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Biofeedback and acquired dysarthria treatment: Is what you see what you get?

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Pediatric Rehabilitation, 3 (1), 5-20. Rubrow, R.T, Rosenbek, J.C., Collins, M.J., Celesia, G.G. (1984). Reduction of hemifacial spasm and dysarthria following EMG ... – PowerPoint PPT presentation

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Title: Biofeedback and acquired dysarthria treatment: Is what you see what you get?


1
Biofeedback and acquired dysarthria treatment Is
what you see what you get?
  • Adult Speech Motor EBP Group
  • December 2007
  • Presented by Sarah Townsend

2
Clinical Question
  • In patients with acquired dysarthria does
    biofeedback improve intelligibility?

3
Definition of biofeedback
  • Biofeedback involves presenting a physiological
    variable to a person in a format that will
    facilitate shaping of their behaviour eg levels
    of activity in respiratory muscles during speech
    breathing represented on a visual display or as
    an auditory signal.

4
Initial challenges
  • Definition of the clinical question
  • Definition of biofeedback
  • Determining relevant population

5
Search terms
  • Dysarthria, speech impairment, speech pathology,
    speech therapy, biofeedback, treatment, sEMG,
    EMG.

6
Search engines/databases
  • Cinahl, Medline, PsychINFO, Comdisdome, AMED,
    Cochrane Library.
  • Also manual searching of reference lists.

7
Process Challenges
  • Research limited and in many cases dated.
  • Access to full text journals-especially given
    length of time since publication.
  • Many single subject studies.
  • Book chapters

8
Issues with Results
  • Limited by the lack of evidence of even Level IV
    standard.
  • Studies with healthy subjects.
  • Studies relating to variables affecting speech
    but not directly targeting speech production.

9
Results
  • 22 papers were reviewed.
  • 4 studies were deemed appropriate for inclusion
    in the CAT.
  • Levels of evidence represented by these studies
    Level II, III 3, Level III 1, Level IV.

10
What the studies tell us
  • Please see CAPs for Volin (1998), Yorkston,
    Spencer and Duffy (2003), and Scott and Caird
    (1983) to be presented on EBP network website.

11
What the case studies tell us
  • Some single subject studies are well designed
    with good internal controls. Some are actually
    case studies.
  • Single subject studies report on participants
    with a range of strokes, TBI and progressive
    neurological conditions (ie MS).

12
Clinical Bottom Line (almost)
  • There may be a role for the use of biofeedback
    in the treatment of dysarthria particularly where
    patients demonstrate poor stimulability. More
    research is needed in relation to the following

13
  • Is biofeedback more effective than traditional
    treatments?
  • Is the use of biofeedback more effective with
    particular types of patients/conditions?
  • Is it more effective at different phases of
    rehabilitation?
  • Does biofeedback help to facilitate
    generalisation?

14
Challenges to implementation of the evidence.
  • More evidence needed.
  • Function and cost of biofeedback equipment
    described in studies.
  • The next step
  • ? Investigate this question in relation to other
    speech motor disorders such as apraxia of speech.

15
Questions
16
  • Thank you from Adult Speech Impairment Group.

17
References
  • Scott, S., Caird, F.I. (1983). Speech Therapy
    for Parkinsons Disease. Journal of Neurology,
    Neurosurgery Psychiatry, 46, 140-144.
  • Volin, R.A. (1998). A relationship between
    stimulability and the efficacy of visual
    biofeedback in the training of a respiratory
    control task. American Journal of Speech-Language
    Pathology, 7, (1), 81-90.
  • Yorkston, K.M., Spencer, K.A., Duffy, J.R.
    (2003). Behavioural Management of
    respiratory/phonatory dysfunction from
    dysarthria A systematic review of the evidence.
    Journal of Medical Speech-Language Pathology, 14
    (2), xiii-xxxviii.

18
Further References
  • Berry, W.R., Goshorn, E.L. (1983). Immediate
    visual feedback in the treatment of ataxic
    dysarthria a case study. In W.R. Berry (ed),
    Clinical Dysarthria. College-Hill Press Inc, San
    Diego CA.
  • Caliguiri, M.P, Murry, T. (1983). The use of
    visual feedback to enhance prosodic control in
    dysarthria. In W.R. Berry (ed), Clinical
    Dysarthria. College-Hill Press Inc, San Diego CA.
  • Drazier, A. (1984). Clinical EMG feedback in
    motor speech disorders. Archives of Physical
    Medicine and Rehabilitation, 65, 481-484.

19
  • Murdoch, B.E., Pitt, G., Theodoras, D.G., Ward,
    E.C. (1999). Real-time continuous visual
    biofeedback in the treatment of speech breathing
    disorders following childhood traumatic brain
    injury Report of one case. Pediatric
    Rehabilitation, 3 (1), 5-20.
  • Rubrow, R.T, Rosenbek, J.C., Collins, M.J.,
    Celesia, G.G. (1984). Reduction of hemifacial
    spasm and dysarthria following EMG biofeedback.
    Journal of Speech and Hearing Disorders, 49,
    26-33.
  • Stinger, A.Y. (1996). Treatment of motor
    aprosodia with pitch biofeedback and expression
    modelling. Brain Injury, 10 (8), 583-590.
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