Academic journal article The Journal of Speech-Language Pathology and Applied Behavior Analysis

EMG Biofeedback Treatment of Dysphonias and Related Voice Disorders

Academic journal article The Journal of Speech-Language Pathology and Applied Behavior Analysis

EMG Biofeedback Treatment of Dysphonias and Related Voice Disorders

Article excerpt

Abstract

This article reviews the development of EMG biofeedback as a tool for operant learning, including the development of surface EMG biofeedback and support for the use of such biofeedback for treating dysphonias and related voice disorders. A few, well controlled empirical investigations suggest that EMG biofeedback helps some individuals with dysphonias to gain volitional control over specific laryngeal muscles, reduce tension around the vocal cords and (sometimes) improve vocal quality. EMG biofeedback has also been found effective for treating rare cases of ventricular fold dysphonia and paradoxical vocal cord motion. Further research is needed with clearer specification of electrode placement. However, EMG biofeedback represents a promising application of behavioral technology in the treatment of various functional dysphonias and voice disorders.

Key Words: EMG, biofeedback, dysphonia, voice disorders, vocal tension, vocal quality

Defining Biofeedback

In biofeedback, internal autonomic events such as heart rate, blood pressure, or muscle tension are electronically amplified, providing an individual with body (i.e., bio) information (i.e., feedback) that is commonly unavailable. By using electronic instruments to accurately measure, process, and "feed back" information about the body, an individual is able to learn to develop control over these internal physiological events (Shapiro & Surwit, 1979). That is, internal responses thought to be involuntary have been found to be affected by consequences (i.e., operant learning) and subject to voluntary control as well. Indeed, empirical research has repeatedly demonstrated that through operant learning, humans can gain volitional control over numerous different internal physiological functions and the principle means of developing this control has been with consequences delivered via biofeedback (Schwartz & Olsen, 1995).

The importance of biofeedback in learning to control internal physiology should not be surprising. Skinner predicted as much when he suggested that, "there is no reason why covert behavior could not be amplified so that the individual himself could make use of the additional information..." (pg 282) (Skinner, 1953). Indeed, much of the research on biofeedback has been made possible precisely because of significant advancements in instrumentation for measuring covert physiological behavior (Peek, 1995). Biomedical engineers have developed noninvasive and sophisticated technology for using surface recordings to measure what goes on inside the body. Thus, we can now accurately and reliably monitor, amplify, and transform physiological behavior into audio and or visual signals that are easily understandable. An individual can sit casually in front of a computer, have sensors taped to their skin, and watch a computer monitor to receive information about what is going on within the skin. The biofeedback allows individuals to experience immediate, frequent and potent consequences for even small changes in covert behavior; all features known to enhance the reinforcing effects of consequences during operant learning trials (Miltenberger, 2001).

Defining Surface EMG (sEMG) Biofeedback

One type of biofeedback involves electromyography. An electromyogram is a record of electrical activity from a muscle or group of muscles. The electrical activity is typically reported in microvolts ([micro]V). When that record is obtained from electrodes applied to the skin and the information is used to control muscle activity, it is called surface electromyographic (sEMG) biofeedback. The specificity of the biofeedback from surface muscles depends in part, upon the specificity of the signal, which is influenced by the arrangement of the electrodes. Electrodes placed close together and parallel to the muscle fibers will provide more specificity with respect to the targeted muscles, while electrodes placed farther apart and/or perpendicular to the muscle fibers will provide a more global measure of tension in the targeted area (Fogel, 1995; Sherman, 2003). …

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