Skip to main content
SpringerLink
Log in

Effects of Biofeedback in Phonatory Disorders and Phonatory Performance: A Systematic Literature Review

  • REVIEW ARTICLE
  • Published:
Applied Psychophysiology and Biofeedback Aims and scope Submit manuscript

The purpose of this article was to systematically review the literature on the effects of biofeedback therapy in the domain of phonatory disorders and phonatory performance, using studies in peer-reviewed journals. An extensive definition of biofeedback is given and its place in voice treatment is defined. Eighteen group or case studies or reports considering the effects of electromyographic, laryngoscopic and acoustic biofeedback in dysphonic patients (hyperfunctional voice disorders, hypofunctional voice disorders, psychogenic voice disorder, laryngeal trauma, total laryngectomy, vocal cord dysfunction) and participants with normal voices are included and an analysis of procedure as well as research design and results is presented. The usefulness of biofeedback in phonatory disorders and performance was to be interpreted based on tendencies, since there is a lack of randomized controlled efficacy studies. In only 3 of 18 studies (16.7%) did biofeedback therapy fail to improve voice quality or not result in better results than other forms of therapy. Recommendations for improved methodologies are made, which include the use of acoustic voice quality parameters.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Notes

  1. Holbrook et al. (1974) developed the Vocal Intensity Controller (VIC), a portable instrument that provided immediate auditory feedback contingent on vocal intensity and that automatically stimulated the speaker to avoid abusive loudness after a level-adjusted tone was presented through an earphone.

  2. Vocal cord dysfunction is an obstructive upper airway syndrome that frequently simulates asthma and that is typified by paradoxical inspiratory vocal cord adduction producing wheezing, dyspnea, coughing and chest tightness and frequently induced by physical exercises. Treatment mostly relies on speech therapy with breathing exercises (Newman & Dubester, 1994).

REFERENCES

  • Andrews, S., Warner, J., & Stewart, R. (1986). EMG biofeedback and relaxation in the treatment of hyperfunctional dysphonia. British Journal of Disorders of Communication, 21, 353–369.

    Article  PubMed  Google Scholar 

  • Basmajian, J. V. (1981). Biofeedback in rehabilitation: A review of principles and practices. Archives of Physical Medicine and Rehabilitation, 62, 469–475.

    PubMed  Google Scholar 

  • Bastian, R. W., & Nagorsky, M. J. (1987). Laryngeal image biofeedback. Laryngoscope, 97, 1346–1349.

    Article  PubMed  Google Scholar 

  • Booker, H. E., Rubow, R. T., & Coleman, P. J. (1969). Simplified feedback in neuromuscular retraining: An automated approach using electromyographic signals. Archives of Physical Medicine and Rehabilitation, 50, 621–625.

    PubMed  Google Scholar 

  • Boone, D. R., & Mc Farlane, S. C. (1988). The voice and voice therapy (4th ed.). Englewood Cliffs: Prentice-Hall.

    Google Scholar 

  • Boone, D. R., & Mc Farlane, S. C. (1994). The voice and voice therapy (5th ed.). Englewood Cliffs: Prentice-Hall.

    Google Scholar 

  • Brody, D. M., Nelson, B. A., & Brody, J. F. (1975). The use of visual feedback in establishing normal vocal intensity in two mildly retarded adult. Journal of Speech and Hearing Disorders, 40, 502–507.

    PubMed  Google Scholar 

  • Brooks, S., Fallside, F., Gulian, E., & Hinds, P. (1981). Teaching vowel articulation with the Computer Vowel Trainer: Methodology and results. British Journal of Audiology, 15, 151–163.

    Article  PubMed  Google Scholar 

  • Brunner, M., Stellzig, A., Decker, W., Strate, B., Komposch, G., Wirth, G., et al. (1994). Video-Feedback-Therapie mit dem flexiblen Nasopharyngoskop. Fortschritte Der Kieferorthopadie, 55, 197–201.

    Article  PubMed  Google Scholar 

  • Cook, R. J., & Sackett, D. L. (1995). The number needed to treat: A clinically useful measure of treatment effect. BMJ: British Medical Association, 310, 452–454.

    Google Scholar 

  • Craig, A. R., & Cleary, P. J. (1982). Reduction of stuttering by young male stutterers using EMG feedback. Biofeedback and Self Regulation, 7, 241–255.

    Article  PubMed  Google Scholar 

  • Daniel, B., & Guitar, B. (1978). EMG feedback and recovery of facial and speech gestures following neural anastomosis. Journal of Speech and Hearing Disorders, 43, 9–20.

    PubMed  Google Scholar 

  • D’Antonio, L., Lotz, W., Chai, T. D., & Netsell, R. (1987). Perceptual-physiologic approach to evaluation and treatment of dysphonia. Annals of Otology, Rhinology and Laryngology, 96, 187–190.

    Google Scholar 

  • Davis, S. M., & Drichta, C. E. (1980). Biofeedback theory and application in allied health: Speech pathology. Biofeedback and Self Regulation, 5, 159–174.

    Article  PubMed  Google Scholar 

  • Dejonckere, P. H., Remacle, M., Fresnel-Elbaz, E., Woisard, V., Crevier-Buchmann, L., & Millet, B. (1996). Differentiated perceptual evaluation of pathological voice quality: Reliability and correlations with acoustic measurements. Revue de Laryngologie Otologie Rhinologie, 117, 219–224.

    PubMed  Google Scholar 

  • Dejonckere, P. H., Bradley, P., Clemente, P., Cornut, G., Crevier-Buchman, L., Friedrich, G., et al. (2001). A basic protocol for functional assessment of voice pathology, especially for the investigating efficacy of (phonosurgical) treatments and evaluating new assessment techniques. Guideline elaborated by the Committee on Phoniatrics of the European Laryngological Society (ELS). European Archives of Oto-rhino-laryngology, 258, 77–82.

    Article  PubMed  Google Scholar 

  • Denk, D. M., & Kaider, A. (1997). Videoendoscopic biofeedback: A simple method to improve the efficacy of swallowing rehabilitation of patients after head and neck surgery. ORL: Journal of Oto-Rhino-Laryngology and its Related Specialties, 59, 100–105.

    Google Scholar 

  • Earles, J., Kerr, B., & Kellar, M. (2003). Psychophysiologic treatment of vocal cord dysfunction. Annals of Allergy, Asthma, and Immunology, 90, 669–671.

    Article  PubMed  Google Scholar 

  • Eskanazi, L., Childers, D. G., & Hicks, D. M. (1990). Acoustic correlates of voice quality. Journal of Speech and Hearing Research, 33, 298–306.

    PubMed  Google Scholar 

  • Finley, W. W., Niman, C. A., Standley, J., & Wansley, R. A. (1977). Electrophysiologic behavior modification of frontal EMG in cerebral-palsied children. Biofeedback and Self Regulation, 2, 59–79.

    Article  PubMed  Google Scholar 

  • Fletcher, S. G. (1972). Contingencies for bioelectronic modification of nasality. Journal of Speech and Hearing Disorders, 37, 329–346.

    PubMed  Google Scholar 

  • Frey, L. R., Botan, C. H., Friedman, P. G., & Kreps, G. L. (1991). Investigating communication. An introduction to research methods. Englewood Cliffs: Prentice-Hall.

    Google Scholar 

  • Garber, S. R., Burzynski, C. M., Vale, C., & Nelson, R. (1979). The use of visual feedback to control vocal intensity and nasalization. Journal of Communication Disorders, 12, 399–410.

    Article  PubMed  Google Scholar 

  • Gentil, M., Aucouturier, J. L., Delong, V., & Sambuis, E. (1994). EMG biofeedback in the treatment of dysarthria. Folia Phoniatrica et Logopedica, 46, 188–192.

    Google Scholar 

  • Goebel, M. (1986). A computer-aided fluency establishment trainer (CAFET). Falls Church: Annadale Fluency Clinic.

    Google Scholar 

  • Goldstein, P., Ziegler, W., Vogel, M., & Hoole, P. (1986). Combined palatal-lift and EPG-feedback therapy in dysarthria: A case study. Clinical Linguistics and Phonetics, 8, 201–218.

    Google Scholar 

  • Guitar, B. (1975). Reduction of stuttering frequency using analog electromyographic feedback. Journal of Speech and Hearing Research, 18, 672–685.

    PubMed  Google Scholar 

  • Hammerschlag, P. E., Brudny, J., Cusumano, R., & Cohen, N. L. (1987). Hypoglossal-facial nerve anastomosis and electromyographic feedback rehabilitation. Laryngoscope, 97, 705–709.

    PubMed  Google Scholar 

  • Hand, C. R., Burns, M. O., & Ireland, E. (1979). Treatment of hypertonicity in muscles of lip retraction. Biofeedback and Self Regulation, 4, 171–181.

    Article  PubMed  Google Scholar 

  • Hanna, R., Wilfling, F., & McNeill, B. (1975). A biofeedback treatment for stuttering. Journal of Speech and Hearing Disorders, 40, 270–273.

    PubMed  Google Scholar 

  • Henschen, T. L., & Burton, N. G. (1978). Treatment of spastic dysphonia by EMG biofeedback. Biofeedback and Self Regulation, 3, 91–96.

    Article  PubMed  Google Scholar 

  • Hillenbrand, J., Cleveland, R. A., & Erickson, R. L. (1994). Acoustic correlates of breathy vocal quality. Journal of Speech and Hearing Research, 37, 769–778.

    PubMed  Google Scholar 

  • Hirano, M. (1981). Clinical examination of voice. Wien: Springer.

    Google Scholar 

  • Holbrook, A., Rolnick, M. I., & Bailey, C. W. (1974). Treatment of vocal abuse disorders using a vocal intensity controller. Journal of Speech and Hearing Disorders, 39, 298–303.

    PubMed  Google Scholar 

  • Horii, Y. (1983). Automatic analysis of voice fundamental frequency and intensity using a visi-pitch. Journal of Speech and Hearing Research, 26, 467–471.

    PubMed  Google Scholar 

  • Howard, D. M., Welch, G. F., Gibbon, R. R., & Bootle, C. (1987). The assessment and development of singing ability: Initial results with a new system. Proceedings of the Institute of Acoustics, 9, 159–166.

    Google Scholar 

  • Howard, D. M., & Welch, G. F. (1989). Microcomputer-based singing ability assessment and development. Applied Acoustics, 27, 89–102.

    Article  Google Scholar 

  • Huckabee, M. L., & Pelletier, C. A. (1999). Management of adult neurogenic dysphagia. San Diego: Singular.

    Google Scholar 

  • Huckvale, M. (2005a). SFS/RTSPECT version 2.1: Windows tool for real-time waveforms and spectra. University College London. Retrieved June 2005, from http://www.phon.ucl.ac.uk/resource/sfs/rtspect/

  • Huckvale, M. (2005b). SFS/RTGRAM version 1.1: Windows tool for real-time speech spectrogram display. University College London. Retrieved June 2005, from http://www.phon.ucl.ac.uk/resource/sfs/rtgram/

  • Jankel, W. R. (1978). Bell palsy: Muscle reeducation by electromyograph feedback. Archies of Physical Medicine and Rehabilitation, 59, 240–242.

    Google Scholar 

  • Künzel, H. J. (1982). First applications of a biofeedback device for the therapy of velopharyngeal incompetence. Folia Phoniatrica, 34, 92–100.

    Article  PubMed  Google Scholar 

  • Laukkanen, A. M., Syrjä, T., Laitala, M., & Leino, T. (2004). Effects of two-month vocal exercising with and without spectral biofeedback on student actors’ speaking voice. Logopedics, Phoniatrics, Vocology, 29, 66–76.

    Article  PubMed  Google Scholar 

  • LaVaque, T. J., Hammond, D. C., Trudeau, D., Monastra, V., Perry, J., Lehrer, P., et al. (2002). Template for developing guidelines for the evaluation of the clinical efficacy of psychophysiological evaluations. Applied Psychophysiology and Biofeedback, 27, 273–271.

    Article  PubMed  Google Scholar 

  • Mathieson, L. (2001). Greene and Mathieson's the voice & its disorders (6th ed.). London: Whurr.

    Google Scholar 

  • McGillivray, R., Proctor-Williams, K., & McLister, B. (1994). Simple biofeedback device to reduce excessive vocal intensity. Medical and Biological Engineering and Computing, 32, 348–350.

    Article  PubMed  Google Scholar 

  • Michi, K., Yamashita, Y., Imai, S., Suzuki, N., & Yoshida, H. (1993). Role of visual feedback treatment for defective /s/ sounds in patients with cleft palate. Journal of Speech and Hearing Research, 36, 277–285.

    PubMed  Google Scholar 

  • Moller, K. T., Path, M. P., Werth, L. J., & Christiansen, R. L. (1973). The modification of velar movement. Journal of Speech and Hearing Disorders, 38, 323–334.

    PubMed  Google Scholar 

  • Murdoch, B. E., Pitt, G., Theodoros, D. G., & Ward, E. C. (1999). Real-time continuous visual biofeedback in the treatment of speech breathing disorders following childhood traumatic brain injury: Report of one case. Pediatric Rehabilitation, 3, 5–20.

    Article  PubMed  Google Scholar 

  • Nemec, R. E., & Cohen, K. (1984). EMG biofeedback in the modification of hypertonia in spastic dysarthria: Case report. Archies of Physical Medicine and Rehabilitation, 65, 103–104.

    Google Scholar 

  • Netsell, R., & Cleeland, C. S. (1973). Modification of lip hypertonia in dysarthria using EMG feedback. Journal of Speech and Hearing Disorders, 38, 131–140.

    PubMed  Google Scholar 

  • Netsell, R., & Daniel, B. (1979). Dysarthria in adults: Physiologic approach to rehabilitation. Archies of Physical Medicine and Rehabilitation, 60, 502–508.

    Google Scholar 

  • Newman, K. B., & Dubester, S. N. (1994). Vocal cord dysfunction: Masquerader of asthma. Seminars in Respiratory and Critical Care Medicine, 15, 161–167.

    Article  Google Scholar 

  • Pettersen, V., & Westgaard, R. H. (2002). Muscle activity in the classical singer's shoulder and neck region. Logopedics, Phoniatrics, Vocology, 27, 169–178.

    Article  PubMed  Google Scholar 

  • Portney, L. G., & Watkins, M. P. (2000). Foundations of clinical research, applications to practice (2nd ed.). Upper Saddle River: Prentice-Hall.

    Google Scholar 

  • Prosek, R. A., Montgomery, A. A., Walden, B. E., & Schwartz, D. M. (1978). EMG biofeedback in the treatment of hyperfunctional voice disorders. Journal of Speech and Hearing Disorders, 43, 282–294.

    PubMed  Google Scholar 

  • Ramig, L. O., & Verdolini, K. (1998). Treatment efficacy: Voice disorders. Journal of Speech, Language, and Hearing Research, 41, S101–S116.

    PubMed  Google Scholar 

  • Rossiter, D., & Howard, D. M. (1995). ALBERT: A real-time visual feedback computer tool for professional vocal development. Journal of Voice, 10, 321–336.

    Google Scholar 

  • Rossiter, D., Howard, D. M., & DeCosta, M. (1996). Voice development under training with and without the influence of real-time visually presented biofeedback. Journal of the Acoustical Society of America, 99, 3253–3256.

    Article  PubMed  Google Scholar 

  • Rubow, R. T., Rosenbek, J. C., Collins, M. J., & Celesia, G. G. (1984). Reduction of hemifacial spasm and dysarthria following EMG biofeedback. Journal of Speech and Hearing Disorders, 49, 26–33.

    PubMed  Google Scholar 

  • Rubow, R., & Swift, E. (1985). A microcomputer-based wearable biofeedback device to improve transfer of treatment in Parkinsonian dysarthria. Journal of Speech and Hearing Disorders, 50, 178–185.

    PubMed  Google Scholar 

  • Sackett, D. L., Rosenberg, W. M., Gray, J. A., Haynes, R. B., & Richardson, W. S. (1996). Evidence-based medicine: What it is and what it isn’t. British Medical Journal, 312, 71–72.

    PubMed  Google Scholar 

  • Schliesser, H. F. (1987). EMG biofeedback as a function of voice-quality change. Perceptual and Motor Skills, 64, 719–724.

    PubMed  Google Scholar 

  • Schoentgen, J. (2004). Perspectives in acoustic analysis of voice disorders. Proceedings of VOX 2004. Nijmegen: University Medical Center St. Radboud.

  • Schram, G., & Burres, S. (1984). Non surgical rehabilitation after facial paralysis. In M. Portmann (Ed.), Proceedings of the Vth International Symposium on the Facial Nerve. New York: Masson.

    Google Scholar 

  • Schwartz, M. S., & Andrasik, F. (2003). Biofeedback: A practitioner's guide. New York: Guilford Press.

    Google Scholar 

  • Shelton, R. L., Paesani, A., McClelland, K. D., & Bradfield, S. S. (1975). Panendoscopic feedback in the study of voluntary velopharyngeal movements. Journal of Speech and Hearing Disorders, 40, 232–244.

    PubMed  Google Scholar 

  • Shipp, T. (1967). Frequency, duration, and perceptual measures in relation to judgments of alaryngeal speech and acceptability. Journal of Speech and Hearing Research, 10, 412–427.

    Google Scholar 

  • Sime, W. E., & Healey, E. C. (1993). An interdisciplinary approach to the treatment of a hyperfunctional voice disorder. Biofeedback and Self Regulation, 18, 281–287.

    Article  PubMed  Google Scholar 

  • Stark, R. E. (1971). The use of real-time visual displays of speech in the training of a profoundly deaf nonspeaking child: A case report. Journal of Speech and Hearing Disorders, 36, 397–409.

    PubMed  Google Scholar 

  • Stemple, J. C., Weiler, E., Whitehead, W., & Komray, R. (1980). Electromyographic biofeedback training with patients exhibiting a hyperfunctional voice disorder. Laryngoscope, 90, 471–476.

    Article  PubMed  Google Scholar 

  • Till, J. A., England, K. E., & Law-Till, C. B. (1987). Effects of auditory feedback and phonetic context on stomal noise in laryngectomized speakers. Journal of Speech and Hearing Disorders, 52, 243–250.

    PubMed  Google Scholar 

  • Titze, I. R. (1994). Principles of voice production. Englewood Cliffs: Prentice-Hall.

    Google Scholar 

  • Van Lierde, K. M., Claeys, S., De Bodt, M., & Van Cauwenberge, P. (2004). Outcome of laryngeal and velopharyngeal biofeedback treatment in children and young adults: A pilot study. Journal of Voice, 18, 97–106.

    Article  PubMed  Google Scholar 

  • Van Borsel, J. (2004). Wetenschappelijk onderzoek in de logopedie. [Scientific research in speech-language therapy.] Leuven: Acco.

  • Volin, R. A. (1991). Microcomputer-based systems providing biofeedback of voice and speech production. Topics in Language Disorders, 11, 65–79.

    Article  Google Scholar 

  • Watanabe, H., Komiyama, S., Ryu, S., Kannae, S., & Matsubara, H. (1982). Biofeedback therapy for spastic dysphonia. Auris, Nasus, Larynx, 9, 183–190 (Tokyo).

    PubMed  Google Scholar 

  • Whitehill, T. L., Stokes, S. F., & Man, Y. (1996). Electropalatography treatment in an adult with late repair of cleft palate. Cleft Palate-Craniofacial Journal, 33, 160–168.

    Article  PubMed  Google Scholar 

  • Wuyts, F. L., De Bodt, M., Bruckers, L., & Molenberghs, G. (1996). Research work of the Belgian Study Group on Voice Disorders: Results. Acta Oto-Rhino-Laryngologica Belgica, 50, 331–341.

    PubMed  Google Scholar 

  • Wuyts, F. L., De Bodt, M. S., Molenberghs, G., Remacle, M., Heylen, L., Millet, B., et al. (2000). The Dysphonia Severity Index: An objective measure of vocal quality based on a multiparameter approach. Journal of Speech, Language, and Hearing Research, 43, 796–809.

    PubMed  Google Scholar 

Download references

ACKNOWLEDGMENT

The authors wish to acknowledge librarian Jan Deman for library assistance and article retrieval.

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology, Head & Neck Surgery, Speech and Language Pathology and Audiology, Sint-Jan General Hospital, Bruges, Belgium

    Y. Maryn

  2. Department of Otorhinolaryngology, Head & Neck Surgery, Department of Communication Disorders, University Hospital, UIA, Antwerp, Belgium

    M. De Bodt

  3. Department of Otorhinolaryngology, Head & Neck Surgery, Department of Speech and Language Pathology, University Hospital, Ghent, Belgium

    P. Van Cauwenberge

  4. Department of Otorhinolaryngology, Head & Neck Surgery, Speech and Language Pathology and Audiology, Sint-Jan General Hospital, Ruddershove 10, 8000, Bruges, Belgium

    Y. Maryn

Authors
  1. Y. Maryn
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. De Bodt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. Van Cauwenberge
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Y. Maryn.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Maryn, Y., De Bodt, M. & Van Cauwenberge, P. Effects of Biofeedback in Phonatory Disorders and Phonatory Performance: A Systematic Literature Review. Appl Psychophysiol Biofeedback 31, 65–83 (2006). https://doi.org/10.1007/s10484-006-9005-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10484-006-9005-7

KEY WORDS:

Search

Navigation