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

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

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.

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

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

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

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

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.

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.

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.

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).

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

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?

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.

Questions

Thank you from Adult Speech Impairment Group.

References Scott, S., Caird, F.I. (1983). Speech Therapy for Parkinson’s 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.

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.

Murdoch, B. E. , Pitt, G. , Theodoras, D. G. , Ward, E. C. (1999) 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.