Autogenic-feedback training exercise (AFTE) method and system

• US 5,694,939 A
• Filed: 10/03/1995
• Issued: 12/09/1997
• Est. Priority Date: 10/03/1995
• Status: Expired due to Term

• Current Assignee: The Government of The US As Represented By The Secretary of The Navy
• Original Assignee: United States Of America As Represented By The Administrator Of The National Aeronautics And Space Administration
• Inventors: Cowings, Patricia S.
• Primary Examiner(s): Cohen, Lee S.
• Assistant Examiner(s): WINAKUR, ERIC FRANK
• Application Number:
  US08/543,093
• Time in Patent Office: 798 Days
• Field of Search: 128/731, 128/732, 128/905, 128/630, 128/671, 600/26, 600/27, 600/28
• US Class Current: 600/484
• CPC Class Codes: A61B 5/0205 Simultaneously evaluating both cardiovascular conditions and different types of body conditions, e.g. heart and respiratory condition
• CPC Class Codes: A61B 5/486 Bio-feedback A61B5/375 takes precedence
• CPC Class Codes: A61B 5/6804 Garments; Clothes
• CPC Class Codes: A61M 2021/005 images, e.g. video
• CPC Class Codes: A61M 21/02 for inducing sleep or relaxation, e.g. by direct nerve stimulation, hypnosis, analgesia for massage A61H; electrotherapy A61N, e.g. applying alternating or intermittent electric currents for producing anaesthesia A61N1/36021
• CPC Class Codes: Y10S 128/905 Feedback to patient of biological signal other than brain electric signal

Abstract

The autogenic-feedback training exercise (AFTE) method of the present invention is a combined application of physiologic and perceptual training techniques, such as autogenic therapy and biofeedback. This combined therapy approach produces a methodology that is appreciably more effective than either of the individual techniques used separately. The AFTE method enables sufficient magnitude of control necessary to significantly reduce the behavioral and physiologic reactions to severe environmental stressors. It produces learned effects that are persistent over time and are resistant to extinction and it can be administered in a short period of time. The AFTE method may be used efficiently in several applications, among which are the following: to improve pilot and crew performance during emergency flying conditions; to train people to prevent the occurrence of nausea and vomiting associated with motion and sea sickness, or morning sickness in early pregnancy; as a training method for preventing or counteracting air-sickness symptoms in high-performance military aircraft; for use as a method for cardiovascular training, as well as for multiple other autonomic responses, which may contribute to the alleviaton of space motion sickness (SMS) in astronauts and cosmonauts; training people suffering from migraine or tension headaches to control peripheral blood flow and reduce forehead and/or trapezius muscle tension; training elderly people suffering from fecal incontinence to control their sphincter muscles; training cancer patients to reduce the nauseagenic effects of chemotherapy; and training patients with chronic intestinal pseudo-obstruction (CIP).

Claims

1. An autogenic-feedback training exercise (AFTE) multi-parameter physiological conditioning system for training a trainee to gain better control of a plurality of the trainee'"'"'s physiological responses by using two combined self-regulatory techniques, biofeedback and autogenic therapy, and to permit the trainee to voluntarily and simultaneously control the physiological responses, the system comprising in combination:

a trainer sub-system for use by a trainer and including a processor;

a trainee sub-system for use by the trainee, including an AFTE apparatus connected to said trainer sub-system;

said AFTE apparatus including a sensor assembly for sensing baseline values of a plurality of physiological parameters indicative of the trainee'"'"'s physiological responses, and for further sensing changes in said physiological parameters when the trainee is under stress and during training, in order for said trainer sub-system to develop an individual stress profile for the training;

said AFTE apparatus further comprising an ambulatory, physiological-monitoring apparatus; and

based on said stress profile, said trainer sub-system selectively feeding back one or more of said plurality of physiological parameters to said trainee sub-system, in order to enable the trainee to simultaneously modify and control hierarchy, magnitude and phase relationships of the physiological responses corresponding to said plurality of fed back physiological parameters, so as to normalize the physiological responses by minimizing variances of the physiological responses from their corresponding baseline values.

2. The system according to claim 1, wherein said trainer sub-system selects a physiological parameter and delineates its tonic and phasic properties.

3. The system according to claim 1, wherein said AFTE apparatus further includes a display unit capable of selectively displaying analog and digital numerical displays of the trainee'"'"'s physiological parameters.

4. The system according to claim 3, wherein said trainer sub-system further includes a monitor for selectively displaying at least some of said trainee'"'"'s physiological parameters.

5. The system according to claim 1, wherein audio and data communication between the trainer sub-system and the trainee sub-system is maintained via a data bus.

6. The system according to claim 5, wherein said data bus includes a remote communication link.

7. The system according to claim 6, wherein said AFTE apparatus further includes a belt assembly comprised of system electronic circuitry;

and

wherein said belt assembly includes a modular package that houses the system electronic circuitry, and which is comprised of one or more interconnectable modules.

8. The system according to claim 7, wherein some of the physiological parameters to be displayed by said display unit, either simultaneously or separately are:

blood volume pulse (BVP), skin temperature, heart rate, skin conductance level, and respiration rate.

9. The system according to claim 7, wherein said modules include:

a first module that contains electronic circuits for providing signal conditioning for electrocardiogram, skin conductance level, temperature, blood volume pulse, and respiration signals;

a second module which contains circuitry for a digital sub-system that;

processes physiological signals in real-time;

times AFTE sessions;

generates time and event codes;

multiplexes time and event codes with temperature data;

transmits a periodic time marker to a trainee sub-system processor;

interfaces with diagnostic equipment and said trainer sub-system processor;

configures system operating modes; and

amplifies signals from said sensor assembly;

a third module that collects system inputs from said sensor assembly, and that relays said inputs to said first and second modules; and

a fourth module that includes a power source that supplies power to said AFTE apparatus.

10. The system according to claim 6, wherein said sensor assembly includes at least one ECG electrode for monitoring the trainee'"'"'s cardiac electrical impulses.

11. The system according to claim 10, wherein said sensor assembly further includes at least one skin conductance level (SCL) electrode for monitoring changes in the electrical conductivity properties of the trainee'"'"'s skin.

12. The system according to claim 10, wherein said sensor assembly further includes a respiration transducer for detecting changes in the trainee'"'"'s thoracic cavity size caused by the expansion and contraction of the diaphragm, and for monitoring the frequency of respiration.

13. The system according to claim 10, wherein said sensor assembly further includes a triaxial accelerometer for measuring gross head movements in three directions.

14. The system according to claim 10, wherein said sensor assembly further includes a transducer for measuring skin temperature and a sensor for detecting blood volume pulse.

15. The system according to claim 10, wherein said sensor assembly further includes blood pressure measuring apparatus for measuring the trainee'"'"'s systolic and diastolic blood pressures.

16. The system according to claim 10, wherein said sensor assembly further includes at least one of the following sensors:

impedance cardiograph for providing a reliable index of (a) stroke volume, (b) contractility, (c) cardiac output, and (d) systolic timing intervals;

impedance plethysmograph for monitoring the trainee'"'"'s lower limb volume;

electromyograph (EMG) for monitoring the muscle activity of the trainee'"'"'s legs;

electromyograph for monitoring the muscle activity of the trainee'"'"'s arms;

electroencephalography (EEG) for monitoring the trainee'"'"'s brain electrical potentials;

electro-oculography (EOG) for monitoring the trainee'"'"'s eye movements;

electrogastrography (EGG) for monitoring the trainee'"'"'s gastrointestinal smooth muscle surface potentials.

17. An autogenic-feedback training exercise (AFTE) multi-parameter physiological conditioning method for training a trainee, to gain better control of a plurality of the trainee'"'"'s physiological responses by using two combined self-regulatory techniques, biofeedback and autogenic therapy, and to permit the trainee to voluntarily and simultaneously control the plurality of physiological responses, the method comprising:

using a trainee sub-system formed of an AFTE apparatus connected to a trainer sub-system and including a sensor assembly for sensing baseline values of a plurality of physiological parameters indicative of the trainee'"'"'s physiological responses and for further sensing changes in said physiological parameters when the trainee is under stress and during training, in order for said trainer sub-system to develop an individual stress profile for the trainee;

based on said stress profile selectively feeding back one or more of said plurality of trainee'"'"'s physiological parameters to said trainee sub-system, in order to enable the trainee to simultaneously modify and control hierarchy, magnitude and phase relationships of the physiological responses, so as to normalize the plurality of physiological responses by minimizing variances of the physiological responses from their corresponding baseline values;

said step of using said trainer sub-system providing a sequence of baseline, training and post-training sessions;

said step of providing a baseline session includes selecting at least one of the following steps, and using the selected steps in a predetermined order;

reducing extrinsic stimuli;

determining the trainee'"'"'s optimal range of physiological parameters at rest to obtain that trainee'"'"'s individual baseline profile;

gradually increasing and decreasing stimulus levels to determine the trainee'"'"'s range of physiological parameters under stress, and the relationship of these parameters;

determining the order of change of the physiological parameters change under stress;

determining the magnitude of response and the tonic and phasic relationship of the physiological parameters under stress;

determining the developing symptoms and correlating them to accompanying changes in the physiological parameters;

obtaining the trainee'"'"'s individual profile or specific response pattern under stress;

training the trainee to use passive concentration;

training the trainee to feel and pay attention to various bodily sensations;

training the trainee to focus using passive attention;

providing a baseline test, starting with a specific autogenic exercise;

training the trainee to normalize his/her individual profile and to modify his/her behavior; and

wherein said step of determining the trainee'"'"'s optimal range of physiological parameters at rest includes having the trainer select at least one of the following six autogenic exercises;

1. Heaviness in the arms and legs;

2. Warmth in the periphery;

3. Regulated respiration;

4. Regulated heart beat;

5. Warmth in the solar plexus;

6. Coolness in the forehead.

18. The method according to claim 17, wherein said step of determining the developing symptoms includes the steps of:

having the trainee report his/her symptoms at predetermined intervals; and

grading said symptoms.

19. The method according to claim 18, wherein said step of gradually increasing and decreasing the stimulus levels causes a corresponding increase or decrease of the trainee'"'"'s physiological response levels, which enables the trainer to make at least some of the following determinations:

the trainee'"'"'s range of physiological parameters under stress;

the relationship of these parameters;

the order of change of the physiological parameters;

the magnitude of response and the tonic and phasic relationship of the physiological parameters;

the developing symptoms; and

to correlate these symptoms to accompanying changes in the physiological parameters; and

wherein said step of correlating the symptoms and the physiological parameters includes the step of grading the trainee'"'"'s symptoms based on self-report and the trainer'"'"'s observation of several subjective symptoms such as body temperature, dizziness, headache, drowsiness, sweating, pallor, salivation, and nausea.

20. The method according to claim 19, wherein said step of providing a training session includes the steps of:

training the trainee to normalize his/her physiological responses by simultaneously modifying and controlling the hierarchy, magnitude and phase relationship these several physiological responses, aiming at keeping the levels of these physiological responses at, or close to that trainee'"'"'s individual baseline profile, under stress, in order to alleviate or prevent the developing symptoms; and

training the trainee to maintain normal regulation of the autonomic nervous system by maintaining balance between the two branches of the autonomic nervous system;

the sympathetic and the parasympathetic branches.

21. An autogenic-feedback training exercise (AFTE) multi-parameter physiological conditioning method for training a trainee to gain better control of a plurality of the trainee'"'"'s physiological responses by using two combined self-regulatory techniques, biofeedback and autogenic therapy, and to permit the trainee to voluntarily and simultaneously control the plurality of physiological responses, the method comprising:

using a trainee sub-system formed of an AFTE apparatus connected to a trainer sub-system and including a sensor assembly for sensing baseline values of a plurality of physiological parameters indicative of the trainee'"'"'s physiological responses and for further sensing changes in said physiological parameters when the trainee is under stress, and during training, in order for said trainer sub-system to develop an individual stress profile for the trainee;

based on said stress profile selectively feeding back one or more of said plurality of trainee'"'"'s physiological parameters to said trainee subsystem, in order to enable the trainee to simultaneously modify and control hierarchy, magnitude and phase relationships of the physiological responses, so as to normalize the plurality of physiological responses by minimizing variances of the physiological responses from their corresponding baseline values;

said step of using said trainer sub-system providing a sequence of baseline, training and post-training sessions;

said step of providing baseline session includes selecting at least one of the following steps, and using the selected steps in a predetermined order;

reducing extrinsic stimuli;

determining the trainee'"'"'s optimal range of physiological parameters at rest to obtain that trainee'"'"'s individual baseline profile;

gradually increasing and decreasing stimulus levels to determine the trainee'"'"'s range of physiological parameters under stress, and the relationship of these parameters;

determining the order of change of the physiological parameters change under stress;

determining the magnitude of response and the tonic and phasic relationship of the physiological parameters under stress;

determining the developing symptoms and correlating them to accompanying changes in the physiological parameters;

obtaining the trainee'"'"'s individual profile or specific response pattern under stress;

training the trainee to use passive concentration;

training the trainee to feel and pay attention to various bodily sensations;

training the trainee to focus using passive attention;

providing a baseline test, starting with a specific autogenic exercise;

training the trainee to normalize his/her individual profits and to modify his/her behavior; and

wherein said step of training the trainee to normalize his/her physiological includes the steps of;

identifying one or more leading physiological responses under stress, and one or more trailing physiological responses under stress; and

placing emphasis on training the trainee how to normalize said one or more leading physiological response simultaneously with said one or more trailing physiological responses.

22. An autogenic-feedback training exercise (AFTE) multi-parameter physiological conditioning method for training a trainee to gain better control of a plurality of the trainee'"'"'s physiological responses by using two combined self-regulatory techniques, biofeedback and autogenic therapy, and to permit the trainee to voluntarily and simultaneously control the plurality of physiological responses, the method comprising:

using a trainee sub-system formed of an AFTE apparatus connected to a trainer sub-system and including a sensor assembly for sensing baseline values of a plurality of physiological parameters indicative of the trainee'"'"'s physiological responses and for further sensing changes in said physiological parameters when the trainee is under stress and during training, in order for said trainer sub-system to develop an individual stress profile for the trainee;

based on said stress profile selectively feeding back one or more of said plurality of trainee'"'"'s physiological parameters to said trainee sub-system, in order to enable the trainee to simultaneously modify and control hierarchy, magnitude and phase relationships of the physiological responses, so as to normalize the plurality of physiological responses by minimizing variances of the physiological responses from their corresponding baseline values;

said step of using said trainer sub-system providing a sequence of baseline, training and post-training sessions;

said step of providing a baseline session includes selecting at least one of the following steps, and using the selected steps in a predetermined order;

reducing extrinsic stimuli;

determining the trainee'"'"'s optimal range of physiological parameters at rest to obtain that trainee'"'"'s individual baseline profile;

gradually increasing and decreasing stimulus levels to determine the trainee'"'"'s range of physiological parameters under stress, and the relationship of these parameters;

determining the order of change of the physiological parameters change under stress;

determining the magnitude of response and the tonic and phasic relationship of the physiological parameters under stress;

determining the developing symptoms and correlating them to accompanying changes in the physiological parameters;

obtaining the trainee'"'"'s individual profile or specific response pattern under stress;

training the trainee to use passive concentration;

training the trainee to feel and pay attention to various bodily sensations;

training the trainee to focus using passive attention;

providing a baseline test, starting with a specific autogenic exercise;

training the trainee to normalize his/her individual profile and to modify his/her behavior; and

wherein said step of providing a training session further includes the step of preparing and comparing a plurality of stress profiles for the trainer to identify which of the physiological parameters will be emphasized during subsequent training sessions.

23. An autogenic-feedback training exercise (AFTE) multi-parameter physiological conditioning method for training a trainee to gain better control of a plurality of the trainee'"'"'s physiological responses by using two combined self-regulatory techniques, biofeedback and autogenic therapy, and to permit the trainee to voluntarily and simultaneously control the plurality of physiological responses, the method comprising:

using a trainee sub-system formed of an AFTE apparatus connected to a trainer sub-system and including a senior assembly for sensing baseline values of a plurality of physiological parameters indicative of the trainee'"'"'s physiological responses and for further sensing changes in said physiological parameters when the trainee is under stress and, during training, in order for said trainer sub-system to develop an individual stress profile for the trainee; and

,

based on said stress profile selectively feeding back one or more of said plurality of trainee'"'"'s physiological parameters to said trainee sub-system, in order to enable the trainee to simultaneously modify and control hierarchy, magnitude and phase relationships of the physiological responses so as to normalize the plurality of physiological responses by minimizing variances of the physiological responses from their corresponding baseline values; and

wherein said step of using said trainee sub-system includes the steps of;

starting to collect data on a selected one of said physiological parameters;

starting a timer when said cardiac R pulse is sensed;

inquiring about the occurrence of a subsequent R pulse;

when said subsequent R pulse is sensed, almost simultaneously stopping said timer, recording the length of an RR interval, and resetting said timer; and

processing said data that has been collected on a selected one of said physiological parameters.

24. The method according to claim 23, further including the step of displaying data representative of selected ones of said physiological parameters or the average values of said physiological parameters.

25. The method according to claim 24, wherein said steps of sensing baseline values of said plurality of physiological parameters, and changes in said physiological parameters includes the step of:

determining the pulse rate of the trainee, according to the following equation;

##EQU12##

26. The method according to claim 25, wherein said steps of sensing further include the steps of:

measuring a thoracic impedance Δ

Z;

measuring or determining the average or mean thoracic impedance, i.e., basal impedance Zo; and

measuring the peak or maximum value of the first derivative of the thoracic impedance Δ

Z with respect to time;

##EQU13##

27. The method according to claim 26, wherein said steps of sensing further include the step of determining the stroke volume by correlating the stroke volume and changes in the thoracic impedance, according to the following relationship:

##EQU14##

28. The method according to claim 27, wherein said steps of sensing further include the steps of:

determining the cardiac output, either by directly correlating the stroke volume to the peak value of the first derivative of the thoracic impedance Δ

Z with respect to time, or by calculating the stroke volume based on the following equation;

##EQU15## where ρ

is the specific resistance of blood, L² is the square of the distance L between two voltage electrodes;

TVE refers to the ventricular ejection time, and the basal impedance Zo is a generally measurable constant impedance;

determining the cardiac output according to the following equation;

space="preserve" listing-type="equation">CARDIAC OUTPUT=STROKE VOLUME×

PULSE RATE;

determining the thoracic fluid index (TFI) pursuant to the following equation;

##EQU16##

29. The method according to claim 28, wherein said steps of sensing further include the steps of:

measuring the diastolic and the systolic pressures;

calculating a mean arterial pressure MAP according to the following equation;

##EQU17## and determining a total peripheral pressure TPR, according to the following equation;

##EQU18##

30. The method according to claim 27, wherein said steps of sensing further include the steps of:

measuring the trainee'"'"'s respiration rate, temperature, skin conductance level, electrogastrogram signals, electromyogram (EMG) signals at one or more limbs, pulse volume at one or more parts of the trainee'"'"'s body, and the venous compliance according to the following equation;

space="preserve" listing-type="equation">VENOUS COMPLIANCE=δ

V/δ

P

where δ

V is the pulse volume, δ

P is the change in blood pressure.

31. An autogenic-feedback training exercise (AFTE) multi-parameter physiological conditioning method for training a trainee to gain better control of a plurality of the trainee'"'"'s physiological responses by using two combined self-regulatory techniques, biofeedback and autogenic therapy, and to permit the trainee to voluntarily and simultaneously control the plurality of physiological responses, the method comprising:

using a trainee sub-system formed of an AFTE apparatus connected to a trainer sub-system and including a sensor assembly for sensing baseline values of a plurality of physiological parameters indicative of the trainee'"'"'s physiological responses and for further sensing changes in said physiological parameters when the trainee is under stress and during training, in order for said trainer sub-system to develop an individual stress profile for the trainee;

based on said stress profile selectively feeding back one or more of said plurality of trainee'"'"'s physiological parameters to said trainee sub-system, to in order to enable the trainee to simultaneously modify and control hierarchy, magnitude and phase relationships of the physiological responses, so as to normalize the plurality of physiological responses by minimizing variances of the physiological responses from their corresponding baseline values;

said step of using said trainer sub-system providing a sequence of baseline, training and post-training sessions;

said step of providing a baseline session includes selecting at least one of the following steps, and using the selected steps in a predetermined order;

reducing extrinsic stimuli;

determining the trainee'"'"'s optimal range of physiological parameters at rest to obtain that trainee'"'"'s individual baseline profile;

gradually increasing and decreasing stimulus levels to determine the trainee'"'"'s range of physiological parameters under stress, and the relationship of these parameters;

determining the order of change of the physiological parameters change under stress;

determining the magnitude of response and the tonic and phasic relationship of the physiological parameters under stress;

determining the developing symptoms and correlating them to accompanying changes in the physiological parameters;

obtaining the trainee'"'"'s individual profile or specific response pattern under stress;

training the trainee to use passive concentration;

training the trainee to feel and pay attention to various bodily sensations;

training the trainee to focus using passive attention;

providing a baseline test, starting with a specific autogenic exercise;

training the trainee to normalize his/her individual profile and to modify his/her behavior; and

wherein said step of training the trainee to normalize his/her individual profile includes the step of selectively displaying at least one of the following parameters;

LFPV;

Left Finger Pulse Volume;

RFPV;

Right Finger Pulse Volume;

RESP. RT.;

Respiration Rate;

HEART RT.;

Heart Rate;

TEMP,/B;

Temperature;

LASER PV;

Laser Pulse Volume;

DPLR PV;

Doppler Pulse Volume;

SCL/B;

Skin Conductance Level;

LA EMG;

Left Arm EMG;

RA EMG;

Right Arm EMG;

LL EMG;

Left Leg EMG;

RLL EMG;

Left Leg EMG;

SYS. BP;

Systolic Blood Pressure;

DIA. BP;

Diastolic Blood Pressure;

TPR;

Total Peripheral Pressure;

TFI Thoracic Fluid Index;

STR. VoL.;

Stroke Volume; and

CAR. OUT.;

Cardiac output.