Biofeedback Techniques and Behaviour Modification in the Conservative Remediation of Drooling by Children With Cerebral Palsy

Abstract

SUMMARY In an attempt to decrease the rates of drooling of 12 children with cerebral palsy, the authors investigated the effectiveness of EMG auditory feedback training of the orbicularis oris, of making the act of swallowing a conscious one, and of providing an auditory signal to cue swallowing by means of an Accularm interval timer. After biofeedback training there was a significant decrease in drooling rates and a small increase in swallowing rates. After the Accularm was used the children maintained the decreased drooling rates and there was a further small improvement in swallowing rates. One month after treatment stopped there was a nonsignificant regression in the rates of both drooling and swallowing. The marked decrease in drooling after biofeedback training must be attributed to more effective swallowing as a result of improved oral motor control, rather than to increased rates of swallowing. RÉSUMÉ Dans le but de décroitre l'importance du bavage de 12 jeunes IMC, les auteurs ont cherchéà apprecier l'efficience d'un apprentissage par feedback auditif d'EMG sur l'orbiculaire des lèvres, lors d'un acte conscient de déglutition et fournissant un signal auditif comme clef de déglutition au moyen d'une horloge à intervalle ‘Accularm’. Après un apprentissage en biofeedback, il a été observé une diminution significative du bavage el un faible accroissement de la déglutition. Aprés que l'Accularm ait été utilisé, la baisse du taux de bavage persistait et il y avait un petit progrès associè dans la déglutition. Un mois après l'arrêt du traitement, il y avait une régression non significative dans les taux de bavage et de déglutition. La baisse marquée du bavage après entrainement du biofeedback doit être attribuée à une déglutition plus efficace, résultant d'un contrôle oromoteur amélioré, plutôt qu'à un accroissement des taux de déglutition. ZUSAMMENFASSUNG In dem Bemühen, den Speichfluß bei 17 Kindern mil Cerebralparese zu verringern, untersuchten die Autoren die Wirksamkeit eines EMG auditory Feedback Trainings des Orbicularis oris, wodurch der Schluckakt bewußt gemacht und durch ein akustisches Signal mit einem ‘Accularm’ Interval Timer ausgelöst werden sollte. Nach dem Biofeedback Training fand sich eine signifikante Abnahme des Speichelflusses und ein etwas häufigeres Schlucken. Nach Anwendung des ‘Accularms’ hatten die Kinder weiterhin weniger Speichelfluß und die Rate des Schluckens nahm noch etwas zu. Einen Monat nach Beendigung der Behandlung wurde eine nicht‐signifikante Verschlechterung beider Parameter festgestellt. Die deutliche Abnahme des Speichelflusses nach dem Biofeedback Training muß eher einem effektiveren Schlucken als Ergebnis einer besseren oromotorischen Kontrolle als einem häufigeren Schlucken zugeschrieben werden. RESUMEN En un intento de disminuir el grado de babeo en 12 niños con parálisis cerebral, los autores investigaron la eficacia del entrenamiento del orbicular de los labios con retroalimentación por medio de EMG auditivo, haciendo que el acto de la deglución fuese consciente, f...

A descriptive analysis of studies on behavioural treatment of drooling (1970–2005)

“…[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] Most articles (76%) were published between 1977 and 1987. After 1994, no study on behaviour treatment for drooling appeared.…”

“…In four studies [14][15][16]22 no interobserver reliability was reported. In the other studies, interobserver reliability appeared to be consistently high: above 70%.…”

“…Lancioni et al 18 reported the most extensive follow-up data: at a 1-to 2-monthly period during the first 18 months after the intervention. 17 Target behaviour and type of treatment Target behaviours for treatment were swallowing, 9,12,[14][15][16]21,22,24 wiping, 9,10,12,[17][18][19]22 non-drooling, 10,12,14,20,22,25 mouth closure, 11 head control and imitative vocalization, 23 and self-management. 13,24 In antecedent procedures participants had received verbal, auditory (beeps or electromyography feedback), visual, or vibratory cues at different time schedules to elicit the target behaviour.…”

“…Although the comparison group was comparable with both intervention groups on chronological and mental age, the percentage of drooling during baseline differed substantially: 62% and 75% for the intervention groups versus 31% for the comparison group. The remaining 15 studies used a single participant design: six experiments with AB (baseline and intervention) design, 11,12,14,15,25 six used a reversal design, 9,13,16,19,20,24 in which each participant served as his/her own control. Five studies used a multiple baseline design, either across behaviours 23 (one), across activities 13 (one), across settings 10 (one), or across participants [17][18][19] (two).…”

“…A second rater independently reviewed four of the experiments 12,13,16,19 that were randomly chosen from the total sample (34% of the participants). If both reviewers recorded the same descriptive category for the study variables, they were considered to be in agreement.…”