sleep partner than a speaker on a tabletop unit. Biofeedback headband sensor electrodes typically last through many more uses than adhesive electrodes, and are much less costly to use over time. Finally, mobility is not inhibited by wearing a biofeedback headband as it is by the wiring harness of typical bedside biofeedback equipment.

References[edit]

  1. ^ a b c Shetty, S; Pitti, V; Satish Babu, CL; Surendra Kumar, GP; Deepthi, BC (September 2010). "Bruxism: a literature review.". Journal of Indian Prosthodontic Society 10 (3): 141–8. doi:10.1007/s13191-011-0041-5. PMC 3081266. PMID 21886404. 
  2. ^ a b c Orlando, B; Manfredini, D; Salvetti, G; Bosco, M (Fall 2007). "Evaluation of the effectiveness of biobehavioral therapy in the treatment of temporomandibular disorders: a literature review.". Behavioral medicine (Washington, D.C.) 33 (3): 101–18. doi:10.3200/BMED.33.3.101-118. PMID 18055333. 
  3. ^ Scully, Crispian (2008). Oral and maxillofacial medicine : the basis of diagnosis and treatment (2nd ed.). Edinburgh: Churchill Livingstone. pp. 8,14,30,31,33,101,104,106,291–295,338,339,351. ISBN 9780443068188. 
  4. ^ "Management of Temporomandibular Disorders. National Institutes of Health Technology Assessment Conference Statement". 1996. Retrieved 22 May 2013. 
  5. ^ Nestoriuc, Y; Martin, A; Rief, W; Andrasik, F (September 2008). "Biofeedback treatment for headache disorders: a comprehensive efficacy review.". Applied psychophysiology and biofeedback 33 (3): 125–40. doi:10.1007/s10484-008-9060-3. PMID 18726688. 
  6. ^ "Bruxism Biofeedback Method and Apparatus". WikiPatents.com. 2000-09-12. 
  7. ^ "Bruxism Biofeedback Apparatus and Medhod Including Acoustic Transducer". WikiPatents.com. 2001-08-07.