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.

Biofeedback in dysphonia - progress and challenges.

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.

Effectiveness of biofeedback therapy in patients with chronic constipation

PURPOSE: The purpose of this study was to evaluate the effect of physical therapy in women diagnosed with chronic constipation using functional training of the pelvic floor (biofeedback). PATIENTS AND METHODS: From March 2009 to March 2010, 67 women with chronic constipation were prospectively evaluated. The patients were evaluated and the constipation score proposed by Agachan et al. was applied. Then, they were sent to biofeedback. These patients were divided into 2 groups: with anismus (group I: mean age of 46.90 years old) and without anismus (group II: mean age of 44.89 years old) and diagnosed by anorectal electromanometry. The treatment was performed with different exercises for each group, associated with some hygieno-dietetic directions. At the end of treatment, the constipation score was reapplied. RESULTS: Pre-biofeedback constipation score in group I was 15.04 (standard deviation - SD=2.48) and post-biofeedback constipation score was 3.39 (SD=1.62) (p<0.0001). Pre-biofeedback constipation score in group II was 14.82 (SD=2.401) and post-biofeedback constipation score was 2.90 (SD=1.64) (p<0.0001). Besides, a significant difference (p<0.005) was observed between the groups regarding the number of biofeedback sessions. CONCLUSION: Thus, the authors conclude that biofeedback is effective in the treatment of constipation. (AU)

OBJETIVO: Este trabalho objetivou avaliar o efeito do tratamento fisioterapêutico, em mulheres diagnosticadas com constipação crônica, utilizando treinamento funcional do assoalho pélvico (biofeedback). CASUÍSTICA E MÉTODO: No período de março de 2009 a março de 2010, foram avaliadas, prospectivamente, 67 mulheres com constipação intestinal. As pacientes foram avaliadas e o escore de constipação, proposto por Agachan et al., foi aplicado; então, foram encaminhadas ao biofeedback. Essas pacientes foram divididas em 2 grupos: com anismus (56 pacientes do grupo I: média de idade 46,90 anos) e sem anismus (11 pacientes do grupo II: média de idade 44,89 anos), diagnosticadas pela eletromanometria anorretal. Para o tratamento, foram estipulados exercícios diferentes para cada grupo, associados com orientações higienodietéticas. Ao fim do tratamento, foi reaplicado o escore de constipação. RESULTADOS: O escore de constipação do grupo I, na avaliação pré-biofeedback, foi 15,04 (desvio padrão - DP=2,48) e, no pós-tratamento, foi 3,39 (DP=1,62) (p<0,0001). O escore de constipação do grupo II, na avaliação pré-biofeedback, foi 14,82 (DP=2,401) e, no pós-tratamento, foi 2,90 (DP=1,64) (p<0,0001). Além disso, em relação ao número de sessões de biofeedback entre os grupos, houve diferença significativa (p<0,005). CONCLUSÃO: Concluiu-se que o biofeedback é eficaz no tratamento da constipação intestinal. (AU)