Clinical efficacy of adaptive biofeedback training combined with oral administration of compound polyethylene glycol 4000-electrolyte powder in the treatment of children with outlet obstruction constipation: a prospective randomized controlled trial / 中国当代儿科杂志

OBJECTIVES@#To study the clinical efficacy, advantages, and disadvantages of adaptive biofeedback training combined with oral administration of compound polyethylene glycol 4000-electrolyte powder in the treatment of children with outlet obstruction constipation (OOC).@*METHODS@#A total of 168 children with OOC were enrolled in this prospective study. All the subjects were randomly divided into a test group and a control group based on the order of visiting time, 84 in each group. The test group was treated with adaptive biofeedback training combined with oral administration of compound polyethylene glycol 4000-electrolyte powder, and the control group was treated with oral administration of compound polyethylene glycol 4000-electrolyte powder alone. Eleven children in the test group and two children in the control group withdrew from the study since they could not finish the whole treatment course. Finally, 73 children in the test group and 82 children in the control group were included in this analysis. As clinical outcomes, the total score of clinical symptoms and overall response rate were compared between the two groups at weeks 4 and 8 of treatment.@*RESULTS@#There was no significant difference in the total score of clinical symptoms between the two groups at beginning of treatment and at week 4 (P>0.05), while the test group had a significantly lower total score of clinical symptoms than the control group at week 8 (P<0.05). At week 4, there was no significant difference in overall response rate between the two groups (P>0.05), while the test group had a significantly higher overall response rate than the control group at week 8 (P<0.05).@*CONCLUSIONS@#Adaptive biofeedback training combined with oral administration of compound polyethylene glycol 4000-electrolyte powder is significantly associated with improvement of clinical outcomes in the treatment of children with OOC.

Analyzing the influencing factors of sports fatigue based on algorithm / Análise dos fatores que influenciam a fadiga esportiva baseada em algoritimki / La tecnología de retroalimentación biológica basada en algoritmos

ABSTRACT Objective: This paper discusses the monitoring method of exercise fatigue and analyzes the influencing factors of exercise fatigue. Methods: Based on the feature extraction method of the fatigue image signal, a series of changes caused by exercise fatigue are analyzed by the biofeedback technique. SVM algorithm and neural network model are used to identify the fatigue state of motion. Characteristics of electroencephalogram (EEG) and electromyography (EMG) during fatigue. Results: When sports fatigue occurred, the composite index of bio-feedback technology shows a decrease in HRV index and increases in HRV time-domain indicators, frequency-domain indicators, and SAa values. Conclusions: It has a high degree of systematization. The proposed method is non-invasive and has practical application value. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Objetivo: este artigo discute o método de monitoramento da fadiga do exercício e analisa os fatores que influenciam a fadiga do exercício. Métodos: Com base no método de extração de características do sinal da imagem da fadiga, uma série de alterações causadas pela fadiga do exercício são analisadas pela técnica de biofeedback. O algoritmo SVM e o modelo de rede neural são usados para identificar o estado de fadiga do movimento. Características do eletroencefalograma (EEG) e eletromiografia (EMG) durante a fadiga. Resultados: Quando a fadiga esportiva ocorreu, o índice composto da tecnologia de bio-feedback mostra uma diminuição no índice de VFC e aumentos nos indicadores de VFC no domínio do tempo, indicadores no domínio da frequência e valores SAa. Conclusões: Possui alto grau de sistematização. O método proposto é não invasivo e tem valor de aplicação prática. Nível de evidência II; Estudos terapêuticos- investigação dos resultados do tratamento.

RESUMEN Objetivo: Este artículo analiza el método de seguimiento de la fatiga por ejercicio y analiza los factores que influyen en la fatiga por ejercicio. Métodos: Basado en el método de extracción de características de la señal de la imagen de fatiga, se analizan una serie de cambios causados por la fatiga del ejercicio mediante la técnica de biorretroalimentación. El algoritmo SVM y el modelo de red neuronal se utilizan para identificar el estado de movimiento de fatiga. Características del electroencefalograma (EEG) y electromiografía (EMG) durante la fatiga. Resultados: cuando se produjo la fatiga deportiva, el índice compuesto de la tecnología de bio-retroalimentación muestra una disminución en el índice de HRV y aumentos en los indicadores de dominio de tiempo de HRV, indicadores de dominio de frecuencia y valores de SAa. Conclusiones: Tiene un alto grado de sistematización. El método propuesto no es invasivo y tiene un valor de aplicación práctica. Nivel de evidencia II; Estudios terapéuticos- investigación de los resultados del tratamiento.

Biofeedback eletromiográfico como coadjuvante pode ajudar a manter os resultados da terapia profilática de deglutição em longo prazo na doença de Parkinson? Um estudo piloto / Can adjunctive electromyographic biofeedback help maintain long-term prophylactic swallowing therapy results in Parkinson's disease? A pilot study

RESUMO Objetivo Este estudo piloto teve como objetivo verificar a influência do uso do biofeedback EMG como método coadjuvante para auxiliar na manutenção dos resultados a longo prazo da terapia da deglutição em idosos com doença de Parkinson em uma abordagem profilática. Métodos Os sujeitos foram avaliados quanto ao nível de ingestão oral (Functional Oral Intake Scale - FOIS), qualidade de vida (questionário SWAL-QOL) e videofluoroscopia da deglutição das consistências sólida, pudim e líquida. A gravidade da disfagia foi avaliada por meio do Dysphagia Outcome and Severity Scale (DOSS). Todos os procedimentos foram realizados antes, após três meses e após seis meses do tratamento fonoaudiológico para disfagia orofaríngea. Resultados Três sujeitos foram tratados com terapia fonoaudiológica profilática e três com terapia convencional fonoaudiológica profilática utilizando biofeedback EMG coadjuvante em um total de 18 sessões. Seis pacientes apresentaram melhora nos níveis de ingestão oral, gravidade da disfagia e qualidade de vida após o programa de reabilitação. O nível de ingestão oral foi mantido seis meses após a terapia convencional para dois pacientes e todos os participantes tratados com biofeedback EMG. Conclusão Ambas as modalidades de terapia profilática mostraram melhora na qualidade de vida, nível de ingestão oral e gravidade da disfagia, mas os benefícios foram mantidos ao longo do tempo apenas para os participantes do grupo experimental.

ABSTRACT Purpose This pilot study aimed to verify the influence of using EMG biofeedback as an assisting method to maintain long-term results for swallowing therapy in older adults with Parkinson's disease in a prophylactic approach. Methods: Subjects were evaluated as to the oral intake level (Functional Oral Intake Scale - FOIS), quality of life (SWAL-QOL questionnaire), and videofluoroscopy of swallowing of solid, pudding and liquid consistencies. The severity of dysphagia was assessed using the Dysphagia Outcome and Severity Scale (DOSS). All procedures were performed before, after three months, and after six months of speech-language therapy treatment for oropharyngeal dysphagia. Results: Three subjects were treated with prophylactic speech-language therapy, and three with prophylactic speech-language conventional therapy using adjunctive EMG biofeedback in a total of 18 sessions. Six patients experienced a reduction of the severity of the dysphagia, improved oral intake levels and quality of life after the rehabilitation program. The oral intake level was maintained six months after conventional therapy for two patients and for all participants treated with EMG biofeedback. Conclusion Both therapy modalities with PSLT showed improved quality of life, oral intake level, and reduction of the severity of dysphagia, but the benefits were maintained over time only for participants in the experimental group.

Contracción paradojal del puborrectal como causa de defecación obstructiva: resultados a corto plazo del tratamiento con biofeedback y rehabilitación pelviperineal / Puborectal paradoxical contraction as a cause of obstructive defecation: short-term outcomes of treatment with biofeedback and pelviperineal rehabilitation

Resumen Introducción: En pacientes constipados crónicos por obstrucción de salida, la contracción paradojal del puborrectal (CPP) o "anismo" es frecuente. El tratamiento con Biofeedback y rehabilitación pelviperineal presenta resultados exitosos entre el 40-90%. Objetivo: Evaluar el resultado del tratamiento con Biofeedback y rehabilitación pelviperineal en pacientes con CPP a corto plazo. Materiales y Método: Serie de casos. Datos obtenidos prospectivamente de la Unidad de Piso Pelviano. Se incluyó pacientes entre 2008 y 2015 que cumplían criterios de constipación crónica secundaria a CPP, confirmado por manometría anorrectal y/o defeco-resonancia. Se analizaron datos demográficos, frecuencia de evacuaciones, uso de laxantes, enemas, pujo, Score de Altomare y Score de constipación de Wexner pre y post-tratamiento. Resultados: 43 pacientes, de los cuales 39 son mujeres. Edad media de 40 años (rango: 14-84). Duración de síntomas fue ≥ 5 años en el 72,5%. Mediana de sesiones de Biofeedback de 8 (6-10). El 62,8% presenta ≤ 2 evacuaciones semanales y disminuye a un 29,3% post-tratamiento (p < 0,001). El 76,2% requiere laxantes orales y el 42,9% enemas, disminuyendo a 35,1% (p < 0,001) y 5,4% (p < 0,001) respectivamente post-tratamiento. Sensación de evacuación incompleta/fragmentada en todos los intentos mejoró de 67,4% a 14,6% (p < 0,001) y el pujo excesivo en más de la mitad de intentos mejoró de 76,1% a 10,8% (p < 0,001). Score de Wexner para constipación y Altomare mejoró de 18 a 7 (p < 0,001) y de 16 a 5 (p < 0,001) respectivamente. Conclusión: El biofeedback y la rehabilitación pelviperineal son efectivas en el tratamiento de la CPP.

Introduction: In patients with chronic constipation by obstructive defecation syndrome Paradoxical Puborectalis Contraction or "anismus" is important. Successful results for Biofeedback treatment and Pelviperineal Rehabilitation it described between 40-90%. Aim: To evaluate the outcome of biofeedback and pelviperineal rehabilitation in patients with CPP in the short-term. Materials and Method: Case series. Data was obtained from the prospective database of Pelvic Floor Unit of Universidad Católica de Chile. Patients with anismus were included between 2008 and 2015. Diagnostic criteria were chronic constipation patients by anismus with anorectal manometry and/or defecoresonancy that confirms this disorder and discards other causes of obstruted defecation síndrome. Demographic variables, frequency of bowel movements, use of laxatives, enemas, pushing, Altomare Score and Wexner constipation Score were analyzed pre and post-treatment. Results: Series of 43 patients, 39 of whom where women. Median age: 40 years (range: 14-84). Duration of symptoms ≥ 5 years in 72.5%. Median of Biofeedback sessions: 8 (range 6-10). Pre-treatment, 62.8% had ≤ 2 evacuations weekly and 29.3% post-treatment (p < 0.001). Oral laxatives were required in 76.2% and 42.9% enemas, decreasing to 35.1% (p < 0.001) and 5.4% (p < 0.001) post-treatment respectively. Feeling of incomplete/evacuation fragmented all the time improved from 67.4% to 14.6% (p < 0.001) and excessive pushing in more than half of time improved from 76.1% to 10.8% (p < 0.001). Wexner Score for and Altomare Score improved from 18 to 7 (p < 0.001) and 16 to 5 (p < 0.001) respectively. Conclusion: Adult with chronic constipation by anismus can be treated effectively with Biofeedback and Pelviperineal Rehabilitation.

A new biofeedback approach for the control of awake bruxism and chronic migraine headache: utilization of an awake posterior interocclusal device / Uma nova abordagem via biofeedback para o controle do bruxismo de vigília e de enxaqueca crônica: utilização de um dispositivo interoclusal posterior em vigília

ABSTRACT Background: The relationship of bidirectional comorbidity between chronic migraine and pain in the cephalic segment led us to evaluate the improvement in reducing the pain in patients diagnosed with chronic migraine headache and awake bruxism, when undergoing treatment with a partial posterior interocclusal device designed for the management and control of awake bruxism through biofeedback. Methods: Seventy-four patients were evaluated during the following periods: pretreatment, seven, thirty, ninety, one hundred and eighty days, and one year. The evaluation was carried out by measuring the pain in the pretreatment period and pain reduction after awake bruxism treatment, using clinical evaluation and numerical scales for pain. Results: Most of the patients who complained of headache migraine pain, masticatory myofascial pain, temporomandibular joint and neck pain experienced a significant reduction in overall pain, including headaches, between t0 and t30 (p<0.0001). After 30 days of using the device, it was observed that the improvement remained at the same level without any recurrence of pain up to t90. At t180 and t360, it was observed that even with the device withdrawal (at t90) the improvement remained at the same level. Conclusion: The utilization of a posterior interocclusal device designed for the management and control of awake bruxism through biofeedback seems to contribute to the reduction of pain (including migraine headache) in the majority of patients, and, even with the device withdrawal (at t90), the improvement remained at the same level, suggesting the patients succeeded in controlling their awake bruxism and consequently the pains.

RESUMO Introdução: A relação de comorbidade bidirecional entre enxaqueca crônica e dor no segmento cefálico nos levou a avaliar a melhora na redução da dor em pacientes diagnosticados com cefaleia crônica de enxaqueca e bruxismo de vigília, quando submetidos a tratamento com dispositivo interoclusal posterior parcial projetado para o manejo e o controle do bruxismo acordado através de biorretroalimentação (biofeedback). Métodos: Setenta e quatro pacientes foram avaliados durante os seguintes períodos: pré-tratamento, sete, trinta, noventa e cento e oitenta dias, e um ano. A avaliação foi realizada por meio da avaliação da dor no período pré-tratamento e redução da dor após o tratamento do bruxismo de vigília, através de avaliação clínica e escalas numéricas de dor. Resultados: A maioria dos pacientes que se queixou de dor de cabeça com enxaqueca, dor miofascial mastigatória, articulação temporomandibular e dor no pescoço sofreu uma redução significativa na dor geral, incluindo dores de cabeça, entre t0 e t30 (p<0,0001). Após 30 dias de uso do dispositivo, observou-se que a melhora permaneceu no mesmo nível, sem recorrência da dor até t90. Em t180 e t360, observou-se que, mesmo com a retirada do dispositivo (em t90), a melhoria permaneceu no mesmo nível. Conclusão: A utilização de um dispositivo interoclusal posterior projetado para o controle do bruxismo de vigília através de biofeedback parece contribuir para a redução da dor (incluindo enxaqueca) na maioria dos pacientes, e, mesmo com a retirada do dispositivo (t90), a melhora manteve-se no mesmo nível, sugerindo que os pacientes conseguiram controlar o seu bruxismo de vigília e a dor associada a esse hábito.

Fatores preditivos de insucesso do biofeedback para tratamento da incontinência fecal em mulheres / Predictors of unsuccessful of treatment for fecal incontinence biofeedback for fecal incontinence in female

ABSTRACT BACKGROUND: Biofeedback is an effective method of treatment for fecal incontinence but there is controversy regarding factors that may be correlated with its effectiveness. OBJECTIVE: To evaluate the efficacy of biofeedback in the treatment of fecal incontinence, identifying the predictive factors for unsuccessful treatment. METHODS: Consecutive female patients who had fecal incontinence and were treated with a full course of biofeedback were screened. The symptoms were evaluated using Cleveland Clinic incontinence (CCF) score before and six months after the completion of therapy. Patients had a satisfactory clinical response to biofeedback if the CCF score had decreased by more than 50% at six months (GI) and an unsatisfactory response if the CCF score did not decrease or if the score decreased by <50% (GII). The groups were compared with regard to age, score, anal resting and squeeze pressures and sustained squeeze pressure by manometry, history of vaginal delivery, number of vaginal deliveries, menopause, hysterectomy, and previous anorectal surgery. RESULTS: Of 124 women were included, 70 (56%) in GI and 54 (44%) in GII. The median CCF score decreased significantly from 10 to 5 (P=0.00). FI scores were higher in GII. Patients from GII had more previous vaginal deliveries and previous surgeries. The mean sustained squeeze pressure was higher in GI. Patients from GI and GII had similar ages, number of vaginal deliveries, menopause, hysterectomy, anal pressures, and sphincter defects. The median sustained squeeze pressure increased significantly before and after biofeedback in GI. CONCLUSION: Biofeedback therapy shows effective treatment with 50% reductions in FI score in half of patients. Factors associated with unsuccessful outcome include FI score ≥10, previous vaginal delivery, previous anorectal and/or colorectal surgery, and reduced mean sustained squeeze pressure.

RESUMO CONTEXTO: Biofeedback é um método eficaz de tratamento para a incontinência fecal. No entanto, há controvérsias sobre fatores que podem ser correlacionados com a sua eficácia. Objetivo - Avaliar a eficácia do biofeedback no tratamento da incontinência fecal (IF), identificando os fatores preditivos relacionados ao insucesso do tratamento. MÉTODOS: Consecutivos pacientes do sexo feminino com IF e submetidos a terapia com biofeedback que aceitaram participar do estudo foram incluídos. Os sintomas foram avaliados utilizando o escore de incontinência da Cleveland Clinic-CCF antes e seis meses após termino da terapia. Os pacientes com resposta satisfatória ao biofeedback apresentaram redução no escore de IF ≥50% (GI) e resposta insatisfatória a redução no escore de IF <50% (GII) em seis meses. Os grupos foram comparados de acordo com a idade, escore, pressões anais quantificada pela manometria anorretal (repouso, contração e capacidade de sustentação em 30 segundos), parto vaginal prévio, número de partos vaginais, menopausa, histerectomia e cirurgia anorretal e/ou colorretal prévia. RESULTADOS: Total de 124 mulheres incluídas, 70 (56%) em GI e 54 (44%) em GII. A mediana do CCF escore reduziu significativamente de 10 para 5 (P=0.00). FI escore foi mais elevado no GII, assim como foi observado o maior número de mulheres submetidas a partos vaginais e cirurgias prévias. A pressão média de contração foi significante maior no GI. No entanto, idade, número de partos vaginais, menopausa, histerectomia, pressões anais e presença de defeito esfincteriano foram similares nos dois grupos. A pressão média de sustentação mantida por 30 seg aumentou significamente comparando pré com pós biofeedback no GI. CONCLUSÃO: O biofeedback é um tratamento eficaz com redução em 50% no escore de IF em mais da metade dos pacientes. Os fatores associados ao insucesso do tratamento incluem o escore de IF ≥10, parto vaginal prévio, cirurgia anorretal prévia e pressão média de sustentação reduzida.

Effect of Horse Riding Simulator Exercise on Thickness of Transverse Abdominis in Healthy Adults

PURPOSE: This study examined the effects of horse riding simulator exercise on the thickness changes in the transverse abdominis in normal adults. METHODS: Forty-five healthy adults were recruited and randomized to a horseback riding simulation exercise group (n=15), a sling exercise group (n=15), and a trunk stabilization exercise group (n=15). A horseback riding simulator offers the indoor experience of horseback riding and mimics the rhythmic movement of horseback riding, thereby provided a virtual environment, such as riding a real horse on the front screen. The velocity of the horse riding simulator exercise was regulated within the subject's ability to control the exercise on the horse riding simulator. A sling exercise group performed sling exercise under the inspection of the experimenter. In the trunk stabilization exercise group, the subjects were instructed to perform the exercise accurately and pause the session when pain occurred during the intervention. The subjects in each group carried out the interventions three times per week for six weeks. The thickness of the transverse abdominis was measured using a pressure biofeedback unit and the ultrasound. RESULTS: Significant differences in the thickness of transverse abdominis within the groups were observed between before and after the interventions. On the other hand, there were no differences in the parameters among the groups. CONCLUSION: Horse riding simulator exercise can be an alternative to trunk stabilization exercise by increasing the thickness of the transverse abdominis in healthy adults.

Heart Rate Variability Biofeedback Increased Autonomic Activation and Improved Symptoms of Depression and Insomnia among Patients with Major Depression Disorder

OBJECTIVE: Autonomic imbalance is considered a psychopathological mechanism underlying major depressive disorder (MDD). Heart rate variability (HRV) is an index for autonomic activation. Poor sleep quality is common among patients with MDD. HRV biofeedback (BF) has been used for regulating autonomic balance among patients with physical illness and mental disorders. The purpose of present study was to examine the effects of HRV-BF on depressive symptoms, sleep quality, pre-sleep arousal, and HRV indices, in patients with MDD and insomnia. METHODS: In this case-controlled study, patients with MDD and Pittsburgh Sleep Quality Index (PSQI) score higher than 6 were recruited. The HRV-BF group received weekly 60-minute protocol for 6 weeks, and the control group who have matched the age and sex received medical care only. All participants were assessed on Beck Depression Inventory-II, Back Anxiety Inventory, PSQI, and Pre-Sleep Arousal Scale. Breathing rates and electrocardiography were also performed under resting state at pre-testing, and post-testing conditions and for the HRV-BF group, also at 1-month follow-up. RESULTS: In the HRV-BF group, symptoms of depression and anxiety, sleep quality, and pre-sleep arousal were significantly improved, and increased HRV indices, compared with the control group. Moreover, in the HRV-BF group, significantly improved symptoms of depression and anxiety, decreased breathing rates, and increased HRV indices were detected at post-testing and at 1-month follow-up, compared with pre-testing values. CONCLUSION: This study confirmed that HRV-BF is a useful psychosocial intervention for improving autonomic balance, baroreflex, and symptoms of depression and insomnia in MDD patients.

Chronic Functional Constipation / 대한소화기학회지

Constipation is a common functional problem of the digestive system and may occur secondary to diet, drugs, endocrine diseases, metabolic diseases, neurological diseases, psychiatric disorders, or gastrointestinal obstruction. When there is no secondary cause, constipation is diagnosed as functional constipation. The first steps that should be taken to relieve symptoms are diet and lifestyle modifications, and if unsuccessful, laxative therapy should be initiated. If a patient does not respond to laxative therapy, diagnostic anorectal physiological tests are performed, though they are not routinely recommended. However, these tests may be considered earlier in patients strongly suspected to have a defecatory disorder. The revised guideline on the diagnosis and treatment of chronic constipation will undoubtedly aid the individualized management of chronic constipation in clinical practice.

Clinical effect of psychological and behavioral intervention combined with biofeedback in the treatment of preschool children with attention deficit hyperactivity disorder / 中国当代儿科杂志

OBJECTIVE@#To study the clinical effect of psychological and behavioral intervention combined with biofeedback in the treatment of preschool children with attention deficit hyperactivity disorder (ADHD).@*METHODS@#Sixty children each with inattentive, hyperactive/impulsive or combined type ADHD were enrolled. According to the intervention measure, they were randomly divided into 4 groups: control, psychological and behavioral intervention, biofeedback treatment and comprehensive treatment (psychological and behavioral intervention + biofeedback). Attention concentration time and impulse/hyperactivity and hyperactivity index scores of the Conners Parent Symptom Questionnaire (PSQ) were evaluated after 4 months of treatment.@*RESULTS@#The attention concentration time increased in all types children with ADHD after psychological and behavioral intervention, biofeedback treatment or comprehensive treatment (P<0.05). In children with inattentive ADHD, hyperactive/impulsive ADHD or combined-type ADHD, biofeedback or comprehensive treatment reduced the impulse/hyperactivity index score (P<0.05). In children with inattentive or combined-type ADHD, psychological and behavioral intervention or comprehensive treatment reduced the hyperactivity index score (P<0.05). In children with hyperactive/impulsive ADHD, biofeedback treatment, psychological and behavioral intervention or comprehensive treatment reduced the hyperactivity index score (P<0.05).@*CONCLUSIONS@#In children with ADHD, psychological and behavioral intervention combined with biofeedback treatment can improve the attention concentration and impulsive/hyperactive and hyperactive symptoms. The treatment strategies are slightly different for children with different types of ADHD.

Reabilitação da força da língua utilizando biofeedback: relato de caso / Tongue strength rehabilitation using biofeedback: a case report

RESUMO Esta pesquisa teve o objetivo de relatar um caso clínico em que foi realizada a reabilitação da força lingual com estratégia de biofeedback. Trata-se de uma paciente de 20 anos de idade, cuja avaliação miofuncional orofacial evidenciou diminuição grave de força do terço anterior da língua e alterações na mobilidade e na coordenação linguais. A quantificação da pressão lingual foi realizada por meio do Iowa Oral Performance Instrument durante a elevação, a protrusão e a lateralização, tendo se verificado redução nos valores obtidos em todas as direções medidas em comparação aos padrões de normalidade. Foram realizadas 11 sessões de terapia, com frequência semanal, utilizando estratégia de biofeedback que consistia em jogos computacionais acionados pela língua. Um instrumento encaixado na cavidade oral funcionava como um joystick, sendo método de entrada para jogos digitais específicos. Em casa, a paciente realizou exercícios isométricos de pressão de ponta de língua contra espátula, retração exagerada de língua, afilamento lingual e isotônico de tocar comissuras e lábios alternadamente, diariamente. Após oito sessões, em relação à pressão na elevação, houve melhora de 28,6% para o ápice e 7,1% para o dorso. Quanto à protrusão, houve melhora de 123,5%. Nas medidas de lateralizações esquerda e direita, os valores aumentaram 53,8% e 7,4%, respectivamente. Após 12 sessões, percebeu-se melhora, em relação à avaliação inicial, de 35,7%, 7,4%, 164%, 76,9% e 40,7%, para elevação de ápice, de dorso, protrusão, lateralizações esquerda e direita, respectivamente. Apesar do aumento, valores preconizados na literatura, como normalidade para o sexo e a idade, não foram atingidos com 12 sessões.

ABSTRACT This research had the objective of reporting a clinical case in which the rehabilitation of tongue strength with biofeedback strategy was performed. This case report addresses a 20-year-old patient whose orofacial myofunctional evaluation revealed a severe decrease in the force of the anterior third of the tongue and changes in lingual mobility and coordination. The measurement of tongue pressure was performed using the Iowa Oral Performance Instrument (IOPI) during elevation, protrusion and lateralization, and it was verified a reduction in the values ​​obtained in all measured directions, compared with normality patterns. We performed 11 sessions of therapy, with weekly frequency, using a biofeedback strategy that consisted of computer games controlled by the tongue. An instrument embedded in the oral cavity functioned as a joystick as the input method for specific digital games. The patient performed at home the isometric exercises of pressing the tip of the tongue against a spatula, exaggerated retraction of tongue, tongue tapering, and isotonic exercise of touching the commissures and lips alternately, daily. After eight sessions, in relation to the elevation pressure, there was an improvement of 28.6% for the apex and 7.1% for the dorsum. As for protrusion, there was an improvement of 123.5%. In the measurements of left and right lateralization, the values ​​increased 53.8% and 7.4%, respectively. After twelve sessions, it was observed an improvement of 35.7%, 7.4%, 164%, 76.9% and 40.7% in relation to the initial evaluation, for apex elevation, dorsum elevation, protrusion, and lateralization to left and right, respectively. Despite the increase, values ​​recommended in the literature as normal for sex and age were not reached after 12 therapy sessions.

Técnica quirúrgica de la implantación de dispositivo ajustable transobsturador anti-incontinencia urinaria masculina tipo Atoms en una clínica de III nivel en Bogotá / Surgical Technique of the Implantation of Adjustable Masculine Transobsturador Anti-Incontinence Urinary Device Type Atoms in a Clinic of III Level in Bogotá

La prevalencia de incontinencia urinaria de esfuerzo (IUE) post-prostatectomía varía entre el 4% y el 50%, siendo más frecuente en pacientes que son llevados a prostatectomía radical. Es una condición que afecta la calidad de vida de los pacientes y presenta un impacto de grado variable de severidad. Existen diferentes opciones para el tratamiento de esa entidad, dentro de los cuales se encuentran: terapia de piso pélvico con biofeedback, fisioterapia, sistemas recolectores de orina, clamps peneanos, inyecciones periuretrales de materiales abultantes, esfínter urinario artificial (EUA) y cintas pubouretrales.[1] [2] El gold standard para la IUE es el EUA con tasa de éxito entre 50%­80%, no obstante, con una tasa de explante de hasta el 33%. Se han desarrollado otras alternativas con cintas pubouretrales las cuales han reportado una tasa de éxito hasta del 83%.[2] La principal limitante de esas alternativas en el manejo de la IUE, ha sido la necesidad de reajustar esos dispositivos con procedimientos quirúrgicos, exponiendo en repetidas ocasiones a los pacientes a los riesgos de anestesia y del procedimiento quirúrgico, situación que se ha tratado de mejorar con el dispositivo ATOMS®, introducido en Europa desde marzo del 2009, el cual ofrece la oportunidad de realizar tales ajustes en el consultorio.[3] La indicación para la colocación del ATOMS® es la IUE, sin tener claridad en su severidad, hasta en un 92,9% de las ocasiones, y usualmente son pacientes con antecedente de cirugías previas anti-incontinencia fallidas (34,3%). El tiempo quirúrgico promedio es de 47 minutos, entre 29 minutos a 112 minutos.[1]

Efficacy of biofeedback therapy for objective improvement of pelvic function in low anterior resection syndrome

PURPOSE: There is no established treatment of choice for low anterior resection syndrome (LARS). To evaluate the efficacy of biofeedback therapy for objective improvement of pelvic function in LARS, we performed the present study. METHODS: The primary endpoint was the change of Wexner score. Consenting patients between 20 and 80 years old with major LARS at least 2 months after sphincter preserving proctectomy for rectal cancer were enrolled. After recommendation of biofeedback therapy, patients who accept it were enrolled in the biofeedback group and patients who refuse were enrolled in the control group. Initial and follow-up evaluations were performed and analyzed. RESULTS: Fifteen and sixteen patients were evaluated in the control group and the biofeedback group, respectively. There was no statistically significant difference of LARS score between both groups. Decrease in Wexner score and increase in rectal capacity were significantly higher in the biofeedback group (odds ratio [OR], 5.386; 95% confidence interval [CI], 1.194–24.287; P = 0.028 and OR, 1.061; 95% CI, 1.002–1.123; P = 0.042). CONCLUSION: Biofeedback therapy was superior for objective improvement of pelvic function to observation in LARS. It can be considered to induce more rapid improvement of major LARS.

Is urotherapy alone as effective as a combination of urotherapy and biofeedback in children with dysfunctional voiding?

ABSTRACT Objective: To compare standard urotherapy with a combination of urotherapy and biofeedback sessions and to determine the changes that these therapies promote in children with dysfunctional voiding. Patients and Methods: The data of 45 patients who participated in the study from January 2010 to March 2013 were evaluated. All patients underwent urinary system ultrasonography to determine post-void residual urine volumes and urinary system anomalies. All patients were diagnosed using uroflowmetry - electromyography (EMG). The flow pattern, maximum flow rate, and urethral sphincter activity were evaluated in all patients using uroflowmetry - EMG. Each patient underwent standard urotherapy, and the results were recorded. Subsequently, biofeedback sessions were added for all patients, and the changes in the results were recorded and statistically compared. Results: A total of forty - five patients were included, of which 34 were female and 11 were male and the average age of the patients was 8.4 ± 2.44 years (range: 5 - 15 years). After the standard urotherapy plus biofeedback sessions, the post-void residual urine volumes, incontinence rates and infection rates of patients were significantly lower than those with the standard urotherapy (p < 0.05). A statistically significant improvement in voiding symptoms was observed after the addition of biofeedback sessions to the standard urotherapy compared with the standard urotherapy alone (p < 0.05). Conclusions: Our study showed that a combination of urotherapy and biofeedback was more effective in decreasing urinary incontinence rates, infection rates and post - void residual urine volumes in children with dysfunctional voiding than standard urotherapy alone, and it also showed that this combination therapy corrected voiding patterns significantly and objectively.

Biofeedback associado ou não a outras intervenções fisioterapêuticas em pacientes com incontinência urinária pós prostatectomia radical / Biofeedback associated or not with other physiotherapeutic interventions in patients with urinary incontinence after radical prostatectomy

Objetivo: Verificar a eficácia do biofeedback em relação í outras intervenções fisioterapêuticas em pacientes prostatectomizados com Incontinência Urinária. Material e métodos: A revisão sistemática buscou as seguintes fontes de dados: Medline, BVS, PubMed, Lilacs, SciELO e PEDro, nas quais os artigos mais relevantes foram selecionados, sem limite de data. Os critérios de inclusão foram estudos que relacionaram prostatectomizados com Incontinência Urinária e possí­veis atendimentos com biofeedback e qualquer outra intervenção fisioterapêutica, realizados separadamente ou utilizando ambos. Resultados: Dos 64 artigos recuperados, 19 foram excluí­dos por estarem duplicados e 41 excluí­dos por não se adequarem ao tema ou por não obterem o escore mí­nimo de 5,0 na Escala PEDro, restando 4 artigos. Conclusão: Apesar de algumas limitações, os estudos sugerem que o uso do biofeedback pode representar um incremento para promoção da continência pós-prostatectomia. (AU)

Objective: To determine the effectiveness of biofeedback relative to other physical therapy interventions in prostatectomy patients with urinary incontinence. Methods: A systematic review sought the following data sources: Medline, BVS, PubMed, Lilacs, SciELO and PEDro in which the most relevant articles were selected, without date limit. Inclusion criteria were studies that linked prostatectomy with urinary incontinence and possible consultations with biofeedback and any other physical therapy intervention, carried out separately or using both. Results: Of the 64 RCTs retrieved, 19 were excluded because they were duplicates and 41 excluded for not fit the theme or not obtain the minimum score of 5.0 on the PEDro Scale, leaving 4 studies. Conclusion: Despite some limitations, the studies suggest that the use of biofeedback may represent an increase for promoting continence after prostatectomy. (AU)

Effects of biofeedback in the treatment of female fecal incontinence / Efeitos do biofeedback no tratamento da incontinência anal feminina

ABSTRACT Introduction: Fecal incontinence is the involuntary loss of stools and gases, characterized by the inability to keep physiological control of bowel contents. It can negatively affect patients' quality of life. Biofeedback is a therapeutic tool used in the treatment, through the training of the pelvic floor muscles from visual and sound stimuli. Objective: To evaluate the effects of biofeedback in the treatment of female fecal incontinence. Methods: Twenty-three patients with fecal incontinence, diagnosed by clinical evaluation and manometry, and referred for biofeedback treatment, participated responding to the Cleveland Clinic Incontinence Assessment scale, and the Fecal Incontinence Quality of Life Questionnaire to obtain personal data, clinical complaints and incontinence characteristics. Four biofeedback sessions were held once a week. After the protocol, they were reevaluated with anorectal manometry and questionnaires, and they were instructed to daily perform the sphincteric contraction exercises at home. Results: The comparison of the Cleveland Clinic Florida Scoring System and FIQL scores before and after the biofeedback protocol showed a significant decrease (p = 0.0001) in fecal incontinence. The mean anal pressure at rest was 33.3 mmHg before and 49.65 mmHg after biofeedback, while the mean anal pressure of maximal voluntary contraction was 85 mmHg before treatment and 136.65 mmHg after it. Conclusion: Biofeedback is an effective method for the treatment of fecal incontinence, with increased sphincter strength and improved quality of life.

RESUMO Introdução: A incontinência anal é a perda involuntária de fezes e gases, caracterizada pela incapacidade de manter o controle fisiológico do conteúdo intestinal. Pode interferir negativamente na qualidade de vida dos pacientes. Biofeedback é uma ferramenta terapêutica utilizada no tratamento, através do treinamento dos músculos do assoalho pélvico, a partir de estímulo visual e sonoro. Objetivo: Avaliar os efeitos do biofeedback no tratamento da incontinência anal feminina. Metódos: Participaram 23 pacientes portadoras de incontinência anal, diagnosticadas pela avaliação clínica, manométrica e encaminhadas para tratamento com biofeedback, responderam um questionário para obtenção dos dados pessoais, queixas clínicas e características da incontinência, a escala de Avaliação da Incontinência da Cleveland Clinic e o questionário Fecal Incontinence Quality of life. Foram realizadas quatro sessões de biofeedback, uma vez por semana. Após o protocolo foram novamente reavaliadas com exame de manometria anorretal e questionários, foram orientadas a realizar os exercícios de contração esfincteriana diariamente em casa. Resultados: Na comparação dos escores dos questionários Cleveland Clinic Florida Scoring System e FIQL antes e após o protocolo de biofeedback pode-se observar diminuição significativa (p = 0,0001) da incontinência anal. As medias de pressão anal de repouso foi de 33,3 mmHg antes e 49,65 mmHg após o biofeedback, enquanto que a média da pressão anal de contração voluntária máxima foi de 85 mmHg antes do tratamento e 136,65 mmHg após o mesmo. Conclusão: O biofeedback é um método efetivo no tratamento da Incontinência anal, com aumento da força esfincteriana e melhora da qualidade de vida.

Biofeedback in dysphonia - progress and challenges / Biofeedback em disfonia - progresso e desafios

Abstract Introduction There is evidence that all the complex machinery involved in speech acts along with the auditory system, and their adjustments can be altered. Objective To present the evidence of biofeedback application for treatment of vocal disorders, emphasizing the muscle tension dysphonia. Methods A systematic review was conducted in Scielo, Lilacs, PubMed and Web of Sciences databases, using the combination of descriptors, and admitting as inclusion criteria: articles published in journals with editorial committee, reporting cases or experimental or quasi-experimental research on the use of biofeedback in real time as additional source of treatment monitoring of muscle tension dysphonia or for vocal training. Results Thirty-three articles were identified in databases, and seven were included in the qualitative synthesis. The beginning of electromyographic biofeedback studies applied to speech therapy were promising and pointed to a new method that enabled good results in muscle tension dysphonia. Nonetheless, the discussion of the results lacked physiological evidence that could serve as their basis. The search for such explanations has become a challenge for speech therapists, and determined two research lines: one dedicated to the improvement of the electromyographic biofeedback methodology for voice disorders, to reduce confounding variables, and the other dedicated to the research of neural processes involved in changing the muscle engram of normal and dysphonic patients. Conclusion There is evidence that the electromyographic biofeedback promotes changes in the neural networks responsible for speech, and can change behavior for vocal emissions with quality.

Resumo Introdução Há evidências de que o complexo aparato envolvido no ato da fala, juntamente com o sistema auditivo, e seus ajustes podem ser alterados. Objetivo Apresentar evidências da aplicação de biofeedback (biorretroalimentação) para tratamento de distúrbios vocais, enfatizar a disfonia de tensão muscular. Método Realizou-se uma revisão sistemática nas bases de dados de Scielo, Lilacs, PubMed e Web of Sciences, utilizando a combinação de descritores e admitindo como critérios de inclusão: artigos publicados em revistas com comitê editorial, relatos de casos ou pesquisas experimentais ou quase experimentais sobre o uso debiofeedbackem tempo real como fonte adicional de monitoração de tratamento de disfonia de tensão muscular ou para treinamento vocal. Resultados Trinta e três artigos foram identificados em bases de dados, e sete foram incluídos na síntese qualitativa. O início dos estudos de biofeedbackeletromiográficos aplicados à terapia fonoaudiológica foram promissores e indicaram um novo método que permitiu bons resultados na disfonia de tensão muscular. No entanto, a discussão dos resultados carecia de evidências fisiológicas que pudessem servir de base. A busca por tais explicações tornou-se um desafio para os fonoaudiólogos e determinou duas linhas de pesquisa: uma dedicada à melhoria da metodologia de biofeedbackeletromiográfico para distúrbios da voz, para reduzir as variáveis de confusão e outra dedicada à pesquisa de processos neurais envolvidos na alteração do engrama muscular de pacientes normais e disfônicos. Conclusão Há evidências de que o biofeedback eletromiográfico promove mudanças nas redes neurais responsáveis pela fala e pode mudar o comportamento para emissões vocais com qualidade.

Immediate results from biofeedback and anorectal electrostimulation in the treatment of paradoxical puborectal muscle contraction in women with obstructed defecation / Efeitos imediatos do "biofeedback" e da eletroestimulação anorretal no tratamento da contração paradoxal da musculatura puborretal em mulheres com evacuação obstruída

ABSTRACT Objective: This study was conducted to evaluate the effects of "biofeedback" (BF), electrostimulation (ES), and of the high-fiber diet associated with behavioral therapy in women with obstructed evacuation and paradoxical puborectalis contraction and to compare the results among these three modalities. Method: Thirty-one women were evaluated who fulfilled the Rome III Criteria, and with an electromanometric test positive for the presence of contraction in the evacuation maneuver. These patients were randomized into three groups: group I - conventional treatment of constipation, group II - conventional treatment of constipation associated with biofeedback and group III - conventional treatment of constipation associated with electrostimulation. At the beginning of this study and after six weeks, subjective and objective parameters of the anorectal function were evaluated using the Wexner constipation scoring system, the Bristol scale, an visual analogical scale, and anorectal electromanometry. Results: All patients demonstrated improvement in bowel satisfaction, stool frequency, effort and feeling of incomplete evacuation, stool-type modifications, and improvement in the quality of life. On examination, there was increased mean pressure of voluntary contraction in group III (p = 0.043), decreased sensitivity threshold in group II (p = 0.025) and III (p = 0.012) and decreased maximum rectal capacity in group II (p = 0.005). Only 19.4% (n = 6) had their dynamic defecation normalized, and 80.6% (n = 25) expressed clinical, non-instrumental, improvement. Conclusion: The conventional treatment of constipation, biofeedback and electrostimulation show a significant subjective improvement in symptoms of obstructed evacuation and in quality of life, regardless of the reversal of the paradoxical puborectalis contraction.

RESUMO Objetivo: Verificar os efeitos imediatos do "biofeedback" (BF), eletroestimulação (EE) e da dieta rica em fibras associada à terapia comportamental em mulheres com sintomas de evacuação obstruída e com contração paradoxal da musculatura puborretal e comparar os resultados entre as três modalidades. Métodos: Foram avaliadas 31 mulheres, que preenchiam os critérios de Roma III e que, ao exame eletromanométrico, apresentaram contração à manobra evacuatória. Essas pacientes foram randomizadas e sorteadas em três grupos: grupo I - tratamento convencional da constipação (TCC), grupo II - TCC associado ao BF, e grupo III - TCC associado à EE. No início do estudo e após seis semanas, foram avaliados os parâmetros subjetivos e objetivos da função anorretal, por meio do sistema de pontuação para constipação de Wexner, escala de Bristol, escala analógica visual e eletromanometria anorretal. Resultados: As pacientes demonstraram melhora da satisfação intestinal, frequência evacuatória, esforço e sensação de evacuação incompleta, modificações do tipo de fezes e melhora da qualidade de vida. Houve aumento da pressão média de contração voluntária no grupo III (p = 0,043), diminuição do limiar de sensibilidade nos grupos II (p = 0,025) e III (p = 0,012) e diminuição da capacidade retal máxima no grupo II (p = 0,005). 19,4% (n = 6) normalizaram a dinâmica evacuatória, e 80,6% (n = 25) expressaram melhora clínica e não instrumental. Conclusão: O TCC, BF e a EE apresentam melhora subjetiva significante dos sintomas da evacuação obstruída e da qualidade de vida, independente da reversão da contração paradoxal da musculatura puborretal.

Transcranial Direct Current Stimulation Combined with Action Observation and Electromyographic Biofeedback Training in a Patient with Writer's Cramp

We present a 47-year-old right-handed woman with a 15-year history of writer's cramp who was provided with six sessions of cathodal transcranial direct current stimulation (tDCS) combined with observation of writing actions performed by a healthy subject and electromyographic (EMG) biofeedback training to decrease EMG activities in her right forehand muscles while writing for 30 min for 4 weeks. She showed improvement in dystonic posture and writing speed after the intervention. The writing movement and writing speed scores on a writer's cramp rating scale decreased, along with writing time. Our findings demonstrated that cathodal tDCS combined with action observation and EMG biofeedback training might improve dystonic writing movements in a patient with writer's cramp.