A.I. Burnasyan FMBC clinical bulletin. 2026 № 2
A.O. Lebedev, N.Z. Orlova, A.S. Umnikov, E.V. Goloborodko, S.M. Razinkin, A.A. Kish
Evaluation of the Effectiveness of Biofeedback in the Rehabilitation
of Amputees with Combat Trauma
International Office, State Research Center – Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow, Russiа
Contact person: Kish Anna Andreevna: akish@yandex.ru
Abstract
This analytical review systematizes current evidence on the effectiveness of biofeedback (BF) methods in the comprehensive rehabilitation of combat trauma amputees, with an emphasis on their psychophysiological state. The relevance of the problem is determined by the increasing number of individuals who have undergone limb amputation as a result of military conflicts and the need for evidence-based approaches to their medical and psychological rehabilitation. The psychophysiological characteristics of combat trauma amputees are examined, including post-traumatic stress disorder (PTSD), phantom limb pain, depression, and autonomic nervous system dysfunction. The main types of biofeedback (electromyographic, neurofeedback, heart rate variability biofeedback, thermal, respiratory) and the mechanisms of their therapeutic action are analyzed. The results of clinical studies and meta-analyses demonstrating the effectiveness of biofeedback training in gait rehabilitation, prosthesis control training, correction of phantom limb pain and PTSD symptoms are systematized. Particular attention is paid to the multidisciplinary approach and personalized biofeedback protocols, including those using machine learning technologies. The contribution of Russian researchers to the development of methodology for assessing the effectiveness of rehabilitation technologies is discussed.
Keywords: biofeedback, rehabilitation, amputation, combat trauma, post-traumatic stress disorder, phantom limb pain, neurofeedback, electromyography, psychophysiological state
For citation: Lebedev AO, Orlova NZ, Umnikov AS, Goloborodko EV, Razinkin SM, Kish AA. Evaluation of the Effectiveness of Biofeedback in the Rehabilitation of Amputees with Combat Trauma. A.I. Burnasyan Federal Medical Biophysical Center Clinical Bulletin. 2026.2:42-50. (In Russian) DOI: 10.33266/2782-6430-2026-2-42-50
REFERENCES
- Korolev A.D., Petrova V.V., Shandala A.M., Fomkin A.P., Goloborod’ko Ye.V. Use of Biofeedback Technologies in Sports Psychology (Literature Review). Meditsinskaya Nauka i Obrazovaniye Urala = Medical Science and Education of Ural. 2017;18;3:P. 69–76 (In Russ.).
- Tosti B., Corrado S., Mancone S., et al. Integrated Use of Biofeedback and Neurofeedback Techniques in Treating Pathological Conditions and Improving Performance: a Narrative Review. Frontiers in Neuroscience. 2024 Mar 19;18:1358481. Doi: 10.3389/fnins.2024.1358481.
- Udalov Yu.D., Gordiyenko A.V., Samoylov A.S., Zabelin M.V., Bakharev S.A. Psychoemotional Stress in Somatically Burdened Oncosurgical Patients as One of the Factors of Postoperative Complications. Issledovaniya i Praktika v Meditsine = Research’n Practical Medicine Journal. 2018;5;3:117–125 (In Russ.). Doi: 10.17709/2409-2231-2018-5-3-12.
- Goloborod’ko Ye.V. Review of the Main Restorative Technologies in Sports Medicine Based on the Action of Physical Factors. Meditsina. Sotsiologiya. Filosofiya. Prikladnyye Issledovaniya = Medicine. Sociology. Philosophy. Applied Research. 2020;4:27–32 (In Russ.).
- Minshall C., Beard J., Engel L., et al. Post-Traumatic Stress Disorder in UK Military Amputees: a Mixed-Methods Study. Military Medicine. 2024 Mar 20;170;2:99-100. Doi: 10.1136/military-2022-002232.
- Galushka A.S., Vishnevetskiy V.A. Review of Biofeedback Techniques in the Rehabilitation of Posttraumatic Stress Disorder. Modeling, Optimization and Information Technology. 2024;12;3 (In Russ). Doi: 10.26102/2310-6018/2024.46.3.025.
- Nazaryan S.Ye., Orlova N.Z., Pustovoyt V.I. Targets of Psychological Correction in the Rehabilitation of Highly Qualified Athletes. Sportivnaya Meditsina: Nauka i Praktika = Sports Medicine: Research and Practice. 2023;13;1:72–79 (In Russ.). Doi: 10.47529/2223-2524.2023.1.10.
- Nazaryan S.Ye., Orlova N.Z., Bragin M.A. The Contribution of Social and Psychological Factors to the Functional Readiness of an Athlete. Meditsinskaya Nauka i Obrazovaniye Urala = Medical Science and Education of Ural. 2017;18;2:107–110 (In Russ.).
- Nazaryan S.Ye., Samoylov A.S., Fedin A.B., Orlova N.Z., Nikol’skaya A.V., Pustovoyt V.I. Application of Cognitive Psychotherapy Methods in the Psychological Support of Athletes during the Rehabilitation Period. Lechebnaya Fizkul’tura i Sportivnaya Meditsina = Therapeutic Physical Education and Sports Medicine. 2019;1:58–61 (In Russ.).
- Ramachandran V.S., Hirstein W. The Perception of Phantom Limbs: The D.O. Hebb Lecture. Brain. 1998;121;9:1603–1630. Doi: 10.1093/brain/121.9.1603.11.
- Bragin M.A., Goloborod’ko Ye.V., Kotenko N.V., Samoylov A.S., Kalinina M.Yu. Efficiency of Hardware and Software Systems in Assessing the Psychophysiological State of Individuals in Extreme Professions. Vestnik Vosstanovitel’noy Meditsiny = Bulletin of Rehabilitation Medicine. 2021;20;6:111–118 (In Russ.).
- Escamilla-Nunez R., Michelini A., Andrysek J. Biofeedback Systems for Gait Rehabilitation of Individuals with Lower-Limb Amputation: A Systematic Review. Sensors. 2020;20;6:1628. Doi: 10.3390/s20061628.
- Sturma A., Hruby L.A., Prahm C., Mayer J.A., Aszmann O.C. Rehabilitation of Upper Extremity Nerve Injuries Using Surface EMG Biofeedback: Protocols for Clinical Application. Frontiers in Neuroscience. 2018 Dec 4;12:906. Doi: 10.3389/fnins.2018.00906.
- Tosti B., Corrado S., Mancone S., et al. Integrated Use of Biofeedback and Neurofeedback Techniques in Treating Pathological Conditions and Improving Performance: a Narrative Review. Frontiers in Neuroscience. 2024 Mar 19;18:1358481. Doi: 10.3389/fnins.2024.1358481.
- Razinkin S.M., Korolev A.D., Bragin V.V., Kryntsalov A.I. Evaluation of the Effectiveness of a Methodology for Correcting the Psychoemotional State of Athletes of the Russian National Biathlon Team. Vestnik Nevrologii, Psikhiatrii i Neyrokhirurgii = Bulletin of Neurology, Psychiatry and Neurosurgery. 2019;1:65–70 (In Russ.).
- Salminger S., Sturma A., Hofer C., et al. Long-Term Implant of Intramuscular Sensors and Nerve Transfers for Wireless Control of Robotic Arms in Above-Elbow Amputees. Science Robotics. 2019 Jul 17;4;32:eaaw6306. Doi: 10.1126/scirobotics.aaw6306. PubMed ID 31609322.
- Goloborod’ko Ye.V., Fomkin P.A., Petrova V.V., Razinkin S.M. Some Approaches to Assessing the Effectiveness of Rehabilitation Measures in Highly Qualified Athletes. Saratovskiy Nauchno-Meditsinskiy Zhurnal = Saratov Journal of Medical Scientific Research. 2017;13;4:947–955 (In Russ.).
- Aszmann OC, Roche AD, Salminger S, Paternostro-Sluga T, Herceg M, Sturma A, Hofer C, Farina D. Bionic Reconstruction to Restore Hand Function after Brachial Plexus Injury: a Case Series of Three Patients. Lancet. 2015 May 30;385;9983:2183-9. Doi: 10.1016/S0140-6736(14)61776-1.
- Kish A.A., Goloborod’ko Ye.V., Razinkin S.M., Komlev A.M. Physical Performance in the System of Assessing the Effectiveness of Sports Medicine Technologies. Vestnik Vosstanovitel’noy Meditsiny = Bulletin of Rehabilitation Medicine. 2021;20;6:119–125 (In Russ.).
- Petrini F.M., Bumbasirevic M., Valle G., et al. Sensory Feedback Restoration in Leg Amputees Improves Walking Speed, Metabolic Cost and Phantom Pain. Nature Medicine. 2019;25:1356–1363.
- Dietrich C., Walter-Walsh K., Preissler S., et al. Sensory Feedback Prosthesis Reduces Phantom Limb Pain: Proof of a Principle. Neuroscience Letters. 2018;507:97–100.
- Askovic M, Soh N, Elhindi J, Harris AWF. Neurofeedback for Post-Traumatic Stress Disorder: Systematic Review and Meta-Analysis of Clinical and Neurophysiological Outcomes. Eur J Psychotraumatol. 2023;14(2):2257435. Doi: 10.1080/20008066.2023.2257435.
- Van der Kolk B.A., Hodgdon H., Gapen M., et al. A Randomized Controlled Study of Neurofeedback for Chronic PTSD. PLoS ONE. 2016;11;12:e0166752. Doi: 10.1371/journal.pone.0166752.
- Kenemore T., Enlow P., Lee T., et al. Heart Rate Variability Biofeedback as a Treatment for Military PTSD: a Meta-Analysis. Mil Med. 2024 Aug 30;189;9-10:e1903-e1909. Doi: 10.1093/milmed/usae003.25.
- Razinkin S.M., Samoylov A.S., Goloborod’ko Ye.V., Kish A.A., Bragin M.A., Rylova N.V., Petrova V.V., Shulepov P.A. Izbrannyye Lektsii po Sportivnoy Meditsine = Selected Lectures on Sports Medicine. Moscow, FMBTS im. A.I. Burnazyana FMBA Rossii Publ., 2022. 382 p. (In Russ.).
- Goloborod’ko Ye.V., Razinkin S.M., Syuris N.A., Yerofeyev G.G., Kazakov V.F. The Role of the System for Assessing the Efficiency and Quality of Medical Technologies in Improving Spa Treatment Programs for Military Personnel. Kurortnaya Meditsina = Resort Medicine. 2021;4:25–29 (In Russ.).
- Sherman R.A. Phantom Pain as an Expression of Referred Sensations. European Journal of Pain. 1997;1;1:59–69.
- Harden R.N., Houle T.T., Green S., et al. Biofeedback in the Treatment of Phantom Limb Pain: A Time-Series Analysis. Applied Psychophysiology and Biofeedback. 2005;30;1:83–93.
- Belleggia G., Birbaumer N. Treatment of Phantom Limb Pain with Combined EMG and Thermal Biofeedback: a Case Report. Applied Psychophysiology and Biofeedback. 2001;26;2: 141–146.
- Morina N., Maier T., Bryant R., et al. Combining Biofeedback and Narrative Exposure Therapy for Persistent Pain and PTSD in Refugees: a Pilot Study. European Journal of Psychotraumatology. 2012;3:1. Doi: 10.3402/ejpt.v3i0.17660.
- Goloborod’ko Ye.V. Razrabotka i Obosnovaniye Sistemy Ekspertnoy Otsenki Meditsinskikh Tekhnologiy dlya Vysokokvalifitsirovannykh Sportsmenov = Development and Substantiation of a System for Expert Evaluation of Medical Technologies for Highly Qualified Athletes. Doctor’s Thesis (Med). Moscow, Natsional’nyy Meditsinskiy Issledovatel’skiy Tsentr Reabilitatsii i Kurortologii Publ., 2022. 215 p. (In Russ.).
- Razinkin S.M., Goloborod’ko Ye.V., Komlev A.M. A Model for Assessing the Means of Correcting the Functional State in Highly Qualified Athletes Using Desynchronosis as an Example. Kurortnaya Meditsina = Resort Medicine. 2021;4:54–57 (In Russ.).
- Samoylov A.S., Razinkin S.M., Khan A.V., Nazaryan S.Ye., Shevyakova N.I. Multidisciplinary Approach to the Rehabilitation of High-Performance Athletes. Voprosy Kurortologii, Fizioterapii i Lechebnoy Fizicheskoy Kul’tury = Problems of Balneology, Physiotherapy, And Exercise Therapy. 2016;93;2:147 (In Russ.).
Conflict of interest. The authors declare no conflict of interest.
Financing. The study had no sponsorship.
Contribution. Article was prepared with equal participation of the authors.
Article received: 29.03.2026. Accepted for publication: 25.04.2026