Abstract
To review systematically the literature and to analyze the effectiveness of surface electromyographic biofeedback in the rehabilitation of adults with behavioral dysphonia. Two authors performed an independent search in the following databases: Clinical Trials, Cochrane Library, Embase, LILACS, PubMed, and Web of Science. A specific search strategy was developed for each database. The review included studies that examined the effectiveness of surface electromyographic biofeedback compared to other direct vocal therapy intervention in adults with behavioral dysphonia. There were no restrictions in regard to language or date of publication. Analysis of the risk of bias, heterogeneity, quantitative and qualitative data, sensitivity, subgroups, and publication bias. 51 studies were identified, but only two cohort studies remained as prospects for analysis. The studies showed 100% uncertain risk of selection, performance, and detection bias. There was a high degree of clinical heterogeneity. The descriptive analysis showed a reduction in muscle electrical activity and improvement in vocal self-assessment using electromyographic biofeedback; however, it was not possible to calculate the effect size of the interventions. The present study was limited by the fact that it was unable to show a consensus for the majority of data analyzed. The available literature does not support a conclusive finding about the effectiveness of surface electromyographic biofeedback compared to other direct interventions used in the rehabilitation of adults with behavioral dysphonia. The studies analyzed vary widely in their clinical procedures and methodology, making it impossible to determine the procedure's effectiveness.
Highlights
Behavioral dysphonias are vocal changes arising from one or more changes in the way the voice is produced or used, and it can be related to improper vocal habits or techniques, excessive muscle tension, or vocal misuse and abuse(1)
The underlying clinical question that structured the present study is the following: “How effective is surface electromyographic biofeedback compared to other direct vocal therapy interventions in the vocal rehabilitation of adults with behavioral dysphonia?”
Group 1—pre: 37.53 ± 9.03; post: 30.78 ± 8.76; Group 2— pre: 34.13 ± 11.96; post: 30.98 ± 12.78; Group 3—pre: 32.81 ± 15.19; post: 28.86 ± 9.82
Summary
Behavioral dysphonias are vocal changes arising from one or more changes in the way the voice is produced or used, and it can be related to improper vocal habits or techniques, excessive muscle tension, or vocal misuse and abuse(1) These dysphonias are commonly associated with voice disorders, such as upper airway disorders; increased tension or mass in the vocal folds that causes postural changes or benign lesions on these folds; tense, rough, whispery, or unstable voice quality; laryngeal or pharyngeal resonance; and restricted articulation(1-5). They can be related to alterations in the tension or function of the shoulder girdle or perilaryngeal muscles(3-12). The direct approach is employed in order to change vocal behavior through practicing vocal techniques and exercises, ranging from production by itself to its association with function, with the goal of achieving an efficient, normative use of the voice
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