A three-dimensional printed laryngoscope holding helmet for continuous laryngoscopy during exercise in a pediatric exercise induced laryngeal obstruction clinic.

Fecal incontinence is a common condition that markedly impairs quality of life. Anal biofeedback therapy is recommended as first-line treatment; however, its widespread use is limited by the need for repeated sessions, trained staff, high cost, and patient embarrassment, often resulting in poor adherence. This study aimed to evaluate the effectiveness of self-administered home-based biofeedback therapy and to determine factors associated with treatment success. This prospective, single-center study included adult patients presenting with fecal incontinence. Disease severity and quality of life were assessed using the Wexner score, fecal incontinence severity index (FISI), and fecal incontinence quality of life (FIQOL) scale. Baseline evaluations included anal manometry, electromyography, perianal magnetic resonance imaging, or endoanal ultrasonography. All patients underwent a 3-month home-based anal biofeedback program. Primary outcomes were changes in Wexner, FISI, and FIQOL scores after treatment. Between September 2019 and January 2021, 24 patients were enrolled. The median Wexner score decreased significantly from 18 (4-20) to 6 (0-16) following therapy (p < 0.001). Similarly, the median FISI score improved from 48 (20-57) to 15 (0-45) (p < 0.001). Anal manometry demonstrated a significant increase in median maximum squeeze pressure from 20 (0-80) mmHg to 60 (17-96) mmHg (p < 0.001). Significant improvements were observed across all four FIQOL domains: lifestyle/coping, self-perception/sexuality, depression/anxiety, and embarrassment. Overall, 86% of patients showed improvement in Wexner scores, ranging from 11% to 100%, and 53% achieved a reduction greater than 50%. Self-administered home-based biofeedback therapy is an effective and practical treatment for fecal incontinence. Given its simplicity, accessibility, and cost-effectiveness, it represents a valuable alternative to conventional biofeedback therapy.

Patient: Male, 82-year-oldFinal Diagnosis: GlaucomaSymptoms: Blurred visionClinical Procedure: —Specialty: OphthalmologyObjective: Unusual clinical courseBackgroundAudio-luminous biofeedback training (BT) is a non-invasive method of vision rehabilitation that uses micro-perimeter devices to improve vision by combining visual stimuli with auditory feedback. This rehabilitation method has previously been described to train patients with nystagmus, macular disease, and brain injury. This report describes the case of an 82-year-old man with bilateral primary open-angle glaucoma and improved visual outcomes following BT.Case ReportAn 82-year-old man with bilateral primary open-angle glaucoma came to our service wearing an occlusive patch on the left eye for several months due to visual loss and discomfort. On examination, best-corrected visual acuity (BCVA) was 20/25 in the right eye and 20/100 in the left eye, as tested with ETDRS charts. Macular MAIA microperimetry revealed tunnel vision in both eyes, worse in the left, with relatively preserved sensitivity 2° inferior to the preferred retinal locus (PRL) in both eyes. The right eye underwent four 20-min sessions of BT targeting a trained retinal locus (TRL) 2° inferior to the PRL, matching the better fields in the left eye. Following training, the patient experienced symptomatic improvement and discontinued the use of the patch. Post-training BCVA improved to 20/20 (right) and 20/60 (left) ETDRS. Objective testing showed gains in contrast sensitivity, reading speed, fixation stability, and stereopsis.ConclusionsAudio-luminous BT can be a valuable adjunct for advanced glaucoma, offering functional benefits without adverse effects, especially in therapy-resistant cases. Future studies should investigate long-term outcomes and underlying neurophysiological mechanisms to better define its role in glaucoma vision rehabilitation.

Biofeedback Therapy for Incontinence in a Post-Duhamel Hirschsprung Patient: A Case Report.

Comparative evaluation of user satisfaction in stroke rehabilitation: Wearable vs traditional electromyography biofeedback for wrist and hand dysfunction.

Using data from a randomized clinical trial, we examined whether daily biofeedback training that modulates heart rate oscillations is associated with changes in microstructural brain texture in Alzheimer’s disease–signature cortical (ADSC) and hippocampal regions. Younger and older adults were randomly assigned to one of two daily biofeedback practices for five weeks: slow-paced breathing designed to increase heart rate oscillations (Osc+) or self-selected strategies aimed at decreasing oscillations (Osc−). Intervention effects were observed in both ADSC and hippocampus regions and were confined to a composite texture factor dominated by uniformity and entropy. Across regions, effects were expressed primarily as Time × Condition interactions, indicating differential texture trajectories between Osc + and Osc−. In the hippocampus, this pattern was further qualified by a Time × Condition × Age Group interaction, reflecting more pronounced effects in older adults, whereas younger adults showed no reliable texture modulation. Partial least squares correlation analyses further demonstrated that training-related texture changes in the left hippocampus, right fusiform gyrus, and right entorhinal cortex covaried with concurrent changes in plasma AD-related biomarkers, with tau- and p-tau–related measures contributing most strongly to the multivariate association. Together, these findings suggest that HRV biofeedback may selectively influence specific dimensions of brain microstructural texture and that such changes are meaningfully coupled with plasma AD-related biomarker profiles.

To evaluate the effectiveness of pelvic floor muscle training (PFMT) combined with biofeedback therapy for stress urinary incontinence (SUI) in postmenopausal women and to explore multidimensional changes in symptoms, urine leakage, pelvic floor muscle function, imaging parameters, and urethral dynamics. This single-center retrospective controlled study included 168 postmenopausal women with SUI treated between January 2021 and December 2023 with a 12-week follow-up. The control group received conventional PFMT (n = 82), and the combined group received PFMT plus EMG biofeedback training (n = 86). Primary outcomes were changes in ICIQ-SF and 1-h pad test leakage. Secondary outcomes included pelvic floor EMG parameters, Oxford scale grade, transperineal ultrasound indices, urethral pressure/LPP parameters, and adverse events. At week 12, the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) score showed a statistically significantly greater reduction in the combined group compared to controls (mean difference [MD] 2.6 points; 95% confidence interval [CI] 1.8-3.4; p < 0.001), although this inter-group difference did not reach the predefined minimal clinically important difference (MCID) of 4 points. Pad-test leakage decreased by a mean of 21.8g in the combined group vs. 12.7g in controls (MD 9.1g; 95% CI 5.4-12.8; p < 0.001). The combined group showed larger gains in maximum voluntary contraction (MVC) (+11.7 vs. +6.3µV) and greater reductions in bladder neck mobility (-5.8 vs. -2.8mm) (all p < 0.01). Urethral dynamics showed modest improvements favoring the combined intervention. No severe adverse events occurred. PFMT combined with biofeedback leads to greater short-term (12-week) reductions in objective urine leakage and improved muscle function compared with PFMT alone. However, the incremental benefit in subjective symptom scores, while statistically significant, did not meet the threshold for minimal clinical importance.

Pelvic floor biofeedback therapy (BFT) is the mainstay treatment for dyssynergic defecation, a condition defined by the Rome criteria. This retrospective study compares outcomes between patients referred for EMG-based BFT after anorectal manometry and balloon expulsion testing (ARM group) and those referred directly without prior ARM (DR group). Records of 466 patients who underwent BFT by a single therapist between 2019 to 2023 were reviewed. Inclusion criteria of referral for constipation, no opioid use, and ≥ 2 BFT sessions yielded 208 patients: 137 in the ARM group and 71 in the DR group. Outcomes were assessed using the Colorectal-Anal Distress Inventory-8 (CRADI-8), abdominal pain and quality-of-life impact scores, and therapist/patient ratings. Statistical analysis included Fisher's exact and Wilcoxon rank-sum tests. Of the 208 patients meeting criteria, 50% achieved successful outcomes and 50% were unsuccessful, including those lost to follow-up. Success rates did not differ significantly between the ARM and DR groups (p = 0.393), although the ARM group had worse baseline symptoms (CRADI-8, strain, and empty scores). A successful outcome was associated with significant improvements in the strain and emptying subscores of the CRADI-8, and in quality-of-life limitation scores in both groups. Higher body weight and the absence of documentation of anxiety/depression were associated with success. ARM diagnoses and balloon expulsion test results were not associated with outcomes. Similar outcomes to BFT were seen in both ARM and DR groups. BFT should be initiated based on clinical assessment when ARM access is limited.

Background Stress urinary incontinence (SUI) is a prevalent condition among women. Biofeedback (BF)-assisted pelvic floor muscle training (PFMT) is a widely used conservative treatment, but there is no consensus on the dosage of its application. This study aimed to establish a consensus among a group of experts on the dosage of BF-assisted PFMT in women with SUI. Methods A Delphi survey was conducted online from May to November 2024 using SurveyPluto. Recruited by purposive and snowball sampling, the participants included healthcare professionals or academics with at least two years of experience in treating women with SUI. In round one, experts provided demographic data and opinions on the BF-assisted PFMT dosage, and these were then converted into statements for round two. Rounds two and three involved ranking these statements on a 5-point Likert scale, with consensus defined as ≥70% agreement. Results The expert panel consisted of 15 experts from eight countries. Response rates of 100%, 87%, and 93% were recorded across the three rounds. Initially, 11 treatment dosage principles were proposed in round one. These suggestions were converted into 17 statements for round two, with 11 items reaching consensus. There were two additional statements proposed by the expert panel in round two. Therefore, eight statements were carried forward to round three. All eight evaluated statements achieved consensus in round three. Combining the consensus statements from rounds two and three, a total of 19 recommendations were developed. Conclusion This Delphi study established a recommended BF-assisted PFMT dosage for women with SUI, which may provide exercise guidelines as a decision-support tool for managing SUI.

Background and aim Functional constipation (FC) represents a common pediatric disorder that significantly impairs the quality of life (QOL) in affected children. Therefore, the effects of acupuncture versus biofeedback training on bowel motility, stool consistency, anxiety levels, and QOL were compared in children with FC. Participants and methods Sixty children with FC, aged from 7 to 15 years, were randomly assigned to two equal groups (n = 30 each). Group A received acupuncture, while Group B received biofeedback training, both for four weeks. The primary outcome measures were bowel movement and stool consistency, evaluated using the CSBM and BSFS, respectively. The secondary outcome measures included anxiety levels and QOL, evaluated by SAS and PAC-QOL , respectively. The outcome measures were assessed pre- and post-treatment. Results Post-treatment analysis revealed significant within-group improvements for all outcomes (p = .001). Between-group comparisons of post-treatment scores demonstrated that Group B had significantly better outcomes than Group A across all primary and secondary measures. Specifically, in CSBMs with small effect size (r = −.286; p = .01), BSFS and PAC-QOL with moderate effect size (r = −.462; p = .001 and Cohen’s d = 0.58; p = .02), respectively. Notably, large effect sizes for the SAS (Cohen’s d = 1.43; p = .001). Conclusions Both interventions improve bowel motility and stool consistency, reducing anxiety levels, and boosting QOL among children with FC. However four-week trial, biofeedback demonstrated greater short-term improvements compared to acupuncture. Long-term follow-up is necessary to evaluate the durability of these effects and confirm long-term efficacy.

Solitary rectal ulcer syndrome (SRUS) is a gastrointestinal disorder with a varied range of clinical, endoscopic and histological features. It is often misdiagnosed as inflammatory bowel disease or rectal malignancy. This review aims to outline a practical approach to diagnosing and managing SRUS. The aetiology remains unclear, with contributing factors such as mucosal prolapse, ischemia, paradoxical puborectalis contraction, and digital trauma. Diagnosis involves a comprehensive approach, including clinical history, digital rectal examination, endoscopy, histopathology, and physiological studies. Treatment includes lifestyle modifications, biofeedback therapy, topical agents, sclerotherapy, and surgical intervention for refractory cases. Ongoing surveillance is necessary, especially in patients at high risk for recurrence. Management of SRUS should be individualised and multidisciplinary, particularly in patients with psychiatric comorbidities or during pregnancy, where invasive interventions are minimised. Further research and standardised treatment protocols for SRUS are needed.

Breathing exercises are a low-cost strategy for mitigating daily stress, yet their enhancement via haptic biofeedback devices remains under-explored. These devices may facilitate adaptive breathing by personalizing rhythms via providing haptic cues based on heart rate, blood oxygenation and heart rate variability. We conducted a 2-month longitudinal trial with 62 healthy participants ( years; 81% female) to test whether a haptic breath pacer (“Moonbird”) augments the stress-reducing effects of breathing exercises. Participants were randomized to: (1) haptic feedback + app, (2) app-only, or (3) a no-exercise control. Ecological Momentary Assessment tracked daily affect (valence/arousal) and weekly stress. Students () also reported pre-examination stress. Between-subjects analyses revealed no condition effects on measured outcomes. However, within-subjects analyses showed that participants who felt higher arousal and valence but performed their breathing exercises felt a significant reduction in arousal and increase of valence on the following day. In the haptic group, these effects were moderated by user experience, indicating that benefits are contingent on device usability. Finally, highly stressed students who performed more exercises reported lower examination stress at the end of the semester, irrespective of their assigned condition.

ObjectiveSurgical correction continues to be the mainstay of treatment for nasal valve collapse. This narrative review explores the efficacy of nasal myofunctional therapy, including biofeedback training, nasal muscle exercises, and electrostimulation, in treating nasal valve collapse.Review MethodsA search for abstracts was performed in April 2026 using PubMed, Science Direct, and Cochrane databases using the search terms "nasal muscle", "nasal valve", "exercise", "electromyography", "electric stimulation", "collapse", and "obstruction". Selection criteria were identified and data was extracted by two independent reviewers from the identified studies.ResultsBiofeedback training with nasal muscle exercises showed some improvement in nasal valve function. Electrostimulation resulted in initial improvement but failed to offer long-term benefits. Nasal muscle exercises as a standalone treatment were not found to provide significant subjective improvement. Notably, the addition of electrostimulation to therapy with biofeedback and muscle exercises did not significantly improve nasal valve obstruction.DiscussionPreliminary evidence suggests that there is insufficient high-quality data to support nasal muscle strengthening therapies, including biofeedback training, as effective treatments for nasal valve collapse. While uncontrolled studies report subjective and objective improvements, the highest level of evidence did not demonstrate statistically significant benefit. The limited and heterogeneous literature, along with potential publication bias, underscores the need for further well-designed studies to clarify efficacy and long-term outcomes.

Low anterior resection syndrome (LARS) is a common postoperative complication in patients with low rectal cancer, presenting with a spectrum of bowel dysfunction symptoms, including urgency, incontinence, evacuation disorders, and changes in stool frequency. Pelvic floor muscle training (PFMT) can alleviate LARS, but its effectiveness may be limited by poor accuracy of technique and low adherence during home-based training due to a lack of real-time feedback and monitoring devices. This study aimed to evaluate the effects of a novel integrated balloon biofeedback device for home-based PFMT on accuracy of technique, adherence, quality of life, and LARS reduction in patients after sphincter-preserving surgery for low rectal cancer. A nonrandomized controlled trial was conducted among 164 patients with low rectal cancer who underwent temporary ileostomy without neoadjuvant therapy. Participants were assigned by surgical date to an intervention group (n=82) using an adjustable-pressure balloon device with real-time waveform feedback via a mobile app or a control group (n=82) performing PFMT without equipment. PFMT was initiated within 72 hours after temporary ileostomy and continued throughout the stoma period until 1 month after ileostomy reversal. Outcomes including PFMT accuracy of technique, adherence, LARS score and incidence, and quality of life (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30) were assessed 1 month after stoma reversal. At baseline, major LARS was present in 47.6% (39/82) of patients in the intervention group and 62.2% (51/82) of patients in the control group. Compared with the control group, the intervention group showed significantly higher PFMT training accuracy and adherence (P<.001 in both cases). LARS scores were significantly lower in the intervention group (median 16.00, IQR 11.00-29.00 vs 32.00, IQR 13.75-36.00), with a markedly reduced proportion of major LARS (17/82, 20.7% vs 45/82, 54.9%; P<.001). Global health/quality of life scores were significantly higher in the intervention group (P<.001). The integrated balloon biofeedback device improved the accuracy of technique and adherence to home-based PFMT, reduced the incidence and severity of LARS, and enhanced quality of life in patients after low rectal cancer surgery. These findings support further development and clinical implementation of the device. However, the nonrandomized, time-sequenced study design and baseline differences between groups may limit causal interpretation of the results, and randomized controlled trials with longer follow-ups are needed to confirm long-term efficacy.

Anorectal Disorders.

To evaluate the effectiveness of home biofeedback therapy in patients with dyssynergic defaecation. This single-centre prospective cohort study was conducted in a tertiary general surgery outpatient clinic. Adult patients with dyssynergic defaecation confirmed according to Rome IV criteria and physiological testing were prospectively enrolled after ethical approval. Participants received training on the use of a home-based anal biofeedback device and performed biofeedback exercises at home for 30 min daily over a 12-week period. Changes in Obstructed Defaecation Syndrome Score (ODS-S) and Patient Assessment of Constipation Quality of Life (PAC-QoL) score were evaluated. Twenty-four patients were included in the study. The median ODS-S significantly improved from 17.5 (range, 13-20) at baseline to 3 (range, 0-12) after treatment (P < 0.001). The median PAC-QoL score also showed a significant improvement, decreasing from 104 (range, 65-126) to 49 (range, 32-81) (P < 0.001). Clinical improvement, defined as an ODS-S < 9, was achieved in 75% of patients. Home-based biofeedback therapy is an effective and accessible treatment option for dyssynergic defaecation. Its low cost, ease of use and ability to preserve patient privacy suggest that this modality may serve as a practical first-line therapy.

Anorectal manometry (ARM) and balloon expulsion testing (BET) are often first-line tests to diagnose dyssynergic defecation (DD), followed by either barium or MR defecography if results are equivocal for a defecatory disorder. However, real-world outcomes for these patients are unclear. We aim to characterize patterns of patient treatment after equivocal results on ARM and BET. A retrospective chart review was conducted of patients who obtained ARM and BET at a single referral motility center between January 2024 and February 2025. Demographic data, results of ARM, BET, and MR defecography if obtained were recorded along with the treatment plan at follow-up. Of 409 charts reviewed, 97 patients with equivocal results were included in the study (81.4% female; mean age of 51.6 ± 18.0) and MR defecography was obtained by 30.9% of patients. Of these, 50.0% had findings consistent with DD and 56.7% had significant structural or anatomic abnormalities. Of the remaining 67 patients (69.1%) who did not obtain MR defecography, 31.3% opted for an empiric trial of biofeedback or pelvic physical therapy (PT), 26.9% continued with optimized medical management alone, whereas 14.4% were lost to follow-up. Fewer than one third of patients obtain MR defecography within 6 months of equivocal ARM and BET; almost half of those had results corroborating a diagnosis of DD or significant structural abnormalities on MR defecography. Among patients who did not obtain MR defecography, most opted for an empiric trial of biofeedback/pelvic PT or optimized medical management. More research is needed to identify which patients will substantively benefit from additional confirmatory testing when there are equivocal results.

Chronic constipation and fecal incontinence (FI) are severe and chronic conditions associated with reduced quality of life and distress for those affected. Instrumented anorectal biofeedback has demonstrated efficacy in both conditions and is often described as a learning process, suggesting efficacy is mediated via central cognitive and motivational pathways, but empirical evidence is lacking. The aim of this exploratory study was to seek evidence of change in psychological processes as central mediators of biofeedback treatment efficacy. Patients (n = 135) were prospectively recruited from a tertiary care hospital, diagnosed with constipation likely due to dyssynergic defecation and/or FI. A range of psychological traits covering cognitive processes, emotion regulation, and others were measured at the beginning and end of therapy, along with patient outcomes. Changes in psychological traits were correlated with corresponding changes in patient outcomes, including condition-specific quality of life measures. Improvement in constipation impact on quality of life was most notably correlated with reduced external locus of control (p = 0.004) and reduced use of acceptance as an emotion regulation strategy (p = 0.048). Correlates of improvement in FI impact on quality of life were also related to reduced use of acceptance as well as improvements in measures of executive function (p = 0.0003 to p = 0.03), cognitive flexibility (p = 0.0001 to p = 0.02), and emotional regulation (p = 0.002 to 0.045). Our data strongly support the hypothesis that improvements in the disease impact of constipation and FI during biofeedback are related to concomitant changes in central psychological processes, suggesting that psychological factors play an important part in the mechanism of action of biofeedback therapy.

Aims To conduct a preliminary evaluation of the effectiveness of a clinical virtual-reality (VR) treadmill-based biofeedback treatment program in children and adolescents with cerebral-palsy (CP). Methods This study included preliminary retrospective data from 17 children with CP (mean ± SD age 11.3 ± 3.1 years, Gross-Motor-Function-Classification System level I/II = 8/9). All participants were referred to a series of VR treadmill-based biofeedback training in the Gait Real-time Analysis Interactive Lab system (7–12 treatments for 3–6 wk), adhering to a clinical paradigm. One of the treatment aims for all participants was to increase the knee extension angle during initial contact. Outcome measures included spatiotemporal parameters, dimensionless walking speed (DWS), Gait-Profile-Score (GPS), Gait-Variable-Score (GVS), and kinematics waveforms. Results All but one participant completed all treatments in their series. There was a significant improvement in DWS (p = 0.008), step-length in the more-involved leg (p < 0.001) and reduction in variance in most spatiotemporal parameters (p < 0.05), in addition to small changes in the less-involved leg kinematic waveforms (p < 0.05). Conclusions Overall reductions in spatiotemporal gait deviations were observed following the VR treadmill-based biofeedback series, with strong participant adherence, although no consistent increase in knee extension angle was found. VR biofeedback may be a promising intervention within a clinical paradigm for individuals with CP.

Background: The relationship between facial aesthetic procedures and changes in the stomatognathic system has attracted increasing interest, motivating investigations into their functional and structural impacts. This longitudinal observational study analyzed molar bite force and orofacial tissue pressure in adults who underwent hyaluronic acid injections in the mandibular angle. Methods: Ten adults (eight women and two men; mean age 34.3 ± 11.2 years) with normal occlusion and no temporomandibular disorders were included. The MD Codes guided injection points of 2 mL of hyaluronic acid in the mandibular angle. Maximum right and left molar bite force was measured using a digital dynamometer, and tongue, lip, and cheek pressures were measured with a Pro-Fono Biofeedback device. Assessments occurred before and at 15, 30, and 60 days. Repeated measures ANOVA with Bonferroni correction was applied (p < 0.05), and effect sizes and 95% confidence intervals were calculated. Results: No statistically significant differences were observed in maximum molar bite force throughout the follow-up period. Regarding orofacial pressures, a significant main effect of time was observed for tongue pressure (p = 0.03); however, the effect size was moderate-to-large, and values showed considerable variability across participants. Lip and cheek pressures remained stable over time. Conclusions: Hyaluronic acid injection in the mandibular angle did not show clinically detectable changes in maximum molar bite force, suggesting short-term preservation of masticatory function within the 60-day follow-up period. These findings are limited to short-term observations and specific sample characteristics. The observed variation in tongue pressure may reflect adaptive functional adjustments, although variability across participants was considerable.