A 12-year-old male, unresponsive to therapy for symptoms associated with reflex sympathetic dystrophy, was treated by thermal biofeedback techniques. Within the first four treatment sessions, transfer of training from digital warming to warming the affected knee area produced skin temperature elevation around the gastrocnemius and patellar areas. Attenuation of localized vasospasm and cold intolerance resulted, followed by total abolition within ten sessions. After symptom alleviation, a return to premorbid activity levels was reported. Implications for use of thermal biofeedback as a primary noninvasive technique for treatment of symptoms associated with reflex sympathetic dystrophy are discussed.

Sleep disturbances are a frequent reason for pediatric consultation. When the disturbance persists in the form of delays in entering or maintaining sleep (DIMS), a vicious cycle develops. As part of the cycle, vigilance or arousal occurs, further inhibiting sleep occurrence. Persistent DIMS requires treatment to interrupt this self-perpetuating sequence. Interruption requires reduction in psychophysiological arousal and deconditioning of the events surrounding sleep. Electromyographic (EMG) and thermal biofeedback in conjunction with relaxation training were used with three children who maintained high levels of arousal resulting from stresses common to their developmental stages. Within seven sessions, all three patients showed attenuation of arousal and symptom abatement marked by uninterrupted sleep.