# PWR-048 — Closed-loop physiological biofeedback: learner worksheet Release: Revision 7T · Full Tutorial Edition Estimated time: Estimated 14 min reading; practical time is provider-set Difficulty: Intermediate Equipment: Specialist equipment — One provider-approved sensor system for a single signal, such as surface EMG, peripheral temperature or respiratory rate.; Manufacturer instructions and a calibration or signal-quality check.; A supportive task position and provider-set timer.; A block record for raw signal summary, cue, artefact, symptom, feedback state and functional outcome. Space: Specialist setting Automated structural checklist: 10 of 10 structural checks present Evidence quality/context: G4; Detailed research depth Automated method-quality band: Comprehensive Method-rating basis: Structure coverage, instruction/check specificity, alternative distinctness, source troubleshooting, comparison depth and whether purpose/check fields are authored rather than derived. Editorial review: Pending manual editorial sign off ## Before you begin - [ ] I read the tutorial authority and stop conditions. - [ ] I have the required equipment/space or a declared accessible alternative. ## Canonical source context Biofeedback can make selected body signals trainable; every claim belongs to a particular person–sensor–feedback–task system. Closed-loop biofeedback shows a measured body signal and lets Jo test one response strategy. Jo's EMG therapist selects a valid sensor, target and dose; Jo calibrates, practises in short blocks, names artefacts and tests a hidden-feedback block. A display change is not automatically a health change. In Jo's surface-EMG fixture, Jo learns the visual signature of quiet muscle activity, purposeful contraction and cable-motion artefact before trying to lower unnecessary shoulder recruitment during a reach. Target outcome: In a qualified session, Jo completes baseline, feedback, correction and display-hidden blocks for one declared signal with artefacts and symptoms recorded. ### Authority and setup conditions - Name the single signal, target direction and reason for training; do not mix several displays into one score. - The provider checks contraindications, skin, device integrity, privacy and whether the signal has a clinically meaningful use. - Agree one low-effort strategy and one stop rule before the baseline. - Keep medication, prescribed devices and ordinary supports unchanged. ### Required or supplied materials - One provider-approved sensor system for a single signal, such as surface EMG, peripheral temperature or respiratory rate. - Manufacturer instructions and a calibration or signal-quality check. - A supportive task position and provider-set timer. - A block record for raw signal summary, cue, artefact, symptom, feedback state and functional outcome. ## 1. Name the loop Say what the surface electrodes measure, how EMG display represents it, what action you will try and what outcome matters beyond EMG display. Why: A clear person-sensor-feedback-task loop prevents vague “body control” claims. Success check: Jo can point to each link and name the measurement unit. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “Jo can point to each link and name the measurement unit.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 2. Check signal quality Jo's EMG therapist places surface electrodes, follows EMG unit check and asks Jo to make a known small action to confirm that EMG display responds as expected. Why: Poor contact, motion and electrical noise can masquerade as physiology. Success check: EMG trace is stable at rest and changes appropriately during the check. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “EMG trace is stable at rest and changes appropriately during the check.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 3. Capture a quiet baseline Complete a therapist-timed EMG interval without using shoulder-release cue. Record posture, support, signal and artefacts. Why: A baseline shows drift and normal variation before feedback learning. Success check: The raw baseline remains visible and is not discarded for looking untidy. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “The raw baseline remains visible and is not discarded for looking untidy.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 4. Apply one strategy Use only the agreed action, such as releasing a selected muscle or making an easy breathing change, during the feedback block. Why: Changing several things at once hides which action affected EMG waveform. Success check: Shoulder-release cue is observable and stays within comfortable effort. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “Shoulder-release cue is observable and stays within comfortable effort.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 5. Read trends, not flicker Watch the therapist-selected EMG trend and ignore isolated spikes. Pause when movement, speech or sensor contact creates an artefact. Why: Closed-loop learning depends on valid feedback, not chasing noise. Success check: Artefact periods are marked and excluded under the predeclared rule. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “Artefact periods are marked and excluded under the predeclared rule.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 6. Correct one error Use the EMG therapist’s feedback to change one feature—posture, effort, cue timing or sensor contact—and repeat a matched block. Why: One controlled correction makes cause and effect easier to interpret. Success check: EMG waveform log names the error and the single correction. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “EMG waveform log names the error and the single correction.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 7. Hide EMG display Repeat a matched block with EMG display hidden or delayed if Jo's EMG therapist approves, while using the same shoulder-release action. Why: This tests immediate dependence on feedback. Success check: Feedback state is labelled and the rest of the configuration is unchanged. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “Feedback state is labelled and the rest of the configuration is unchanged.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 8. Check function and recovery End the shoulder-release cue, inspect electrode site and complete the therapist-chosen supported-reach or symptom check. Why: A better trace matters only if burden, safety and intended function are not worse. Success check: Skin is intact, symptoms remain acceptable, and the supported-reach result is recorded separately. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “Skin is intact, symptoms remain acceptable, and the supported-reach result is recorded separately.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 9. Label three EMG signatures While the arm is supported, Jo's EMG therapist records a quiet-muscle segment, one gentle shoulder activation and one deliberately marked lead-motion segment that does not pull on the skin. Jo names which trace segment is physiology and which is artefact before training begins. Why: Jo cannot use an EMG graph safely if a cable bump and a muscle response look equally meaningful. Success check: Quiet, activation and marked artefact segments are retained with time labels, and Jo classifies all three correctly. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “Quiet, activation and marked artefact segments are retained with time labels, and Jo classifies all three correctly.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 10. Compare matching reach phases Divide each supported reach into start, lift, place and return. Compare the chosen shoulder cue only within matching phase across resting-trace, visible-screen and hidden-screen intervals; do not compare a moving phase with quiet sitting. Why: Surface EMG varies with shoulder action being performed, so phase matching is needed before a smaller trace can be attributed to the cue. Success check: Every interval has matching object, reach distance, pace and four phase markers, with discomfort and movement quality recorded beside EMG trace. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “Every interval has matching object, reach distance, pace and four phase markers, with discomfort and movement quality recorded beside EMG trace.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## Reflection What changed? ________________________________________________________________________________ What remains difficult? ________________________________________________________________________________ What will I repeat, adapt, ask for help with, or stop? ________________________________________________________________________________ --- Completion of this worksheet demonstrates tutorial participation only. It does not establish capability, qualification, safety clearance, diagnosis, treatment or independent validation.