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Telemedicine Application of Autogenic-Feedback Training Exercise as a Treatment for Specific Patient Populations
Organization/Location
This study will be conducted by physicians at Morehouse University School of Medicine in Atlanta, Georgia. There will be substantial involvement by investigators from the Psychophysiological Research Laboratory, which is part of the Human Factors Research and Technology Division (Code IH), Human Information Processing Research Branch (Code IHH). Their involvement will include: instruction for equipment operation and methods for administering Autogenic- Feedback Training Exercise; data processing, and analyses. All investigators will co-author resulting publications. This work is being performed under a Cooperative Agreement.
Investigators
Principal Investigator —
Elizabeth Ofili, M.D.
Head, Clinical Research Center
Morehouse School of Medicine
Atlanta, GA
(404) 752-1192
FAX (404) 752-1104
e-mail: ofilie@msm.edu
Co-Principal Investigator —
Patricia S. Cowings, Ph.D.
Research Psychologist
Human Systems Integration Division (Code TH)
NASA-Ames Research Center
Moffett Field, California 94035
(650) 604-5724
FAX (650) 604-1484
e-mail: Patricia.Cowings@mail.arc.nasa.gov
Coinvestigators —
William B. Toscano, Ph.D.
NASA-Ames Research Center
(650) 604-2324
A. Seleimeh Hines, Ph.D.
National Research Council Postdoctoral Associate
(650) 604-3084
Bruce Taylor, Ph.D.
University of Akron, Ohio
(330) 972-5232
Mae Jemison, M.D.
Biosentients Inc.
Houston Tx.
(281) 486-7918
Purpose
The primary purpose of this research is to determine if Autogenic-Feedback Training Exercise (AFTE) will provide relief from the symptoms of nausea, hypotension and/or essential hypertension in selected patient populations under treatment at Morehouse School of Medicine. The introduction of AFTE methods and systems, both the Autogenic Clinical Laboratory System (ACLS) and ambulatory monitoring equipment, will allow more comprehensive assessment of autonomic function in these patients and allow standardization of methods and data formats needed to evaluate treatment efficacy. The present study will include documenting baseline autonomic function in specific patient populations, and establishing procedures for internet monitoring and training. Remote training and monitoring capabilities are essential to future planned use of AFTE for astronaut and cosmonaut operational training to improve crew operational readiness during long-duration space flight. It is further anticipated that AFTE training methods will be utilized by medical, commercial and military personnel for applications in other environments.
Background
AFTE involves training subjects to voluntarily control several of their own physiological responses. The rationale for using AFTE was based on the observation that there are profound autonomic nervous system (ANS) changes associated with motion sickness. This training method has been shown to enhance motion sickness tolerance, accelerate physiological adaptation to space, and improve performance during high stress tasks. It is unlikely that it has any of the detrimental side-effects associated with pharmacological treatments.
AFTE is a combined application of several physiological and perceptual training techniques that include Autogenic Therapy, and biofeedback. Autogenic Therapy is a self-regulatory technique that has been shown to have wide effects on autonomic reactivity. This training method involves the use of self- suggestion exercises that are designed to induce bodily sensations (e.g., warmth in the hands) that are highly correlated with specific physiological responses such as peripheral vasodilatation. When these exercises are practiced in series, the result is a relaxed (i.e., parasympathetic-like) physiological profile within the subject that prevents the emergence of behavioral and physiological reactions to stress. Biofeedback consists of providing the subject with augmented sensory information about ongoing activity levels of some physiological response (e.g., heart rate on digital panel meter), and rewarding him whenever such levels fluctuate in a direction selected by the trainer (i.e., heart rate fluctuates above baseline). The result is that the subject can eventually maintain these changed levels for longer periods of time. Physiological control is enhanced with repetition and practice.
Recently, physicians at the University of Tennessee at Memphis administered AFTE to thirty-five patients to determine its potential efficacy as a treatment for gastrointestinal disorders. Patients' symptoms and physiological data from autonomic function tests were compared before and after six sessions of AFTE. Up to 60% of the patients reported improvement in gastrointestinal (GI) symptom scores. AFTE effects on autonomic function revealed the following: 55% showed improvement in cholinergic arch functions, 30% in sympathetic arch functions, and 40% in enteric nervous system functions. Some patients reported that frequency of allergic symptoms as well as vulnerability to upper respiratory and urinary tract infections were remarkably reduced.
In order to evaluate AFTE as a clinical tool for treating patients it will be necessary for the Morehouse investigators to install an ACLS system at their facility. This real-time data acquisition system can accommodate up to twenty physiological measures during training. The ACLS data files will easily import to an existing database enabling researchers at Ames to process and analyze the data, and to compare patient data to other subject populations (i.e., normals in laboratory conditions or field tests of soldiers, astronauts).
Why Human Research Is Required
The autonomic function tests to be used by Morehouse University physicians are designed to assess the degree and nature of autonomic pathologies in human patients. The AFTE methods were specifically designed for training human subjects to control their own autonomic responses.
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