Influence of cognitive rehabilitation on pelvic floor muscle contraction: A randomized controlled trial.

Abstract

Distraction task (DT), which led to a modification of voluntary and involuntary reflex pelvic floor muscle (PFM) activation, might potentiate urinary incontinence, through an alteration of the temporal course between intra-abdominal pressure and PFM contraction. We evaluated whether cognitive rehabilitation (dual-task method) could prevent the effect of a mental distraction task on the reaction time of PFM contraction. Thirty-nine healthy volunteers underwent two sessions of electromyographic (EMG) PFM recordings separated by a 2-week interval. We recorded external anal sphincter EMG activity during voluntary and involuntary PFM contraction with and without a DT (Paced Auditory Serial Addition Task). Two main parameters were recorded: RT1 (latency between an order for PFM contraction and the onset of the external anal sphincter EMG activation during voluntary PFM contraction) and RT3 (latency between the onset of the involuntary external anal sphincter EMG activation and the onset of the external intercostal muscle EMG activation during involuntary PFM contraction). Volunteers were randomized (ratio 1:2) in two groups: dual task cognitive (an attentional test, the n-back test, and PFM exercises) rehabilitation program (n = 13) and control group (n = 26). The control group had no specific instructions and did not have to do PFM exercises. Concerning voluntary PFM contraction, following a 2-week interval, in the study group RT1 in DT conditions decreased from 461.11 ms [357.14-557.41] to 290.74 ms [262.96-308.88] (ratio 0.63, P = 0.0063). In the control group, RT1 in DT conditions was not significantly different. Concerning involuntary PFM contraction, in the study group RT3 without a DT increased from -68.52 ms [-107.40; -40] to -127.78 ms [-163.06; -93.33] (ratio 1.86, P = 0.0327). In DT conditions, in the study group RT3 increased from -42.59 ms [-52.09; -6.66] to -59.25 ms [-119.44; -44.44] (ratio 1.39, P = 0.0478). The alteration of the reaction time of PFM provoked by a distraction task can be prevented by specific cognitive rehabilitation.