Biofeedback In Children Research Articles

Efficacy and safety of solifenacin combined with biofeedback in children with overactive bladder

BackgroundOveractive bladder is a common chronic urological disorder in children, liable to impact normal social activities, disrupt sleep and even impair self-esteem. We aimed to evaluate the efficacy and safety of solifenacin combined with biofeedback for paediatric overactive bladder.MethodForty-five children with overactive bladder were enrolled and divided into three groups: 15 patients in Group A were treated with solifenacin, 15 cases in Group B with biofeedback, and the other 15 patients in Group C with the combination of solifenacin plus biofeedback. Each group was subdivided into the non-urge incontinence (non-UI) and urge incontinence (UI) groups. The remission rates were compared among the three groups at 2, 4, 8 and 12 weeks from the beginning of treatment. The side effects of solifenacin were recorded and followed up.ResultAfter 2 weeks since initial treatment, the complete response rates were 33.3% (5/15), 20.0% (3/15), and 53.3% (8/15) in the three groups. At 4 weeks, the complete remission rates were 46.7% (7/15), 33.3% (5/15), and 60.0% (9/15) respectively. Moreover, the complete remission rates of the UI groups were higher than the non-UI groups (p < 0.05). At 8 weeks, the complete response rates were 53.3% (8/15), 40.0% (6/15), and 67.7% (10/15). At 12 weeks, the complete response rates were 67.8% (10/15), 60.0% (9/15), and 86.7% (13/15). The complete response rates were higher and urodynamic parameters were improved obviously in group C than the other two groups (p < 0.05) during the follow-ups. The median voiding frequency decreased and median functional bladder capacity increased obviously in Group C after 4 weeks (p < 0.05). Dry mouth was observed in 2 patients (4.4%). 2 patients experienced constipation (4.4%), and neither case was severe. The symptoms of these four patients had relieved by reducing the dose of solifenacin.ConclusionSolifenacin combined with biofeedback had good efficacy and compliance for children experiencing overactive bladder. It took only 2 weeks to achieve the complete response rate over 50%, especially for the improvement of UI symptoms.

Rational Use of Drugs in the Complex Treatment of Bronchobstructive Syndrome in Children

Treatment of biofeedback in children and the complex use of drugs, that is, each drug must be pathogenetically justified, taking into account the individual characteristics of the child, and also based on knowledge of the mechanism of their action and pharmacokinetics. It is necessary to have a complex effect on individual links in the pathogenesis of broncho-obstructive syndrome in many cases, which justifies the use of complex drugs with a combined mechanism of action. Thus, the treatment of biofeedback in children is a responsible task for the pediatrician, which consists in the rational selection of drugs.

Visual Feedback and Virtual Reality in Gait Rehabilitation of Hemiparetic Children and Teenagers after Acquired Brain Injury: A Pilot Study

Hemiparesis as a term refers to a neurological disorder that can be extremely variable, especially with regard to walking abilities. Few works have assessed the use of virtual reality and biofeedback in children and adolescents with hemiparesis. The aim of this study is to provide insights about the rehabilitation of hemiparetic children and teenagers with visual biofeedback in a virtual reality environment. Six hemiparetic subjects (mean age 13.13 years, age range (7-18), 4 males) received 20 personalized rehabilitation GRAIL (Gait Real-time Analysis Interactive Lab) sessions plus 20 sessions of traditional physiotherapy. After an initial evaluation of rehabilitation needs, training focused on gait pattern correction (GP), walking endurance (WE), or gross motor functions (GMFs). All subjects were assessed for their gait analysis by GRAIL, the Gross Motor Function Measure (GMFM), and the 6-Minute Walking Test (6MWT) before and after rehabilitation. All subjects reached their rehabilitation goals, save for one who showed reduced collaboration. In addition, 4 subjects reached a better GP, 3 subjects reported improvements in WE, and 2 subjects improved in GMF. This personalized training with visual biofeedback delivered in a VR setting appears to be effective in modifying motor control and improving gait pattern, in addition to resistance and functional activities, in subjects with hemiparesis.

Multi-session adaptation to combined audiovisual and sensorimotor biofeedback in children with cerebral palsy

Multi-session adaptation to combined audiovisual and sensorimotor biofeedback in children with cerebral palsy

Is heart rate variability biofeedback useful in children and adolescents? A systematic review.

Heart rate variability (HRV) is considered as an index of both physical and emotional health, and biofeedback aiming to increase the level of HRV has demonstrated extensive beneficial effects. Although HRV biofeedback is commonly and reliably applied in adults, the use of this technique, alone or in addition to other treatments, in children and adolescents has not been widely explored to date. This systematic review following PRISMA guidelines covers all human studies using HRV biofeedback in children and adolescents. A literature search was conducted in PsycINFO, PubMed and Scopus, and a standardized methodological quality assessment was performed. Results showed the efficiency of HRV biofeedback sessions with children and adolescents to reduce physical and mental health-related symptoms and enhance well-being. These findings underline the therapeutic value of using HRV biofeedback as a complement to more conventional behavioural and cognitive interventions to help children to manage stress and/or pain. Capitalizing on the identified strengths and shortcomings of available results, we propose research avenues as well as evidence-based clinical guidelines for using HRV biofeedback in clinical paediatric settings.

Biofeedback in pediatric populations: a systematic review and meta-analysis of treatment outcomes.

Biofeedback is commonly used for both pediatric and adult patients with a myriad of diagnoses in clinical settings. The majority of previous research has focused on the use of biofeedback in adults, with only a small body of literature examining the usefulness of biofeedback in treating children. The current systematic review and meta-analysis seeks to quantitatively examine the usefulness of biofeedback in addressing pediatric conditions. A systematic review of biofeedback interventions in children was conducted using four databases (Ovid MEDLINE, EMBASE, PsycINFO, and Cochrane CENTRAL). Outcomes included changes in symptoms of associated conditions or changes in physiological functioning. Out of 3,128 identified articles, 23 studies (with 24 effect sizes) were eligible for inclusion in the meta-analysis. Using a random effects model, the overall effect of pediatric biofeedback was statistically significant with a large effect size. Despite the large effect size, general study quality was low, limiting interpretation of findings. Despite widespread clinical use of biofeedback in pediatric populations, research is still limited concerning the efficacy of biofeedback in children. While findings suggest potential positive effects of biofeedback to address pediatric conditions, high-quality studies are necessary to fully support the use of biofeedback in children.

Eucapnic voluntary hyperventilation test in children.

In children, exercise-induced dyspnea is a common symptom that can be due to dysfunctional breathing. EVH test has bee used especially in elite athletes as bronchoprovocation test. Currently, there are only few studies on the EVH test. New research methods are required alongside the traditionally used tests especially due to dysfunctional breathing disorder. The purpose of the "pilot study" was to study the usability of the EVH test with real time biofeedback in children of 10-16years of age in the diagnostics of exercise-induced dyspnea. Six 10-16-year-old teenagers with history of exercise-induced dyspnea and three healthy control subjects were selected for the study. A 6-minute EVH test with realtime biofeedback was performed on the patients and the diagnosis was confirmed on the basis of clinical findings and spirometry follow-up either as normal, asthma or dysfunctional breathing. The study was successful in the patients. In the spirometry follow-up, three patients had bronchoconstriction (FEV1 decline over 10%), dysfunctional breathing condition was observed in three patients and three control patients experienced no symptoms. Only two DFB-patients didn't reach the target level of minute ventilation due to a clinical symptom (inspiratory stridor). The EVH test was successful in the 10-16-year-old children having participated in the study and the test was well tolerated. Through the study, it was possible to provoke both dysfunctional breathing disorder and bronchoconstriction in the symptomatic patients. Based on the pilot study, EVH test seems to be usable in the diagnostics of pediatric exercise-induced dyspnea but larger studies are warranted to confirm our preliminary findings.

C191: Results of application of biofeedback in children with functional bladder outlet obstruction

C191: Results of application of biofeedback in children with functional bladder outlet obstruction

Comparing tomographic EEG neurofeedback and EMG biofeedback in children with attention-deficit/hyperactivity disorder

Two types of biofeedback (BF), tomographic electroencephalogram (EEG) neurofeedback (NF) and electromyographic biofeedback (EMG-BF), both with phasic and tonic protocols, were compared for treatment effects and specificity in attention-deficit/hyperactivity disorder (ADHD). Thirteen children with ADHD trained their brain activity in the anterior cingulate cortex (ACC), and twelve trained activity of arm muscles involved in fine motor skills. In each training session, resting state 24-channel EEG and training performances were recorded. Both groups showed similar behavioral improvements and artifact reduction in selected conditions, with no significant advantages despite medium effect sizes on primary outcomes for NF. Only the EMG-BF group, however, showed clear improvement in training regulation performance, and specific motor coordination effects. The NF group tended to present individual normalization of trained frequency bands in the ACC during rest across training. The results provide evidence for some specific effects in our small sample, albeit only to a small extent.

Cochrane review: Behavioural and cognitive interventions with or without other treatments for the management of faecal incontinence in children

AbstractBackgroundFaecal incontinence is a common and potentially distressing disorder of childhood.ObjectivesTo assess the effects of behavioural and/or cognitive interventions for the management of faecal incontinence in children.Search strategyWe searched the Cochrane Incontinence Group Specialised Trials Register (searched 1 February 2006).Selection criteriaRandomised and quasi‐randomised trials of behavioural and/or cognitive interventions with or without other treatments for the management of faecal incontinence in children.Data collection and analysisReviewers selected studies from the literature, assessed study quality, and extracted data. Data were combined in a meta‐analysis when appropriate.Main resultsEighteen randomised trials with a total of 1168 children met the inclusion criteria. Sample sizes were generally small. All studies but one investigated children with functional faecal incontinence. Interventions varied amongst trials and few outcomes were shared by trials addressing the same comparisons.Combined results of nine trials showed higher rather than lower rates of persisting symptoms of faecal incontinence up to 12 months when biofeedback was added to conventional treatment (OR 1.11 CI 95% 0.78 to 1.58). This result was consistent with that of two trials with longer follow‐up (OR 1.31 CI 95% 0.80 to 2.15). In one trial the adjunct of anorectal manometry to conventional treatment did not result in higher success rates in chronically constipated children (OR 1.40 95% CI 0.72 to 2.73 at 24 months).In one small trial the adjunct of behaviour modification to laxative therapy was associated with a significant reduction in children's soiling episodes at both the three month (OR 0.14 CI 95% 0.04 to 0.51) and the 12 month assessment (OR 0.20 CI 95% 0.06 to 0.65).Authors' conclusionsThere is no evidence that biofeedback training adds any benefit to conventional treatment in the management of functional faecal incontinence in children. There was not enough evidence on which to assess the effects of biofeedback for the management of organic faecal incontinence. There is some evidence that behavioural interventions plus laxative therapy, rather than laxative therapy alone, improves continence in children with functional faecal incontinence associated with constipation.Plain language summaryBehavioural interventions for the treatment of faecal incontinence in childrenChildren with "faecal incontinence" cannot control their bowel movements and so they soil their underwear. Sometimes people use the word "soiling" or "encopresis" to mean the same thing. Faecal incontinence can be caused by either physical or psychological problems. The term "organic faecal incontinence" is used when faecal incontinence is due to a physical damage or abnormality whilst "functional faecal incontinence" is used when faecal incontinence is caused by non‐organic/psychological factors. Behavioural interventions (toilet training, rewards) are used to reduce children's anxiety and to restore normal bowel habits. Biofeedback is a technique that can be used to teach children how to control the muscles around their back passage.This review identified 18 studies with a total of 1168 children. Behavioural interventions when used together with laxative therapy may improve continence in children with non‐organic faecal incontinence and constipation whilst biofeedback does not add any long‐term benefit. Children who received biofeedback treatment had not always evaluated beforehand for the suitability of the treatment.There was not enough evidence to assess the effects of biofeedback in children with organic faecal incontinence.

Application of Biofeedback in Children with Primary Nocturnal Enuresis

近年来,生物反馈治疗作为一种新的行为治疗方法在原发性遗尿症患儿中逐渐得到应用,主要应用于膀胱功能紊乱,尤其是逼尿肌-括约肌收缩不协调的患儿.治疗模式主要包括膀胱生物反馈训练、排尿生物反馈治疗及交互式电脑游戏生物反馈.治疗的频率一般为每周1～2次,效果随访时间至少3个月.疗效评估指标主要依据临床症状改善情况、尿动力学及残余尿改变情况等.治疗效果与患儿的依从性、理解力、膀胱容量及便秘习惯等因素有关。

Is it Reasonable to Treat Refractory Voiding Dysfunction in Children With Botulinum-A Toxin?

We present our results with botulinum-A toxin transperineal pelvic floor/external sphincter injection combined with behavioral and biofeedback reeducation in children with voiding dysfunction who had been resistant to previously applied therapies. Eight boys and 12 girls between 7 and 12 years old (mean age 9) with recurrent urinary tract infection, an interrupted or fractional voiding pattern and high post-void residual urine in whom behavioral, short biofeedback and alpha-blocker therapies had failed were included in the study. They were treated with botulinum-A toxin at a dose of 50 to 100 U. Botulinum-A toxin was injected transperineally into the pelvic floor and/or external sphincter in all patients. In boys the sphincter was localized endoscopically before injection (endoscopically assisted transperineal approach). Behavioral and biofeedback reeducation started 15 days after injection. Followup was between 9 and 14 months. All patients were without urinary tract infection and fever, while 5 were still on chemoprophylaxis. Six months after treatment residual urine decreased in 17 of 20 patients by 0 to 130 ml (mean +/- SD 45.75 +/- 32.17 ml, t = 6.360, p <0.001). Nine patients reestablished a normal voiding curve and 8 showed improvement. Three did not manifest any significant improvement. In 1 girl transitory incontinence resolved spontaneously within 48 hours. There were no other complications. The effect of botulinum is transitory. However, it can break the circle of detrusor-sphincter dyssynergia and the period when it is sustained can be used for retraining the patient in normal voiding. At this moment botulinum-A toxin is one of last options in refractory cases of voiding dysfunction.

High-intensity, short-term biofeedback in children with Hinman's syndrome (non-neuropathic voiding dyssynergia)

Objective To evaluate the long-term response to high-intensity, short-term biofeedback in children with severe voiding dysfunction. Patients and methods We retrospectively reviewed patients who underwent short-term, high-intensity biofeedback therapy from 1996 to 2004. Improvement was classified based on clinical and radiographic findings. Patients were categorized as having Hinman's syndrome when, in addition to urinary incontinence, at least four of the following categories were present: sphincter dyssynergia, bladder trabeculation, large post-void residual (PVR), hydronephrosis, vesicoureteral reflux (VUR) and urinary tract infections. There were 14 patients (eight males and six females), 13 of whom had Hinman's syndrome. Age when biofeedback was initiated varied from 5.6 to 12.9 years ( μ = 8.9 ± 2.2). Before biofeedback, all had large PVRs, bladder trabeculation and sphincter dyssynergia. Nine had hydronephrosis and five had VUR. One patient had renal failure. Results Before biofeedback, the mean PVR was 109 ml (25–270 ml); after biofeedback, this decreased to 21 ml (0–150 ml), including two patients who eventually failed treatment. All 14 patients were able to relax their external sphincter and reduce the PVR during biofeedback and on short-term follow up. Long-term follow up ( μ = 59.4 months) in 12 patients established that seven had a durable response with remission of symptoms, reduced PVR and radiographic improvement. In three, symptoms partially recurred over time and two failed treatment completely. Conclusion Short-term, high-intensity biofeedback achieves a durable response in the majority of children with Hinman's syndrome. Long-term follow up is needed to assure compliance.

Assessment of the Effectiveness of Biofeedback in Children with Dyssynergic Defecation and Recalcitrant Constipation/Encopresis: Does Home Biofeedback Improve Long-Term Outcomes

The purpose of this study was to determine whether biofeedback benefits children with dyssynergic defecation and constipation/encopresis, and whether home biofeedback improves long-term outcomes. Thirty-six patients with chronic constipation who had failed at least 6 months of conventional treatment and demonstrated dyssynergic defecation at anorectal manometry were randomized to biofeedback in the laboratory alone (group 1, n=24) or in the laboratory and at home (group 2, n=12) and followed up at 2, 4, and a mean of 44 months. Thirty patients were available for long-term follow-up. Bowel movements increased in all from a mean of 1.4/week to 5.1, 5.8, and 5.1 per week at 2 months, 4 months, and long-term, respectively (p < or = 0.001). Soiling decreased in all from a mean of 5.5/week to 0.6, 0.1, and 1 per week at 2 months, 4 months, and long-term, respectively (p < or = 0.001). Laxative use decreased from a mean of 4.1 days/week to 0.6, 0.3, and 0.7 per week at 2 months, 4 months, and long-term, respectively (p < or = 0.001). Twenty-seven of 30 parents ranked their satisfaction a mean of 2.2 (range 1-excellent to 3-good). There were no significant differences in outcomes between the laboratory alone group and the laboratory plus home group. Biofeedback is beneficial for some children with chronic constipation and dyssynergic defecation. Supplemental home biofeedback does not improve long-term outcomes.

CHANGING CONCEPTS CONCERNING THE MANAGEMENT OF VESICOURETERAL REFLUX

Conservative estimates indicate that up to 54% of patients who present with vesicoureteral reflux have dysfunction voiding. Children with voiding dysfunction and vesicoureteral reflux historically have a high breakthrough infection rate of 34% to 43%. Breakthrough infection represents significant morbidity and it is the most common indication for surgical intervention for vesicoureteral reflux. Voiding dysfunction is present in 79% of patients who proceed to reflux surgery. We evaluated the impact of pelvic floor muscle retraining combined with a medical program in patients with voiding dysfunction and vesicoureteral reflux. Children with a history consistent with voiding dysfunction and vesicoureteral reflux were screened by uroflowmetry/electromyography, bladder scan for post-void residual urine, renal ultrasound and voiding cystourethrography. Confirmed cases of voiding dysfunction and vesicoureteral reflux were prospectively enrolled in this study. Children participated in an interactive, computer assisted, pelvic floor muscle retraining program that involved a conservative medical regimen and pelvic floor muscle retraining. All patients received prophylactic antibiotics. We evaluated the rate of breakthrough urinary tract infection, reflux outcome and surgical intervention. A literature review with the key words vesicoureteral reflux, voiding dysfunction and urinary tract infection was performed to identify historical control cases for comparison. Study enrollment criteria were fulfilled by 49 girls and 4 boys 4 to 13 years old (average age 8.8), representing 72 units with low grades I to II (48) and high grades III to V (24) reflux. Mean followup was 24 months. Initial uroflowmetry/electromyography and bladder scan revealed a staccato flow pattern and normal post-void residual urine in 11% of cases, staccato flow pattern and elevated post-void residual urine in 10%, flattened flow pattern and normal post-void residual urine in 28%, and flattened flow pattern and elevated post-void residual urine in 51%. Breakthrough infection developed in 5 patients (10%), including 1 in whom reflux had resolved and 1 with grade I reflux who underwent observation. The parents of 2 patients elected to complete biofeedback without surgical intervention and these patients did not have a repeat infection. Reimplantation was performed in 1 case (2%). There was resolution in 18 low and 7 high grade refluxing units, including 2 older patients with a long history of high grade bilateral disease. Average time to resolution was 7.8 months. We noted elevated post-void residual urine in 88% of the patients with high grade reflux. Average age at resolution was 9.2 years. During a 24-month period one of us (P. H. M.) noted a greater than 90% decrease in surgical intervention. A combined conservative medical and computer game assisted pelvic floor muscle retraining program appears to have decreased the incidence of breakthrough urinary tract infections and facilitated reflux resolution in children with voiding dysfunction and vesicoureteral reflux. Patients with high grade reflux and voiding dysfunction commonly present with elevated post-void residual urine, contraindicating the indiscriminate administration of anticholinergics. Decreasing the rate of urinary tract infections may have a dramatic impact on the need for surgical intervention and enable the reflux resolution rate to approximate that in patients without voiding dysfunction. Prospective controlled trials are needed to determine whether pelvic floor muscle retraining combined with a conservative medical regimen alters the natural history of vesicoureteral reflux in patients with voiding dysfunction.

The usefulness of a minimal urodynamic evaluation and pelvic floor biofeedback in children with chronic voiding dysfunction.

To report our experience of assessing children with chronic voiding dysfunction (>6 months' duration) using a minimal urodynamic evaluation, and the management of detrusor-sphincter dyscoordination (DSdc) using pelvic floor biofeedback. From 1994 to 1997, 120 children (mean age 7.5 years) with three predominant and associated symptoms were referred to one urologist; they had nocturnal enuresis (28 children), urge incontinence (42) or urinary tract infection (50). All patients were assessed by urinary culture, renal ultrasonography and a minimal urodynamic evaluation, i.e. urinary flowmetry with sphincter electromyography (EMG) using perineal surface electrodes. If they had urinary tract infection and/or renal dilatation, they underwent voiding cysto-urethrography. In children with DSdc, urinary training with frequent voiding was instituted initially, with subsequent pelvic floor biofeedback exercises if the improvement was deemed unsatisfactory. DSdc was diagnosed in 33 children (28%), none of whom had isolated nocturnal enuresis. Pelvic floor biofeedback was undertaken by 15 children (12 girls and three boys); it was well accepted because it was administered as a computer game. In all affected patients the DSdc resolved on EMG and there was a significant clinical improvement. Vesico-ureteric reflux was detected in 24 patients, associated with DSdc in 10. The reflux resolved spontaneously on antibiotic prophylaxis in six children and after urinary re-education in four. A minimal urodynamic evaluation seems to be useful in the diagnosis of DSdc which caused urinary tract infection and/or bladder overactivity. The results with pelvic floor biofeedback were excellent in these children.

Clinical and Psychophysiological Effects of Temperature Biofeedback in Children with Migraine

Clinical and Psychophysiological Effects of Temperature Biofeedback in Children with Migraine

Skin temperature biofeedback in children and adults

Skin temperature biofeedback performance was studied in 38 children, ages 6 to 10, and 38 of their parents, across two sessions of audio biofeedback segments in which the participants alternately attempted hand-warming and hand-cooling. Skin temperature from each hand was monitored throughout, but only one hand at a time was in the feedback loop. The major finding was that children were superior to adults in controlling skin temperature in the presence of biofeedback ( p < .001). Adults showed no skin temperature control. For children, temperature changes were greater for the hand in the feedback loop as compared to the contralateral hand ( p < .001). Children were equally successful in increasing and decreasing skin temperature. The results are consistent with earlier studies and suggest that children have considerable potential for neuropsychological self-regulation.