Neuromuscular Reeducation in Biofeedback


in partnership with the
Behavioral Medicine Research & Training Foundation

Non-profit Scientific & Educational Organization 91-1948669 operating under Section 501c3 of the US Internal Revenue Code 6576 Blue Mountain Road, Port Angeles, WA 98362

Course Description and outline for:
Biofeedback Applications for Neuromuscular Reeducation
45 CEs, Course Fee: $750

Presented by: Susan J. Middaugh, PhD, PT

Course Concept and Description: This course is designed to teach assessment and biofeedback protocols for treatment of musculoskeletal and neuromuscular disorders from a neuromuscular reeducation perspective, primarily using surface-recorded EMG. These protocols are based on motor learning principles and the neurophysiology of the disorders being treated. The therapeutic goals are those of physical rehabilitation: to increase muscle strength, enhance muscle relaxation, improve muscle coordination, decrease pain, and improve function during daily activities and work. The course content is taught using a clinical case study format. Protocols for assessment and treatment of a given diagnostic category, such as Bell’s Palsy, are presented in terms of a typical case. Readings are assigned to provide the basic neurophysiology and anatomy needed to understand and work effectively with that disorder. This course is designed for two different categories of students. (1) This course is appropriate for students who work from a psychology, counseling, behavioral science or education perspective and are interested in broadening their knowledge base and skills by learning about neuromuscular reeducation applications of biofeedback. (2) This course is also appropriate for those who work from a physical rehabilitation perspective, such as physical therapy or occupational therapy, and are interested in developing expertise in biofeedback procedures that are applicable to their clinical caseload. For both types of students, this course is intended to enhance the knowledge and skills of the clinician or educator who works within his or her legal scope of practice and licensure.

Learning objectives: The course objective is to teach protocols for using surface-recorded EMG effectively for clinical assessment and biofeedback treatment of musculoskeletal and neuromuscular disorders, from a neuromuscular reeducation perspective.

The course is designed to help you (the student):

  1. Understand the history and theory underlying a neuromuscular reeducation approach to EMG biofeedback treatment procedures.
  2. Learn surface-recorded EMG recording parameters and electrode placement principles appropriate for muscle assessment and biofeedback training
  3. Learn EMG biofeedback protocols for assessment and treatment of one or more musculoskeletal disorders, such as cervical or low back pain.
  4. Learn EMG biofeedback protocols for assessment and treatment of one or more neuromuscular disorders, such as pelvic floor disorders, Bell’s Palsy or Writer’s Cramp.

Prerequisite: Basic EMG recording skills and basic experience with EMG biofeedback is required. Experience with neuromuscular reeducation applications and rehabilitation patients are not required.

Text (optional, as determined by the instructor and the student) :

Lundy-Ekman, Laurie, Neuroscience Fundamentals for Rehabilitation. Philadelphia: W.B. Saunders Company, 2 nd Ed., 2002. (IBSN 0-7216-9373-3, paperback, available from & others)

Required Readings:
Selected book chapters and journal articles relevant to rehabilitation applications of EMG biofeedback will be assigned for each unit. Those not readily available on the internet will be provided.

Course Format:
Home study supported by e-mail, internet and/or phone discussion. The course is divided into 11 units. Each unit consists written lectures provided on the course web site with power point illustrations and/or assigned readings; review questions to be answered in brief essay form; and a real time recitation with the instructor after the review questions are completed. This discussion at the end of each unit provides the student with an opportunity to ask questions and obtain extra information on topics of special interest, and provides the instructor with an opportunity to identify and clarify gray areas. Laboratory work is carried out in two parts:

Lab activities relevant to course units are assigned to complement lectures. These labs are designed to be carried out independently, as part of the home study, to familiarize the student with the specific EMG recording methods and the clinical biofeedback protocols that are presented in the lectures. These are structured educational activities that are carried out by the student on herself / himself and not on clients or patients.

Grading: Work is assessed as Pass or Fail based on written answers to questions and oral discussion. Any unit failed will be repeated until passed. Lab work is not graded, but all lab work must be completed at a satisfactory level.

DISCLAIMER: Completion of this continuing education course is strictly for educational / informational purposes and does not imply competency, proficiency, and/or experience. The course completion certificate is not a clinical certification nor a license to practice.

Computer and Computer Knowledge Requirements: Anybody with a modern computer and a bit of basic understanding of computer operation (at the level of being able to send e-mails) can play this course with minimal problems. You must have a computer (a) capable of connecting to the internet and running a typical internet program, (b) containing/running a modern word processor such as Microsoft word or Word Perfect, (c) the capability to play sounds such as music (has speakers and appropriate software which normally come with any modern computer), and (d) a slide viewing program such as Power Point (you can probably get a slide viewing program free off the internet if you don’t have one). Any modern (e.g., built within the last ten years), IBM style computer running Windows 98 and more recent platforms (e.g., XP or Windows 8) should be able to do this. Speed, hard disk size, and RAM are not factors for computers in the above category.

Dozens of students have used recent Apple products (MACs etc.) for the course however they frequently have more difficulty playing the course materials than PC users do. If you are using a MAC type of computer, you must have a current version of “quicktime”. If you do not have it, you can download it for free from the web.

Faculty: Susan Middaugh, Ph.D, PT, received her degree in Physical Therapy in 1965 and her doctorate in experimental physiology in 1971. She is a professor in the departments of rehabilitation medicine and anesthesia at the medical university of South Carolina and director of its clinical biofeedback program. She also directs the department of rehabilitation medicine’s chronic pain rehabilitation program. Her primary research effort has been directed toward investigating methods for applying basic learning principles in the treatment of patients with neuromuscular and musculoskeletal diagnoses. Treatment procedures using electromyographic feedback, based on this rationale, have proven to be effective in patient treatment. The present research program is directed toward controlled clinical study, development of experimental models, testing of theoretical assumptions, and gathering of basic information concerning the nature and extent of feedback-related gains areas of interest to rehabilitation professionals including neuromuscular re-education following CNS or PNS damage, musculoskeletal pain including work-related overuse syndromes, and fecal and urinary incontinence. She has a long history of grant support for her research and has published widely in her field with over 100 articles and abstracts in recognized journals.

This course will cover following topics:

1) Introduction to neuromuscular reeducation (NMR) approaches to EMG biofeedback:
History, Theory, Professional scope of practice and Ethical considerations

2) EMG Recording for Rehabilitation Applications:
EMG recording methods for dynamic applications
Principles of EMG electrode placements and exceptions
Basic EMG biofeedback protocols for muscle strength, relaxation, coordination and function

3) EMG biofeedback protocols for assessment and treatment using NMR approaches.
The course emphasis will be based on the clinical / educational interests of the individual.

Musculoskeletal Pain and other Pain Disorders: Cervical and Low Back Pain, Headache and Tempormandibular Disorders Work-related Musculoskeletal Disorders (WRMSD) and Ergonomics. Complex Regional Pain Syndrome (CRPS) and Phantom Limb Pain Pelvic Floor Disorders: Incontinence, Retention and Pain Peripheral Nerve Injury: Bell’s Palsy and Nerve Transfer Spinal Cord Injury: Neuromuscular Reeducation, Pain and Repetitive Strain Injury Cerebrovascular Accident (Stroke) and Head Injury: recovery, CNS plasticity and forced use Cerebral Palsy: pediatric, teen and adult Movement Disorders: Focal Dystonia (Writer’s Cramp, Torticollis)

Administrative Information

Schedule: You can start the course whenever wish to within six months of the purchase date and work at your own pace as long as you complete the course within one year of purchase.

Duration of course validity: You must begin the course within six months of the purchase date and complete it within one year of the purchase date. Courses not completed by that time are void and must be repurchased if still available. No refunds are provided for courses not completed within one year of purchase.

CE Credit : Saybrook University is regionally accredited and approved by the state of California to grant degrees. These are continuing education, not university accredited, courses. CE credits are given through (1) the state of California’s Board of Behavioral Sciences (Approval # PCE1895); (2) The National Board of Certified Counselors (Provider # 6270), and (3) the Behavioral Medicine R&T Foundation is approved by the American Psychological Association to sponsor continuing education for psychologists. The Foundation maintains responsibility for this program and its content. Saybrook University is regionally accredited and approved to grant degrees by the state of California.

BCIA: This course is accepted by the Biofeedback Certification International Alliance for both certification and recertification.

Purchasing courses: Courses can be purchased from Biofeedback International Resources by clicking the Buy Me button for the specific course HERE.

Full refund will be made until the students are given access to the course website.

After getting access to the course website, there is no refund at all, as Saybrook University and the Foundation have committed their resources to you and you have access to all of the course materials.

A course would only be cancelled due to an extreme emergency on the part of the course instructor or the Foundation. In the highly unlikely event a course is cancelled, you would receive a full refund.

Scholarships: Saybrook University and the Foundation give scholarships consisting of 25% off the cost of the course(s) to (a) students and professionals (e.g. clinicians, coaches, teachers) from emerging nations and (b) full time graduate students in developed nations.

Course updates: Updates to all courses are placed on the course web site as they are made. Students are informed when updates are available.