Method and apparatus for biofeedback

Method and apparatus for biofeedback
.
US005343871A
Unlted States Patent [191
[11] Patent Number:
Bittman et a].
[45]
[54]
Sep. 6, 1994
METHOD AND APPARATUS FOR
4,896,675
l/ 1990 Ohsuga et a1. .................... .. 128/671
4,919,143
4/1990
Ayers
.. . .. ..... ....
. . . ..
128/732
4,928,704
5/ 1990
Hardt
. .. ....... . .. .
. . . ..
128/732
Assignee:
4,932,880 6/ 1990 Kotick et a1.
128/715
Jeffrey R_ cram, Nevada city, calig
4,984,158
1/1991 Hillsman ....... ..
5,024,235
6/1991
Ayers
Mindscope Incorporated, Meadville,
5,036,858
8/1991
Carter et a1. . . . .
Pa.
5,076,281 12/1991
[21] APPL No‘, 850,673
364/413.04
. . . . . . .. . . . . . .
. . . ..
128/732
. . . .. 128/732
Gavish .............................. .. 128/721
Primary Examiner-William E. Kamm
_
Assistant Examiner-Scott M. Getzow
[22] Flledl
Mar- 13, 1992
Attorney, Agent, or Firm-Webb, Ziesenheim, Bruening,
[51]
Int. Cl.5 .............................................. .. A61B 5/02
[52]
US. Cl. .................................. .. 128/732; 128/905;
L°gsd°m Ork‘“ 8‘ Hans”
[57]
ABSTRACT
128/670' 128/733
A method and apparatus for medlatmg a blofeedback
Field of Search .............. .. 128/905, 732, 670, 733
References Cited
Session with a human subject in which measurements of
electrophysiological quantities are used to control the
presentation to the subject of a series of prestored audio
visual sequences of varying levels of clarity resident on
_
[58]
[56]
Date of Patent:
BIOFEEDBACK
[75] Inventors: Barry B. Bittman, Meadville, Pa.;
[73]
5,343,871
.
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U'S' PATENT DOCUMENTS
3,837,331
9/1974 Ross .................................. .. 128/1 C
3,355,998 12/ 1974 Hidalgo-Bliccno 128/2-1 B
S11v3 et a1. ...... ..
.
.
a direct-access video storage device. The sequences are
real scenes designed to induce a desired psychological
...
3,916,876 11/1975 Freeman ..... ..
128/2.1 M
B
Statephysiological
his
when viewed.parameters’
As the
the clarity
succeeds
ofinthe pres_
3,942,516
3/1976
Glynn et al. ..
128/2.1 B
128” C
ented lmage and sound lmprove as an mdicatlon of
3’978’847
9/1976
' '' '
' ' ' ' ‘ "128/2 1 B
success. By using the invention, the subject develops a
"
“(V148
..... .. 340/148
his Physiological Parameters even when away from the
3 967 616 7/1976 R
4:056:805 11 A977 Brady ““““
4,140,997 2/1979 Brady
.
_
.
.
.
.
conditioned response to the scenes and is able to control
4,354,505 10/1932
shiga , . _ _ .
_ , _ _ _ ,_ 128/732
apparatus by remembering the audio-visual sequences
4,461,301
7/1984
Ochs . . . . . . . . . . . . . .
. . . . . ..
128/630
used during treatment.
4,665,926
5/1987
Leuner et a1
. . . . . 1.
128/716
4,683,891
8/1987 Cornellier et a1.
4,776,323
4,823,808
10/1988
Spector
. ... .
..... .. 128/630
..... ... .. ...
. . . ..
4/1989 Clegg et a1. .
20 Claims, 2 Drawing sheets
128/25 B
'
..... .. 128/773
_
Micro?che Appendix Included
4,883,067 11/1989 Knispel et a1 .................... .. 128/732
(2 Micro?che, 111 Pages)
BIOFEEDBACKAPPARATUS
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Sep. 6, 1994
Sheet 1 of2
5,343,871
BIOFEEDBACK APPARATUS
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U.S. Patent
Sep. 6, 1994
Sheet
VIDEODISC
2 of 2 100,7
CLUSTER 1107
LVRI 1
LVRI 2
LVRI 3
LVRI 4
LVRI 5
111
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Fig. 3.
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5,343,871
2
signals from the subject, is not a biofeedback device
METHOD AND APPARATUS FOR BIOFEEDBACK
because the subject is not guided by stimuli to modify
his own physiological parameters. Cornellier et al. U.S.
Pat. No. 4,683,891 teaches use of a visual display to
5 indicate the values of a subject’s physiological parame
Two micro?che appendices are provided. Micro?che
Appendix A comprises 46 frames on micro?che 1 of 2.
Micro?che Appendix B comprises 56 frames on micro
?che 2 of 2.
ters at the point where stress is induced during perfor
mance of a goal-oriented task.
A number of prior art biofeedback devices employ
BACKGROUND OF THE INVENTION
1. Field of the Invention
purely audio feedback to the subject. Silva et al. U.S.
10 Pat. No. 3,875,930 teaches using a fixed audio signal that
This invention relates to a method of mediating a
decays to silence as an indication that the desired brain
biofeedback session with a human subject in which
wave waveform has been achieved. Spector U.S. Pat.
measurements of certain of the subject’s electrophysio
No. 4,776,323 teaches playing sounds through head
logical parameters are used to control the presentation
phones to induce relaxation in a subject for the purpose
to the subject of a series of prestored audio-visual se 15 of creating a calm state that can then be interrupted by
quences of varying levels of clarity or perspective to
high-amplitude noises to cause stress. Knispel et al. U.S.
provide targets whose viewing induces in the subject a
Pat. No. 4,883,067 teaches a method of transforming
desired psychological state.
2. Description of the Prior Art
brainwave activity into musical sound, which is fed
back to the subject via headphones.
Biofeedback is a process in which electrodes are con 20
nected to a human subject to monitor electrophysiologi
cal parameters such as heart rate, electroencephalo
Numerous prior art devices combine audio and visual
feedback Glynn et a1 U.S. Pat. No. 3,942,516 teaches
simultaneous monitoring of a plurality of electrophysio
logical parameters to produce a single audio-visual out
put for feedback. Fehmi et al. U.S. Pat. No. 3,978,847
graphic signals and galvanic skin resistance. These sig
nals are converted to a visual or audio display that can
been seen and/or heard by the subject, who attempts to 25 teaches using audio tones and a light that increases in
alter the parameters using the display as a guide to his
amplitude and stroboscopic frequency as the frequency
progress. If it is desirable to reduce blood pressure, for
of the subject’s brainwaves increases. Clegg et al. U.S.
example, the display may consist of a bar graph indicat
Pat. No. 4,823,808 teaches a method for treating eating
ing the magnitude of the pressure. If the subject is suc
disorders by measuring parameters of the gastrointesti
cessful in lowering his blood pressure, he will see the 30 nal tract and providing indications of gastric activity by
size of the bar diminish and will thus know he is making
visual and audio means, as by amplifying stomach
progress.
noises. Ohsuga et al. U.S. Pat. No. 4,896,675 teaches
Traditional biofeedback methods employ such mech
providing graphs of physiological parameters and si
anisms as analog meters, computer-generated displays,
multaneously generating a sound pattern to be used by
targets shown in cross-hairs, acoustic tones and audio 35 the subject to control his rate of respiration. Ayers U.S.
beat frequencies to indicate to the subject the values of
Pat. Nos. 4,919,143 and 5,024,235 teach a sound and
the parameters being monitored.
light box in addition to graph waveforms as output from
Biofeedback is commonly performed by a biofeed
a biofeedback system. Hardt U.S. Pat. No. 4,928,704
back technician, who directs the subject verbally to
teaches combining tone feedback with display of digital
achieve a state of calm by coaching him to develop a 40 data to the subject. Hillsman U.S. Pat. No. 4,984,158
mental image of a relaxing scene. Unfortunately, it can
teaches auditory prompts and use of visual graphs for
be difficult to relax during such a session because the
instructing subjects to use a metered dose inhalation
subject is forced to concentrate on a computer display
system. Carter et al. U.S. Pat. No. 5,036,858 teaches use
or audio tone to gauge his progress. That is, the result or
of light goggles and headphones to convey beat signals
display viewed by the subject is not in itself calming, 45 to a subject indicative of how much his brainwave fre
and may actually interfere with the desired objective.
quency differs from a desired frequency. Gavish U.S.
Biofeedback can be used to treat migraine and tension
Pat. No. 5,076,281 teaches using synthesized sound
headaches, pain disorders such as temporomandibular
patterns and optical effects indicative of parameters of
joint dysfunction (TMJ) and myofascial syndromes,
musculoskeletal tension, hypertension, anxiety and
panic disorders, asthma, dyspepsia, and other conditions
biorhythmic activity.
50
that can be controlled by reducing muscular tension,
inducing a state of calm or stabilizing autonomic func- '
tion. Biofeedback can be used both for treatment and
prevention of such syndromes.
Biofeedback devices and methods comprising visual
displays are known in the prior art. Ross U.S. Pat. Nos.
3,837,331 and 3,967,616 teach use of a “transducing
means” for exhibiting sensory signal output to the
human subject, which may include a matrix of num
bered lamps, slides projected on a screen, or an audible
55
Freeman U.S. Pat. No. 3,916,876 teaches measure
ment‘of muscle tension in two selected muscles while
the subject watches electrical meters displaying the
tension measurements and other quantities derived from
them. There is no audio or visual feedback other than
meter readings.
Brady U.S. Pat. Nos. 4,056,805 and 4,140,997 disclose
a video display comprising a matrix of colored lights
that is controlled in response to brainwaves. Brady’s
invention does not comprise a biofeedback system, but
is directed to conveying a visual indication of a subject’s
response to sound, particularly music. Shiga U.S. Pat.
No. 4,354,505 teaches measurement of the length of
closes an entertainment device that monitors electro
time a subject has remained in a relaxed state by display
physiological parameters of a human subject and pres
ing numerals indicative of the said length. Ochs U.S.
ents “audio-visual stimulation” comprising passages of 65 Pat. No. 4,461,301 teaches display of numerical indica
music, ?ashing lights or projected images intended to
tions dependent on the values of monitored electro
place the subject in a desired psychological state. The
physiological parameters. Leuner et al. U.S. Pat. No.
Hidalgo-Briceno invention, while it receives electrical
4,665,926 teaches a system for measuring a person’s
chime. Hidalgo-Briceno U.S. Pat. No. 3,855,998 dis
3
5,343,871
relaxation state, but in which displayed information is
not fed back to the subject but is instead monitored by
4
prestored audio-visual scenes at varying levels of visual
and acoustic clarity. The scenes themselves are of plea
surable images designed to induce relaxation, such as
a technician.
It is a drawback of prior art biofeedback devices and
views of beaches with rolling surf, lush ?ower gardens,
methods that the feedback provided to the subject is
merely a display of values of physiological parameters
a sunset, a waterfall and the like. As the subject gradu
or an indication of how successful the subject has been
becomes progressively enhanced. The “reward” to the
in achieving his goal. They do not provide a target,
subject for approaching the desired state is a succes
sively clearer image, closer view or movement of an
ally attains the desired physiological state, the image
desirable in itself, to assist in the attainment of success.
In fact, the prior art devices utilize feedback means that
can actually interfere with the desired objective by
object. In this way, the subject is able to perform bio
feedback without the distraction of prior art feedback
forcing the subject to concentrate on a wave tracing,
?ashing light or blip on an oscilloscope screen in order
ing. Subsequent to the treatment, the subject is able to
indicators, which are not themselves relaxation induc
to gauge his progress. In prior art methods, the subject
must generally be coaxed by an assistant into imagining
induce a relaxed state in himself by recalling the scenes
used during treatment.
a relaxing scene or locale in order to alter his electro
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 shows a block diagram of the apparatus of the
physiological responses.
The following are objects of the present invention:
1. To improve the efficacy of biofeedback by elimi
nating dependence on stress-inducing visual or audio
present invention;
FIG. 2 shows a layout of clusters of audio-visual
scenes on a videodisc of the type used in the present
targets on which the subject must concentrate.
2. To determine an effective weighted combination of
invention; and
physiological potentials for a given subject that can be
used in conditioning biofeedback response.
FIG. 3 shows the internal arrangement of a single
and reporting data concerning the subject’s responses
DETAILED DESCRIPTION OF THE
INVENTION
Referring now to FIG. 1, which shows a block dia
cluster of audio-visual scenes on the videodisc of FIG.
3. To monitor and record a subject’s progress 25 2.
through one or more biofeedback treatments by storing
on a digital computer so that the combination of physio
logical potentials monitored can be altered to maximize
the effectiveness of the treatment.
30 gram of the apparatus of the present invention, compris
4. To provide a means by which a subject’s success in
ing a biofeedback system 10. Electrodes 15 lead from
controlling his physiological potentials causes presenta
human subject 11 into the input terminals of preampli
tion of a graded sequence of pleasant scenes of succes
?er and converter 20. Preampli?er and converter 20
sively greater video and audio clarity.
contains preampli?ers and ampli?ers and analog-to
5. To combine conventional biofeedback devices 35 digital converters to transform analog signals into digi
with a videodisc to permit the presentation of selected
tal outputs indicative of the magnitude of said analog
image sequences in arbitrary order as a way of reward
signals. Preampli?er and converter devices of this type
ing the subject for positive psychological responses.
are well-known in the prior art. Examples of such de
6. To train the subject through biofeedback to induce
vices are the Autogenics A-8000, the J&J I-330 Modu
self-relaxation subsequent to a training session without 40 lar System, and the SRS Orion 8600 and PRO Series
having to rely on a machine for audio-visual response.
Model 421. The digital output of preampli?er and con
7. To develop a conditioned response on the part of a
subject so that he can induce in himself a desired psy
verter 20 is connected to an input port of digital com
puter 30. In a preferred embodiment, digital computer
cho-neurological state by recalling to memory one or
30 is compatible with an International Business Ma
more prestored audio-visual scenes.
45 chines personal computer running the DOS operating
system and preferably containing an Intel 386SX or
SUMMARY OF THE INVENTION
higher microprocessor. A fast microprocessor is re
quired, for example, to process EEG signals, which
Accordingly, we have invented a biofeedback system
in which the feedback provided to the subject is itself
exhibit a high information rate. In a preferred embodi
calculated to induce the desired state, eliminating the 50 ment, digital computer 30 includes a hard disk (not
need for the subject to imagine a nonexistent scene. The
shown) for data storage, a keyboard 40 for entering
apparatus comprises (1) a high-quality display device,
commands, a printer 45, preferably a laser printer, for
preferably a high-resolution television screen and high
printing reports and a high-resolution graphic monitor
?delity audio system; (2) a playback device capable of
50 to display command menus and graphs of the sub
playing back realistic prestored audio-video sequences 55 ject’s progress to the biofeedback technician. In a pre
quickly and in arbitrary order, preferably a laser disc
ferred embodiment, keyboard 40 has at least ten ftmc
player; and (3) a digital computer to monitor bioelectric
tion keys, F1 through F10. An asynchronous serial port
signals and control the display device and the playback
of computer 30 is connected to video player 60,
device. The apparatus is used in conjunction with a
whereby the player can be controlled by the computer.
conventional set of biofeedback electrodes and associ 60 In a preferred embodiment, video player 60 is a laser
ated ampli?ers and analog-to-digital converters.
videodisc player such as the Pioneer Model LD-VSOOO
The apparatus monitors and records such electro
and the connection to computer 30 is made with a Pio
physiological parameters as, among others, (1) electro
neer serial cable P/N CC-l3. The Model LD-V8000 is
myographic (EMG) signals; (2) galvanic skin resistance
(GSR); (3) electroencephalographic (EEG) signals; (4)
skin temperature; (5) blood pressure (BP); and (6) heart
rate (HR) or pulse. Signals indicative of these parame
ters are monitored by a computer capable of displaying
capable of holding a video image while access to a
65
different portion of the videodisc is being established.
This eliminates blanking of the display device between
selection, which is undesirable because it interrupts the
concentration of the subject. Video player 60 need only
5,343,871
5
6
be capable of directly and quickly accessing video se
within a cluster are partially degraded versions of the
quences in arbitrary order on a video storage medium of
suf?cient capacity to conduct a session of suf?cient
same desirable image, the subject recognizes the target
scene and anticipates improvement in the display, fur
ther inspiring his effort at biofeedback.
Negative feedback can be provided by decreasing the
level of reality if the subject’s physiological parameters
move away from the desired direction. The present
invention has divided reality levels into discrete steps so
that the subject is not presented with a constantly ?uc
duration that no reloading is required during a biofeed
back session, which would cause interruption of treat
ment.
The video output of video player 60 is connected to
video display 70, which is preferably a large screen
television monitor having a resolution of at least 350
horizontal lines. The left and right stereophonic audio
outputs of video player 60, respectively, are connected
to left speaker 80 and right speaker 81. In an alternate
embodiment, speakers 80 and 81 are integrated into a set
of headphones worn by subject 11. In a further embodi
ment, video display 70 is a television set incorporating
built-in speakers 80 and 81.
A manual describing the use of the system in the best
mode known to the inventors is reproduced in Micro
?che Appendix A.
tuating image on which attention or enjoyment would
be difficult. For example, if the size of a viewed object
were to change continually based on the subject’s gal
vanic skin resistance, the subject would have no ?xed
target on which to gaze and would be distracted or
disturbed by its incessant movement. By dividing the
range of responses into discrete quanta, the subject is
better able to concentrate on the scenes being pres
ented.
,
During the use of the present invention, the human
FIG. 2 shows the schematic layout of a typical video 20 subject sees and hears only material designed to induce
disc used with the present invention. Videodisc 100
and lead the subject to the desired state. No objective
comprises eight clusters 101-108 and a title sector 109.
indications of progress, such as graphs, meters, ?ashing
The playing time of each of the clusters 101-107 is
lights, moving dots or other means used in prior art
approximately 7.5 minutes. The playing time of cluster
devices and which (1) cause distraction; and (2) do not
108 is approximately 2.5 minutes. The playing time of 25 provide the subject with a desirable mental image for
the title sector is approximately 30 seconds. The playing
time of the entire videodisc 100 is approximately one
hour.
later recall are here employed.
FIG. 3 shows a schematic layout of a typical cluster
audio-visual scene. Cluster 110 comprises ?ve LVRI
Videodisc 100 is removably inserted in video player
segments 111-115 in order of reality index from highest
70. The videodisc contains title information and eight 30 (LVRI 1) to lowest (LVRI 5). The playing time of each
ordered sequences, or clusters, of information, each
LVRI segment is approximately 1.5 minutes. If the
cluster comprising ?ve segments containing related
subject has not progressed during that time, the segment
audio-visual scenes. The scenes are related in that they
is automatically replayed or “looped.”
depict substantially the same subject matter but may
The LVRI segments are created by capturing real
differ in such respects as level of audio-visual quality,
scenes on videotape using high-quality commercial
viewpoint from which the scenes were photographed
television equipment. Varying levels of clarity can be
or may show one or more objects in differing positions
achieved by degrading the image during taping as ex
in each scene. The objective is to provide a graded
plained below. After the segments are recorded on
sequence of scenes in which each is an improvement on
videotape, acoustic degradation and further video deg
the preceding scene in some respect; that is, each scene 40 radation can be performed in an editing studio. When all
is more real or more desirable than its predecessor.
segments are of appropriate length and LVRI level, a
Within each cluster, therefore, the ?ve scenes are re
master videotape is made from which a videodisc can be
corded at differing levels of “reality.”
For example, a scene may be made more real to the
subject by presenting it in progressively sharper focus,
produced by known methods.
The scenes to be recorded on videodisc are chosen so
45 that the audio-visual segments themselves both induce
beginning with a blurry image and ending with a clear
the desired psychological state in the subject and to
one. Alternatively, an object may be shown in a begin
ning scene at a great distance from the subject and in
successive scenes shown coming closer and closer. A
provide memorable audio-visual images that the subject
third method of changing the reality level is to show the
object moving within the scene toward a natural goal,
as the sun setting, an airplane landing, a climber reach
ing the top of a peak, a runner approaching the ?nish
line of a race, and the like. The objective of these se
quences is to provide the subject with a audio-visual
objective that becomes better as the subject improves
his physiological parameters.
may bring to mind subsequent to the biofeedback ses
sion for therapeutic effect.
Audio-visual degradation must be performed in a
way that allows the subject to focus his attention on a
single scene to avoid distraction or confusion of physio
logical response. This can be achieved by utilizing one
audio-visual scenario and successively reducing its qual
ity. At all times, however, the goal scene is maintained
in view, though it may be distant or fuzzy. The images
representing the scene are presented to the subject in
A discrete level of reality is known as a Laser Video
order of increasing clarity to serve as a reward for
Reality Index (LVRI). The ?ve levels are assigned the
labels LVRI 1 through LVRI 5. LVRI 1 represents the
highest level of reality; LVRI 5 represents the lowest
level of reality. The subject is rewarded for favorable
biofeedback response by being shown an audio-visual
scene at a higher reality level (lower LVRI level). The
achieving desired response levels.
Video degradation to produce different LVRI levels
can be accomplished by analog or digital means
through (1) defocusing the image; (2) eliminating or
reducing color; (3) zooming by magnifying or demagni
fying the image; or (4) photographing objects in the
purpose of using differing reality levels is to provide the 65 scene in varying positions or states. In a preferred em
subject with successive related image targets and to
bodiment, video degradation is performed by analog
indicate to the subject by nondistracting means that
means as the scenes are being recorded on the videotape
biofeedback is succeeding. Because all of the scenes
from which a videodisc is later made. This is done by (l)
5,343,871
7
8
defocusing by moving the focus ring on the video cam
era; (2) altering the apparent distance to the scene by
zooming; (3) recording successive scenes in which an
panic attacks.
object progressively moves toward a goal, such as a
ing time for certain motor skills as typing, stenography
other phobias such as vertigo, reactive anxiety states or
Reduction of tension has been shown to reduce learn
series of images of the sun setting, with attendant color 5 and repetitive manufacturing activities. It also improves
work ef?ciency and can assist athletes in preparing for
ful illumination of the sky; and (4) varying video color
competitive sporting events. The present invention is
parameters such as hue and tint by adjusting analog
also useful in these applications.
controls. The analog method of video degradation is
A number of distinct audio-visual sequences can be
preferred because it appears more natural to the subject.
recorded on a single videodisc and are available for
Audio degradation is accomplished by simulta
neously (l) reducing the stereo separation of the left and
right audio signals; (2) reducing the volume of the sig
nals; (3) reducing the amplitude of the audio signal at or
above selected frequencies (clipping); and (4) audio
selection by the biofeedback technician controlling the
session.
The software used to control the apparatus of the
present invention is listed in source code form in Micro
panning, which varies the extent to which sounds move 15 ?che Appendix B. It is written in a programming lan
guage known as the B08 Protocol Programming Lan
from the left to right stereo channels and vice versa.
guage implemented under the Biomedical Operating
Table 1 indicates how the ?rst two of these parameters
System (BOS), which is available for license from Stu
vary by LVRI in a preferred embodiment.
art Enterprises, 11330 Southwind Court NE, Bain
TABLE 1
20 bridge Island, Wash. 98110. BOS supports popular bio
Level
LVRI
LVRI
LVRI
LVRI
LVRI
feedback processors comprising electrodes, ampli?ers
and analog-to-digital converters, making it possible to
Audio Degradation at Different LVRI Levels
Stereo
Cut at 3 kHz
Rolloff at 5.5 kHz
Reality
l
2
3
4
5
Separation
(decibels)
(decibels)
100%
75%
50%
25%
0%
0
3
6
ll
18
0
3
6
12
20
connect the present invention to many types of standard
biofeedback equipment. B08 and its programming lan
25 guage, in which the software of the present invention is
written, are described in full in the publication, BOS
Biomedical Operating System User’s Manual, copyright
1990, published by Stuart Enterprises.
The invention can be used in the following manner. A
Audio distancing, another method of obtaining differ 30 physician evaluates the subject and determines the pro
ing LVRI levels, is accomplished by simultaneously
tocol to be used and the desired physiological objec
reducing the stereo separation of the left and right audio
signals and the overall amplitude of the audio signal.
Table 2 indicates how these parameters vary by LVRI
tives, based on which a series of scenes is chosen for
The subject does not see or interact with the system
35
in a preferred embodiment.
TABLE 2
screen. The subject is presented only with audio-visual
imagery so as to keep his attention focused on the treat
ment. The subject may even be placed in a room remote
Audio Distancing at Different LVRI Levels
Reality
Level
Stereo
Separation
Amplitude Reduction
(decibels)
LVRI
LVRI
LVRI
LVRI
LVRI
100%
100%
90%
80%
60%
O
3
6
ll
16
l
2
3
4
5
presentation to the subject.
from the computer and other equipment, with only a
television set to observe. This separation is particularly
bene?cial for subjects who experience anxiety in inter
acting with a computer.
During a ?rst session with a human subject, a biofeed
back technician explains the techniques that will be
employed and explains the protocol and objectives. The
technician then performs an initial evaluation to cali
An example of the use of video degradation and en
hancement is in behavior modification. By gradually
exposing a phobic subject to a series of stressful scenar
ios, the subject can be rewarded via audio-visual feed
back for generating a desired physiological response,
the reward consisting of a change in the audio-visual
template. For example, an acrophobic individual (one
brate the subject’s electrophysiological responses. In
- the initial evaluation, the subject is seated in a comfort
able chair, with biofeedback electrodes in place, and
shown a series of different high-quality audio-visual
scene sequences, each lasting 90 seconds. Electrophysi
ological parameter measurements are recorded by the
computer and reported in graphic and tabular form to
the technician, who may select a sequence for viewing
during later treatment sessions. The technician may also
who fears heights) can be acclimatized to differing ele
vations under controlled conditions without actual risk 55 select one or more parameters whose values will be
by being shown a sequence of scenes taken at varying
used to control changes in clarity levels in the chosen
heights. The method is not restricted to achieving relax
sequence.
ation. A rehabilitation patient who is being trained to
For a treatment session, the technician places elec
use certain muscles can be rewarded for exerting stress
trodes on the subject and inserts in the videodisc player
rather than relaxing.
a disc containing the scene sequence to be used during
An agoraphobe (one who fears being out in public)
treatment. Of the several sequences that may be present
can be treated by presenting scenes commencing at
on the disc, the particular one to be used can be chosen
home, gradually moving outdoors, a quiet street, an
by the technician from a menu of choices presented on
intersection, and then a mall or busy city block. As the
graphic monitor 50. The technician controls the appara
subject relaxes, as monitored by the apparatus, the jour 65 tus by viewing the monitor and entering information
ney progresses. The subject becomes conditioned to
associate relaxation with situations that formerly in
duced anxiety. Similar methods can be used to treat
through computer keyboard 40. During the session, the
monitor displays graphically the values of the subject’s
electrophysiological parameters. The technician inter
5,343,871
acts with computer 30 through screens that appear on
monitor 50. The screens, whose content and order is
10
Menu Screen permits the choice of seven functions,
each of which is invoked by depressing one of the pro
grammed function keys F1 through F6 and F10 on
computer keyboard 40. The Main Menu Screen func
controlled by software in computer 30, provide menu
choices that are selected by pressing one of the function
keys F1 through F10. The technician may also be asked
to enter textual or numeric information through key
board 40.
The technician may choose the duration of the bio
feedback session and the particular set of parameters to
be recorded during the session. The parameters being
recorded are not necessarily all used to control changes
in LVRI level. The technician may choose, for each"
recorded parameter, whether it is to participate in
LVRI changes, and, if so, what linear weight will be
tions are:
Main-F1. Demographics. This option invokes an
other screen permitting the technician to record bio
graphical data, including the subject’s name and other
identifying information, for later report generation.
Main-F2. Initial Evaluation. This causes the com
puter to display to the technician the values of actual
signals being received by the biofeedback electrodes
115 so the electrodes can be adjusted. It also presents
the subject with a sequence of audio-visual displays so
given to the parameter. That is, the function used to
control LVRI changes is a linear combination
the technician can determine which scene on the video
disc produces the most favorable response from the
(weighted average) of values of selected recorded pa
rameters. The parameters that make up this function are
subject.
Main-F3. Screen Selection. This permits a choice of
ter, the technician has the ability to scale the parameter 20 the scene sequence to be used for the present biofeed
back session, among those available on the videodisc
by specifying the range of values, from “best” to
that is currently mounted.
“worst,” that the parameter may assume. Values near
called “linking parameters.” For each linking parame
Main-F4. Control Screen. This screen controls the
“best” are associated with the most clear LVRI image
(LVRI 1); those near “worst” cause the most distant, or
fuzziest, LVRI image to be displayed (LVRI 5).
By adjusting the scaling of linked parameters in sub
sequent sessions, the technician may vary the degree of
actual biofeedback session and itself provides eight pro
25
grammed functions, discussed below.
Main-F5. Reports Screen. This invokes a screen to
control report generation, including selection of report
format, as discussed below.
progress the subject must make in biofeedback before
Main-F6. Utilities Screen. This invokes the Disk Op
being rewarded with a clearer LVRI image. In begin
ning sessions, it may be desirable to reward the subject 30 erating System (DOS) housekeeping functions, such as
copying, formatting, etc.
for only having made a small amount of progress in
altering a parameter. As the subject becomes more
Main-F10. End. This terminates the session.
skilled, the requirements can be adjusted so that more
The following functions are available on the Control
relaxation, for example, can be achieved for the same
Screen, which is invoked from the Main Menu by de
level of reward. Scaling information is presented on a 35 pressing the'F4 key:
graphical report so the technician can review the sub
Control-F1. Session Time. Allows the technician to
ject’s attainment during the session and decide on the
set the duration of the session.
appropriate scaling for the next session.
Control-F2. Modalities. Allows selection of electro
When the session is complete (i.e. the preset session
physiological parameters to be recorded for this session.
time has elapsed), the system produces printed reports 40 Control-F3. LVRI Link. Establishes a relationship
and graphs for analysis by the technician and physician.
These include the values of recorded parameters and
LVRI level changes against time, in the form both of
tables and plotted graphs. The technician also has the
between electrophysiological parameters and the reality
index progression for this session. The technician is able
to choose which of the recorded parameters will actu
ally be used to change LVRI levels and can assign
capability of annotating the reports from the keyboard. 45 relative weights to their importance.
The annotations and a signature line in accordance with
Control-F4. Scaling. Allows setting of baseline levels
accepted medical record keeping practice appear on the
and ranges for electrophysiological parameters.
printed reports, which are produced on laser printer 45.
Control-F5. Start/Stop. Begins and ends a biofeed
The result of the session is that the subject has been
back session and controls recording of parameters and
made to relax and to associate the relaxation with the
output of reports.
particular audio-visual sequence that was displayed.
Control-F6. Pause. Temporarily halts data recording
Furthermore, the sequence itself, as a result of the initial
to allow interruptions, such as for adjustment of elec
evaluation, is known to assist the subject in attaining the
trodes.
desired relaxation. The technician does not need to
Control-F7. Progress. Allows toggling between the
coach the subject to conjure up an imagined scene. The 55
Control
Screen and the Progress Screen. The Progress
subject will be able, after one or more sessions, to in
Screen displays to the technician a graphic representa
duce himself into a state of relaxation outside of a mod
erated biofeedback session by remembering the particu
lar audio-visual sequence. By using the present inven
tion, the subject develops a conditioned biofeedback
response.
The technician controls the system by interacting
with it through a small number of screen displays,
which are primarily menu-driven. The complete com
tion of the recorded parameters versus time so the
progress of the subject can be monitored.
Control-F10. Main Menu. Returns to the Main Menu.
This option cannot be selected until a session has been
halted with the F5 key.
The following functions are available on the Video
Screen, which can be invoked from the Main Menu by
puter source code implementing these functions is given 65 depressing the F6 (Utilities) key.
in Micro?che Appendix B.
Video-F1. Help. Provides documentation of options.
The Initial Screen simply displays title information
Video-F2. Status. Indicates the position of the disc
stored on videodisc 100 in title sector 109. The Main
and slide door.
11
5,343,871
Video-F3. Open Slide Door. Opens the disc drawer
12
b) presenting to the subject a sequence of versions of
on video player 60 so videodisc 100 may be inserted or
an audio-visual scene, said versions exhibiting
removed therefrom.
Video-F4. Close Slide Door. Closes the disc drawer
varying audio and visual reality wherein said audio
so that the disc can be read and a session can begin.
Video-F10. Return to Main Menu.
and visual reality are increased as said monitored
5
parameters indicate that the subject’s psychologi
cal response has become more desirable.
The following functions are available on the Reports
Screen, which can be invoked from the Main Menu by
6. The method of claim 5 further comprising the step
of:
depressing the F5 (Reports) key.
c) repeating steps a and b on distinct occasions until
Report-F1. Graphs. Generates a line graph versus 10
said monitored parameters indicate that the subject
time for each modality selected in the Control Screen,
has become conditioned to exhibit the desired re
which correspond to the electrophysiological parame
sponse to said audio-visual scene.
ters being monitored for this subject.
7. The method of claim 6 wherein the desired psycho
Report-F2. Tables. Generates a table of numerical
logical state is relaxation and further comprising the
values of each modality at discrete time steps through
step of:
out the session.
(1) teaching the subject to perform a motor skill while
Report-F3. Progress Note. Invokes a word processor
presenting to the subject said audio-visual scene at
so the technician can introduce notes into the patient’s
a time subsequent to the conditioning, whereby the
medical record.
subject’s ability to learn said skill is enhanced by
Report-F4. All Reports. Causes the system to pro~
the subject having been conditioned to enter said
duce all possible output reports for this session.
desired psychological state.
Report-F10. Return to Main Menu.
8. The method of claim 6 wherein the desired psycho
It will be evident to those skilled in the art that the
logical state is relaxation and further comprising the
invention is not limited to the details of the foregoing
steps of:
illustrative embodiment and that the present invention
d) presenting the subject with material to be learned
may be embodied in other speci?c forms without de
while presenting to the subject said audio-visual
parting from the spirit or essential attributes thereof.
scene at a time subsequent to the conditioning,
The present embodiments are therefore to be consid
ered in all respects as illustrative and not restrictive.
The scope of the invention being indicated by the ap
pended claims and rather than by the foregoing descrip
tion and all changes which come within the meaning
and range of the equivalency of the claims are therefore
whereby the subject’s ability to learn said material
is enhanced by the subject having been conditioned
to enter said desired psychological state.
9. The method of claim 5 wherein said audio and
visual reality are increased occurs in discrete steps.
10. The method of claim 5 wherein at step b, said
intended to be embraced therein.
35 increase is in response to a weighted combination of said
We claim:
parameters and said audio and visual reality are de
1. An apparatus for mediating a biofeedback session
creased as said weighted combination indicates that the
with a subject, at least one of whose electrophysiologi
subject’s psychological response has become less desir
able.
a) means for receiving signals indicative of the mea 40
11. The method of claim 10 wherein said increase and
surements of the parameters;
said
decrease in said reality occurs in discrete steps.
b) audio-visual storage means capable of recalling in
12. The method of claim 5 wherein the desired psy
any order audio-visual sequences of acoustically
chological state is relaxation and further comprising the
and visually degraded versions of a scene, said
sequences being prestored in said storage means; 45 step of:
c) teaching the subject to perform a motor skill when
0) control means for receiving said signals and con
the subject’s psychological response has become
trolling an order of recall of said sequences based
more desirable, whereby the subject’s ability to
on said signals; and
cal parameters is being measured, comprising:
learn said skill is enhanced by the subject’s being in
said desired psychological state.
50
13. The method of claim 5 wherein the desired psy
2. The apparatus of claim 1 wherein said audio-visual
chological state is relaxation and further comprising the
storage means is selected from the group consisting of a
step of:
videodisc player, and optical digital storage device and
c) presenting the subject with material to be learned
a computer with magnetic disk storage.
when the subject’s psychological response has be
3. The apparatus of claim 1 wherein said audio-visual 55
come more desirable, whereby the subject’s ability
storage means is a videodisc and said audio-visual out
to learn said material is enhanced by the subject’s
put means is selected from the group consisting of a
being in said desired psychological state.
television set, a computer screen and a television moni
14. The method of claims 12, 13, 7 or 8 wherein said
tor with associated loudspeakers.
improvement in said reality occurs in discrete steps.
4. The apparatus of claim 1 wherein said audio-visual
15. An apparatus for conditioning a desired psycho
storage means is a videodisc, said audio-visual output
logical response in a subject comprising:
means is a television set and said control means is a
(a) means for monitoring at least one of the subject’s
digital computer.
electrophysiological parameters indicative of his
5. A method of conditioning a desired psychological
response in a subject comprising the steps of:
psychological response;
a) monitoring at least one of the subject’s electro
(b) means for determining from the values of said
d) audio-visual output means whereby the subject is
able to view and hear said sequences.
'
physiological parameters indicative of his psycho
logical response; and
monitored parameters when the subject’s psycho
logical response has become more desirable;
13
5,343,871
14
a plurality of physically contiguous audio-visual
sequences progressively degraded in reality;
0) playback means for retrieving said sequences from
said medium;
(0) means for presenting to the subject a sequence of
versions of an audio-visual scene, said versions
exhibiting varying audio and visual reality; and
(d) means for controlling said presenting of said se
d) control mean for receiving said signals and con
trolling an order of retrieval of said sequences
based on said signals; and
quence so as to display to the subject a scene of
increased audio and visual reality when said moni
tored parameters indicate that the subject’s psycho
e) audio-visual output means whereby the subject is
logical response has become more desirable.
able to view an hear said sequences.
19. The apparatus of claim 18 wherein said control
16. The apparatus of claim 15 wherein said determin 10
means is a digital computer, said digital computer fur
ing means measures a weighted combination of said
ther comprising a computer program.
20. The apparatus of claim 19 wherein said computer
monitored parameters and said controlling means also
displays a scene of decreased audio and visual reality
when said monitored parameters indicate that the sub
program is a computer program for controlling a bio
feedback session in which at least one of said signals is
acquired from a subject and version of an audio-visual
scene are exhibited to the subject, said versions having
ject’s psychological response has become less desirable.
17. The apparatus of claim 16, wherein said present
ing means further comprises means for increasing and
varying levels of reality, said computer program com
prising:
decreasing said reality in discrete steps.
18. An apparatus for mediating a biofeedback session 20
b) means for computing a weighted average of said
cal parameters is being measured, comprising:
monitored signals;
a) means for receiving signals indicative of the mea
surements of the parameters;
b) audio-visual storage medium comprising at least
one cluster, wherein each of said clusters comprises
a) means for selecting a combination of said signals to
be monitored;
with a subject, at least one of whose electrophysiologi
0) means for repeatedly selecting one of said versions
25
for exhibition to the subject based upon said
weighted average.
*
30
35
45
50
55
65
1r
*
*
*
UNITED STATES PATENT AND TRADEMARK OFFICE
CERTIFICATE OF CORRECTION
PATENT NO. :
DATED
5,343,371
September 6, 1994
INVENTOR(S) :
Barry B. Bittman and Jeffrey R. Cram
It is certified that error appears in the above-indenti?ed patent and that said Letters Patent is hereby
corrected as shown below:
Claim 8 Line 25 Column 12 "steps" should read --step—-.
Claim 9 Line 33 Column 12 delete "occurs".
Claim 18 Line 5 Column 14 "mean" should read --means--.
Claim 18 Line 9 Column 14 "an" should read -—and—-.
Claim 20‘ Line 16
--versions-—.
Column
14 "version"
_
should read
Signed and Sealed this
Twenty-second Day ofNovember, 1994
BRUCE LEHMAN
Arresting O?‘icer
Commissioner of Patents and Trademarks
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