Effect of EMG Biofeedback and Progressive Muscle Relaxation Training on Awareness of Frontalis Muscle Tension

Awareness of muscle tension, as estimated by a modification of the Kinsman et al. (1975) procedure for determining probability of correct estimation (P(c)) of absolute differences in muscle tension between adjacent trials, was examined before and after volunteer subjects underwent 4 sessions of either: 1) EMG biofeedback (BF) training, 2) progressive muscle relaxation (PMR) training, or 3) a placebo-control (MC) procedure which involved listening to music as an alleged guide for relaxation. The subjects were 30 females (mean age = 28.3 yrs) responding to an offering of experimental treatment for anxiety and tension. Measurements of frontalis muscle tension (EMG) and P(c) were made before and after training. The results showed that EMG was significantly reduced by BF and PMR training but not by the MC procedure. Increases in P(c) after training were significantly greater for BF than for PMR or MC training. There were no group differences for subjective report of tension. Correlations between pre- to post-training EMG and P(c) change scores were significant only for the BF group and the combined group of BF and PMR subjects. These results suggest that: 1) both BF and PMR training were effective in producing frontalis EMG reductions, 2) the following relationship may exist among training groups in terms of relative influence upon awareness of tension—BF training > PMR training > MC training, and 3) awareness of tension appears to be related to the ability to reduce EMG although the exact nature of this relationship remains unclear.     

The effect of changes in facial muscle tension on respiratory resistance

The relationship between changes in facial electromyographic (EMG) levels and respiratory resistance was examined. Thirty adult males were assigned equally to 1 of 3 groups; a facial muscle tension increase group (EMG increase), a facial tension decrease group (EMG decrease), and a noncontingent group (EMG noncontingent). Biofeedback procedures, based on EMG recordings made form electrodes positioned over the frontalis muscles, were used to effect muscle tension changes. Individuals in the EMG increase group exhibited increases in facial tension, but individuals in the EMG decrease group failed to show muscle tension changes. Respiratory resistance increased in individuals in the EMG increase group but did not change in individuals in the EMG decrease group. Like the EMG decrease group subjects, EMG noncontingent group subjects changed neither in facial tension nor in respiratory resistance. The results provided some support for a hypothesis linking facial muscle tension and respiratory resistance.     

Striate Muscle Tensional Patterning in Frontalis EMG Biofeedback

Four normal male subjects were exposed to 5 30-min alternate-day sessions of continuous frontalis EMG biofeedback training preceded by 15-min adaptation periods. A computer-controlled scanning electromyograph sampled integrated EMG activity from the frontalis and seven adjunctive muscle groups. Tensional profiles for all eight muscle groups were assembled every 1.84 sec, resulting in an 8 × 960 data array for each session. Statistical analyses revealed that although frontalis EMG levels decreased significantly in the training, those of adjunctive recording sites did not. Cross correlation analyses for session 1 frontalis and adjunctive site EMG levels showed typically negligible correlations at all temporal lags, although some neck sites showed moderate cross correlation with the frontalis in 2 subjects. Separate principal-component analyses for sessions 1 and 5 produced little evidence for a general muscle tension factor. Low coefficients of congruence between session 1 and session 5 truncated-component solutions demonstrated little replicability of tensional linkages from the first to the last session.     

Lack of Correlation Between Frontalis EMG and Either Neck EMG or Verbal Ratings of Tension

Eight normal subjects were trained with the aid of EMG feedback to successively increase and decrease the activity of the frontalis muscle on 5 consecutive days. Along with the activity of the frontalis, sternomastoid EMG was recorded from 4 subjects and EMG from both the semispinalis and splenius capitus was recorded from the other 4 subjects. Estimates of the degree of subjective tension or relaxation were obtained following Baseline, Increase Frontalis, and Decrease Frontalis periods on each treatment day. Frontalis EMG activity showed significant increases and decreases relative to baseline levels during appropriate periods. Sternomastoid EMG did not change significantly during either Increase Frontalis or Decrease Frontalis periods. Semispinalis/splenius EMG activity also did not change during Increase Frontalis periods, but increased significantly during Decrease Frontalis periods. Subjects’estimates of subjective tension increased above baseline during increases in frontalis EMG activity, but did not change significantly during decreases in frontalis EMG. These data support the findings of Alexander that changes in frontalis EMG neither generalize to other somatic muscles nor correlate with verbal reports of cognitive tension or relaxation.     

Continuous Biofeedback and Discrete Posttrial Verbal Feedback in Frontalis Muscle Relaxation Training

During training to relax the frontalis muscle, continuous biofeedback (BF) was compared to discrete verbal feedback (VF) delivered immediately after each trial. Both feedback modalities were based on frontalis electromyographic (EMG) activity. Training consisted of 3 consecutive daily session-each comprised of 3 baseline (nonfeedback) trials followed by 10 training trials of 128 see. The presence or absence of the two informationally positive feedback modalities were combined factorially to define four training conditions: BF + VF, NO BF + VF, BF + NO VF, and NO BF + NO VF. Results indicated that while VF alone facilitated muscle relaxation, BF was clearly prepotent ill effecting consistent decreases in EMG activity both across trials and days of training. Additionally, the facilitating effect of BF transferred to nonfeedback trials while VF did not affect performance on nonfeedback trials. Finally, accuracy of self-evaluations of performance on a trial by trial basis was markedly improved by BF, while VF improved accuracy only for trials having a very large absolute difference between levels of EMG activity. Ss receiving no feedback neither reduced muscle tension during training not were able to evaluate their performance accurately even when large absolute differences occurred between trials in frontalis EMG activity.     

Muscle tension patterns during auditory attention.

Although there is much evidence demonstrating muscle tension changes during mental work, there are few data concerning muscle tension patterns during effortful attention to simple sensory stimuli. In the present study, sensory attention was evoked by a pitch discrimination task at three levels of difficulty, with a digit retention task administered for comparison. Twenty-four females each performed both tasks at all levels of difficulty, while the EKG, and the corrugator supercilii, frontalis, lip, jaw, chin, and forearm area EMG were recorded. As expected, heart rate decreased significantly with increasing difficulty of the pitch task. A pattern of facial EMG responses accompanied the pitch task, which included significant increases in corrugator and frontalis, and decreases in the jaw as a function of difficulty, and time within trials. The tension pattern observed during sensory intake is discussed in terms of its relation to emotional expressions and motor theories of attention.     

Control of masseter muscle tension during sleep

This study evaluated whether muscle tension could be controlled during sleep. Twelve volunteers were assigned to an experimental condition or to a no treatment control group. Experimental subjects were instructed to reduce the tension in their masseter (jaw) muscle when signalled with an auditory tone. These subjects demonstrated cue-controlled tension reductions during awake training sessions. Although both groups evidenced muscle tension increases in response to the tones presented during sleep, experimental subjects produced significantly smaller increases in response to tone stimuli than did control subjects. More importantly, experimental subjects sustained lower tonic levels of muscle tension throughout the sleep sessions than did control subjects. Sleep was moderately disrupted for subjects in both groups. However, experimental subjects evidenced the greatest tension reductions during those responses in which they shifted to a lighter stage of sleep rather than fully awakening. These data suggest that muscle tension can be moderated during sleep.     

The relationship of sleep and anxiety in anxious subjects

The present study provided polysomnographic corroboration of the frequently reported relationship between anxiety and subjective sleep disturbance. When compared to normals, anxious individuals were found to have significantly less sleep period time, total sleep time, percent stage REM and percent stage 4; shorter latency to stage REM; and greater percent stage 1. Partial correlations (holding depression constant) showed significant positive relationships between anxiety rating and number of awakenings, latency to stage 1, and percent stage 2. A significant negative relationship was found between anxiety and percent stage 4, and a nonsignificant negative trend was found between anxiety and latency to stage REM. Overall there was a tendency toward less sleep and lighter sleep in subjects with anxiety, thus validating subjective reports. The decreased latency to stage REM and its negative relation to anxiety, raised the possibility that this variable may not be specifically indicative of depression.     

额肌腱膜的解剖学观察及临床意义

目的：为临床应用额肌加额肌腱膜组织瓣悬吊上睑、治疗重症上睑下垂症,提供解剖学基础。方法：在手术显微镜下,解剖观测３０侧额肌腱膜的起止点、宽、厚度及腱膜与面神经颞支、眶上神经的关系。用组织切片光镜下观察腱膜的组织结构。结果：额肌腱膜起点距眶上缘的外、中、内１／３上方的距离分别是０．６ｃｍ、０．９ｃｍ、０．６ｃｍ。腱膜呈半月形,厚０．０５ｃｍ,宽３．４ｃｍ,外侧缘距面神经颞支１．９ｃｍ。腱膜的组织构成为致密结缔组织,成束排列的胶原纤维方向与额肌纤维的方向一致。结论：应用额肌腱膜和额肌组织瓣悬吊上睑,可最大程度减少手术固定部位撕裂,提高手术效果。     

The Effect of Repeated Tense-Release Sequences on EMG and Self-Report of Muscle Tension: An Evaluation of Jacobsonian and Post-Jacobsonian Assumptions About Progressive Relaxation

This study tested three psychophysiological hypotheses generated from assumptions underlying post-Jacobsonian progressive relaxation techniques and assumptions that conflict with the rationale for Jacobson's progressive relaxation method. Twenty-eight subjects tensed and released tension from the forearm extensor and frontalis muscles during a series of trials interspersed with intervals of relaxation. Correlations between self-report of tension and EMG were moderate during relaxation, but did not increase across successive tense-release trials, thus indicating no increase in self-awareness of muscle tension. As predicted by Jacobson, paying attention to either muscle produced increased tension in the frontal area, but Jacobson's prediction of increases in forearm tension while paying attention to the forearm was not confirmed. Evidence was equivocal for the existence of the “pendulum effect” predicted by Bernstein and Borkovec. Tense-release trials produced gradual decreases in frontal EMG, but no changes in forearm EMG. Declines below baseline in self-reported muscle tension occurred only several minutes after the end of the tense-release trials, and did so for the forearm despite lack of EMG decreases in that area. This finding may reflect the influence of cognitive rather than muscular processes.     

Sleep and sleepiness in children with attention deficit / hyperactivity disorder and controls

The present study assessed the association between habitual sleep patterns and one night of PSG measured sleep with daytime sleepiness in children with ADHD and typically developing children. Eighty‐two children (26 ADHD, 56 typically developing children), between 7 and 11 years, had nighttime sleep recorded using actigraphy over five nights (habitual sleep patterns) and polysomnography during one night (immediate sleep patterns), both within their home environments. Daytime sleepiness was examined using the multiple sleep latency test within a controlled laboratory setting the following day. Using Spearman correlations, the relationships between mean sleep latencies on the multiple sleep latency test and scores on a modified Epworth Sleepiness Scale with polysomnographic measures of sleep quality and architecture and with actigraphic sleep quality measures were examined. Longer sleep latency, measured using polysomnography and actigraphy, was related to longer mean sleep latencies on the multiple sleep latency test in typically developing participants, whereas actigraphic measures of sleep restlessness (time awake and activity during the night), as well as time in slow‐wave sleep, were positively related to mean sleep latency on the multiple sleep latency test in children with ADHD. These results show a differential relationship for children with ADHD and typically developing children between habitual and immediate sleep patterns with daytime sleepiness and suggest that problems initiating and maintaining sleep may be present both in nighttime and daytime sleep.     

Cognitive imagery and physiological feedback relaxation protocols applied to clinically tense young adults: a comparison of state, trait, and physiological effects

Examined changes in targeted and general tension behaviors as well as reductions in physiological tension associated with cognitive imagery and electromyographic biofeedback relaxation procedures. Three groups of 15 female college students participated. During three weekly sessions each person received either guided cognitive imagery relaxation, frontalis muscle feedback relaxation, or a self-rest control procedure. The Anxiety Differential was administered before and after each session, while frontalis EMG, heart rate, and skin temperature were monitored continuously. A second Temperament Analysis was administered after the final session. The imagery procedure was associated with moderate reductions in physiological tension and significant reductions in state anxiety and three tension-related personality dimensions. Self-rest persons displayed lesser reductions in general tension with little physiological change. While biofeedback persons showed the largest reductions in physiological tension, they displayed only small and variable changes in state anxiety and personality dimensions. The data raise continued questions about the application of physiologically based operant relaxation procedures and support the use of cognitively mediated protocols for the treatment of specific or general anxiety behaviors.     

Sleep Duration and Sleep Quality: Associations With Depressive Symptoms Across Adolescence

This study explored whether short sleep duration and sleep quality mediate the relationship between age and depressive symptoms. For comparison, we also explored whether depressive symptoms mediate the relationship between age and short sleep duration and sleep quality. The sample comprised 741 adolescents (63.5% female, mean age 15.78 years, range 11.92–19.67 years) in grades 7–12 from 11 secondary schools in metropolitan Melbourne, Australia. Students completed the Pittsburgh Sleep Quality Index (PSQI) and Center for Epidemiologic Studies Depression Scale (CES-D). Path analyses suggested that short sleep duration significantly mediated the relationship between age and depressive symptoms. Poor sleep quality also significantly mediated this relationship when sleep quality was defined by subjective judgement, but not sleep disturbance, sleep efficiency, or sleep onset latency. Depressive symptoms significantly mediated the relationship between age and short sleep duration and sleep quality (subjective judgement, sleep disturbance, sleep efficiency, and sleep onset latency). These findings suggest that the population-wide increase in depressive symptoms across adolescence is partially mediated by sleep-related developmental changes. They also highlight the importance of examining specific sleep problems when investigating the relationship between sleep and mood in this age group.     

Relationship between REM sleep latency and nocturnal cortisol concentrations in depressed patients

SUMMARY  Due to conflicting reports on the possible association between shortening of rapid eye movement (REM) latency and increased cortisol secretion in patients with severe depression, this study examined the relationship between REM sleep latency and nocturnal cortisol concentration in 12 outpatients with major depression. The results showed a significant inverse correlation ( r = —0.71, P <0.01) between REM sleep latency and mean (23.00 hours-03.00 hours) plasma cortisol concentration. Age and severity of depression did not contribute to the inverse relationship. REM activity and density during the first REM period showed no significant correlations with the cortisol measures. A review of the literature suggests that this relationship might be unique to subjects with major depression, and again raises the possibility that these biological disruptions may have a common neurochemical basis.     

The Maintenance of Wakefulness Test and driving simulator performance

STUDY OBJECTIVES: It has been suggested that the Maintenance of Wakefulness Test (MWT) may be clinically useful to assess fitness to drive, yet little is known about the actual relationship between sleep latency and driving performance. This study examined the ability of 2 MWT trials to predict driving-simulator performance in healthy individuals. DESIGN: Experimental. SETTING: NA. PATIENTS OR PARTICIPANTS: Twenty healthy volunteers (mean age 22.8 years; 9 men). INTERVENTIONS: NA. MEASUREMENTS AND RESULTS: The MWT and driving-simulator performance were examined under 2 conditions-partial sleep deprivation and a combination of partial sleep deprivation and alcohol consumption. Each subject was studied a week apart, with the order randomly assigned. Subjects completed a nighttime 70-minute AusEd driving simulation task and two 40-minute MWT trials, 1 before (MWT1) and 1 after (MWT2) the driving task. In the sleep-deprived condition, the MWT1 sleep latency was inversely correlated with braking reaction time. During the partial sleep deprivation and alcohol condition, the number of microsleeps during the driving task, steering deviation, braking reaction time, and crashes all negatively correlated with the MWT1 sleep latency. Additionally, construction of a receiver-operator characteristic curve revealed that MWT1 sleep latency in the partial sleep deprivation plus alcohol condition significantly discriminated subjects who had a crash from those who did not. CONCLUSIONS: These results indicate that sleep latency on the MWT is a reasonable predictor of driving simulator performance in sleepy, alcohol-impaired, normal subjects. Further research is needed to examine the relationship between daytime MWT results and driving simulator performance in sleepy patients (eg, those with obstructive sleep apnea) and in experimentally sleep-deprived normal subjects.     

The effect of sleep on reflex genioglossus muscle activation by stimuli of negative airway pressure in humans.

The present study was designed to determine the effect of sleep on reflex pharyngeal dilator muscle activation by stimuli of negative airway pressure in human subjects. Intra-oral bipolar surface electrodes were used to record genioglossus electromyogram (EMG) responses to 500 ms duration pressure stimuli of 0 and -25 cmH2O applied, via a face-mask, in four normal subjects. Stimuli were applied during early inspiration in wakefulness and in periods of non-rapid-eye-movement (non-REM) sleep, defined by electroencephalographic (EEG) criteria. The rectified and integrated EMG responses to repeated interventions were bin averaged for the 0 and -25 cmH2O stimuli applied in wakefulness and sleep. Response latency was defined as the time when the EMG activity significantly increased above prestimulus levels. Response magnitude was quantified as the in ratio of the EMG activity for an 80 ms post-stimulus period to an 80 ms prestimulus period; data from after the subject's voluntary reaction time for tongue protrusion (range, 150-230 ms) were not analysed. Application of the -25 cmH2O stimuli caused genioglossus muscle activation in wakefulness and sleep, but in all subjects response magnitude was reduced in sleep (mean decrease, 61%; range, 52-82%; P = 0.011, Student's paired t test). In addition, response latency was increased in sleep in each subject (mean latency awake, 38 ms; range, 30-50 ms; mean latency asleep, 75 ms; range, 40-110 ms; P = 0.072, Student's paired t test). Application of the -25 cmH2O stimuli caused arousal from sleep on 90% occasions, but in all cases the reflex genioglossus muscle responses (maximum latency, 110 ms) always proceeded any sign of EEG arousal (mean time to arousal, 643 ms; range, 424-760 ms). These results show that non-REM sleep attenuates reflex genioglossus muscle activation by stimuli of negative airway pressure. Attenuation of this reflex by sleep may impair the ability of the upper airway to defend itself from suction collapse by negative pressures generated during inspiration; this may have implications for the pathogenesis of obstructive sleep apnoea.     

Behavioral treatment of presleep tension and intrusive cognitions in patients with severe predormital insomnia

Behavioral approaches to the treatment of predormital insomnia have assumed that hyperarousal is the underlying cause; thus presleep tension has been the most common target treated. A second indicator, presleep intrusive cognitions, has only recently been examined as a target for treatment. In the present study, 20 subjects were randomly assigned to three groups which focused on the treatment of either (1) presleep tension alone, (2) presleep tension and intrusive cognitions, or (3) perception of sleep. Four subjects acted as controls. The findings indicated that reductions in both presleep tension and intrusive cognitions were followed by a significantly greater reduction in latency to sleep onset and daytime impairment than reductions in presleep tension alone. The results obtained from modifying the individual's perception of sleep were not significantly different from those obtained from reductions in presleep tension alone. A 6 weeks follow-up revealed no change in the relative status of the three treatment groups.     

Serotonin transporter polymorphism modifies the association between depressive symptoms and sleep onset latency complaint in elderly people: results from the ‘InveCe.Ab’ study

Previous studies have documented the involvement of the central nervous system serotonin in promoting wakefulness. There are few and conflicting results over whether there is an actual association between bearing the short allele of serotonin transporter promoter polymorphism (5‐HTTLPR) and worse sleep quality. This study examined whether sleep onset latency complaint is associated with the 5‐HTTLPR triallelic polymorphism in the SLC6A4 gene promoter and whether this polymorphism influences the relationship between sleep onset latency complaint and depressive symptoms in elderly people. A total of 1321 community‐dwelling individuals aged 70–74 years were interviewed for sleep onset latency complaint and for sleep medication consumption. Participants’ genomic DNA was typed for 5‐HTTLPR and rs25531 polymorphisms. Depressive symptoms were evaluated with the Geriatric Depression Scale Short form and general medical comorbidity was assessed by the Cumulative Illness Rating Scale. The presence of a past history of depression was recorded. The S′ allele of the 5‐HTTLPR triallelic polymorphism was associated with sleep onset latency complaint. This association was maintained after adjusting for depressive symptoms, sex, age, history of depression and medical comorbidity. After stratification for 5‐HTTLPR/rs25531, only in S′S′ individuals high depressive symptoms were actually associated with sleep onset latency complaint. These data indicate that the low‐expressing 5‐HTTLPR triallelic polymorphism is an independent risk factor for sleep onset latency disturbance. Furthermore, the 5‐HTTLPR genotype influences the association between depressive symptoms and sleep onset latency complaint.     

Narcolepsy and depression and the neurobiology of gammahydroxybutyrate

A voluminous literature describes the relationship between disturbed sleep and depression. The breakdown of sleep is one of the cardinal features of depression and often also heralds its onset. Frequent arousals, periods of wakefulness and a short sleep onset REM latency are typical polysomnographic features of depression. The short latency to REM sleep has been attributed to the combination of a monoaminergic deficiency and cholinergic supersensitivity and these irregularities have been proposed to form the biological basis of the disorder. A similar imbalance between monoaminergic and cholinergic neurotransmission has been found in narcolepsy, a condition in which frequent awakenings, periods of wakefulness and short sleep onset REM latencies are also characteristic findings during sleep. In many cases of narcolepsy, this imbalance appears to result from a deficiency of hypocretin but once established, whether in depression or narcolepsy, this disequilibrium sets the stage for the dissociation or premature appearance of REM sleep and for the dissociation of the motor inhibitory component of REM sleep or cataplexy. In the presence of this monoaminergic/cholinergic imbalance, gammahydroxybutyrate (GHB) may acutely further reduce the latency of REM sleep and induce cataplexy, in both patients with narcolepsy or depression. On the other hand, the repeated nocturnal application of GHB in patients with narcolepsy improves the continuity of sleep, prolongs the latency to REM sleep and prevents cataplexy. Evidence to date suggests that GHB may restore the normal balance between monoaminergic and cholinergic neurotransmission. As such, the repeated use of GHB at night and the stabilization of sleep over time makes GHB an effective treatment for narcolepsy and a potentially effective treatment for depression.