Biofeedback Therapy In Children Research Articles

Commentary to does sacral ratio have any impact on success rate of biofeedback therapy in children with lower urinary tract dysfunction?

Commentary to does sacral ratio have any impact on success rate of biofeedback therapy in children with lower urinary tract dysfunction?

Does sacral ratio have any impact on success rate of biofeedback therapy in children with lower urinary tract dysfunction?

To evaluate the possible impact of patients' sacral ratios (SRs) on response to biofeedback (BF) therapy in pediatric patients with lower urinary tract dysfunction (LUTD). In this retrospective cohort conducted from 2016 to 2018 in our tertiary medical center, we included the medical records of all pediatric patients with LUTD who were nominated for BF due to having abnormal uroflowmetry patterns and simultaneous increase in electromyography (EMG) activity. Ten sessions of weekly animated BF were performed for each patient. All patients underwent a complete urological evaluation, uroflowmetry with simultaneous EMG and post-void residual measurement before and after treatment. SRs were calculated based on plain anteroposterior lumbosacral radiographs. Patients were then divided into normal SR (≥0.74) and low SR (<0.74) and outcomes were compared between them. Of the total 86 patients included in our study, 48 (55.8%) had a normal SR (≥0.74), while 38 (44.2%) had a low SR (<0.74). Our data revealed that BF therapy significantly improved maximum and average urinary flow rates, urine volume, daytime urinary incontinence, enuresis, urinary urgency and constipation; irrespective of the patients' SRs (all P<0.001). Our between-groups analyses showed that after the completion of BF, the SR≥0.74 group had significantly higher maximum urinary flow rate (mean difference [95%CI]: 7.7 [5.4, 10.0], P<0.001) (Figure) and urine volume (mean difference [95%CI]: 49.9 [19.5, 80.4], P=0.002) and significantly lower diurnal urinary incontinence (4.2% vs. 21.1%, P=0.020), enuresis (4.2% vs. 18.4%, P=0.040) and constipation (2.1% vs. 23.7%, P=0.004) compared to the SR<0.74 group. SR has been proposed as a reliable indicator of bony pelvis growth and subsequent lumbosacral neurodevelopment. Additionally, larger SR values are associated with better postoperative sphincter function in children with urological and anorectal malformations. Our results demonstrated that after completion of BF, the normal SR group had a significantly better improvement of some of the uroflowmetry indicators and LUTD-associated symptoms compared to the low SR group. Our findings implied that although BF therapy is an efficient treatment for children with LUTD, irrespective of their sacral development; children with enhanced sacral development may benefit from better clinical response, especially in terms of LUTD-associated symptoms.

Physiotherapy in the Сomplex Rehabilitation of Children with Anorectal Malformations: Systematic Review

Medical rehabilitation is an integral part of the treatment for surgical patients. Regarding pediatric patients with anorectal malformations, the success of the result of surgical treatment is mainly a correctly selected rehabilitation program, including methods of individual physiotherapy. Disturbances of intestinal transit, such as chronic constipation and anal incontinence, according to the world literature, occur in the study group in up to 30% of cases. According to the social significance of constipation and anal incontinence, the psychological aspects, the disabling component, children with anorectal malformations need early and long-term rehabilitation, adapted to their needs. At the moment, there are regulatory documents describing the principles of medical rehabilitation of children, its main characteristics, however, there are no protocols for the use of physiotherapy methods regarding the manifestations of colon transit disorders. Aim. Analysis of modern literature data on physiotherapeutic methods of rehabilitation of children with anorectal malformations. Material and methods. After determining the research criteria, a basic literature review using Web of Science, PubMed, electronic library was conducted, as a result 186 articles were selected that met the search criteria. After the initial assessment, 10 full-text articles were accepted for the analysis. Results. We have assessed the opportunity and mechanisms of the therapeutic action of sacral stimulation and tibial neuromodulation, the effect of various types of currents and a high-intensity magnetic field on the muscles of the complex, studied the possibility and results of using biofeedback therapy in children with colon transit disorders after operations on the anorectal body area in 421 children in 10 studies. Conclusion. Based on the results of scientific research, a range of physiotherapy methods have been established that are effective in relation to rehabilitation measures in children with anorectal malformations.

Biofeedback Therapy in Children with Functional Constipation in Tehran, Iran

Background: Functional constipation is a common disorder in pediatrics and affects about 30 percent of children, causing several physical and emotional complications and having a considerable impact on health expenses and quality of life. Biofeedback is a behavioral therapy that gives the patient information about the activity of pelvic floor muscles and teaches the patients how to properly contract and relax the sphincter. Biofeedback therapy is the most effective in those with constipation due to pelvic floor dyssynergia, which is the abnormal function of sphincter muscles and affects 40% of children with constipation. Objectives: This study aimed to evaluate the effect of biofeedback therapy in children with chronic functional constipation unresponsive to medical and conventional treatments. Methods: Forty-four children with functional constipation (according to ROME 4 criteria) unresponsive to at least six months of taking medical treatment and pelvic floor dyssynergia according to anorectal manometry were selected for biofeedback therapy. After six months, symptoms of patients and the need for laxative consumption were compared to those before therapy. Results: Considering ROME 4 criteria, clinical improvement was achieved in 59.1% of patients. Comparison of symptoms shows improvement in 52 - 89 % of cases. Conclusions: In pediatric patients with functional constipation and pelvic floor dyssynergia who do not respond to conventional treatments, biofeedback therapy could be an alternative therapy, and its effects last for at least six months.

Pelvic floor biofeedback therapy in children: Assessment of symptom scores in responders and non-responders.

Pelvic Floor Biofeedback Therapy (PFBT) can be an effective treatment for pediatric lower urinary tract symptoms (LUTS). Due to differing perceptions of efficacy and practice patterns, we sought to further evaluate PFBT in our practice. We hypothesized that PFBT results in quiescence of EMG activity during voiding and improves questionnaire scores in patients with LUTS. We retrospectively reviewed all patients undergoing PFBT and refined the analysis to females ≥6 years old with ≥2 sessions with completed voiding questionnaires pre- and post-treatment, active EMG during voiding, with non-neurogenic urinary tract complaints refractory to standard urotherapy. Validated Bladder Bowel Dysfunction (BBD) questionnaires were collected at each visit. Quiescence of EMG activity and changes in BBD score were the primary outcomes. 229 patients underwent ≥1 PFBT session, of which 64 females ≥6 years of age with ≥2 PFBT sessions and completed pre and post PFBT voiding questionnaires were identified. In this group, mean age at PFBT start was 10.1 (6.2-17.0). Patients completed 3.1 sessions (2-6). No difference was seen in post-void residual (PVR) between first and last session (23.8 vs 22.6 mL, P = 0.55). Median questionnaire score decreased from 18 (4-42) before to 13 (2-28) following PFBT (P < 0.0001). Responders, characterized by silencing of the EMG after PFBT, occurred in 31% (20/64). Non-responders were younger (P = 0.007) with higher pre-PFBT questionnaire scores. The use of PFBT appears to result in a significant reduction in symptom scores, though quiescence of EMG was observed following therapy in less than 1/3 of patients.

The effectiveness of biofeedback therapy in children with monosymptomatic enuresis resistant to desmopressin treatment.

To investigate the effect of biofeedback therapy on children with desmopressin- resistant primary monosymptomatic enuresis (MsE). The study comprised both retrospective and prospective sections. A total of 262 medical files of patients who were diagnosed as enuresis between November 2012 and January 2015 were retrospectively screened. Patients with neuropathic bladder, daytime voiding problems, anatomical pathology and enuresis-related diseases were excluded from the study. The demographic data and family characteristics of 29 children with desmopressin- resistantprimary MsE were recorded. After biofeedback treatment patients whose frequency of enuretic episodes decrease by more than 50% were included in the successful biofeedback treatment group (SBTG), while other patients were categorized in the unsuccessful biofeedback treatment group (USGBT). The outcomes of uroflowmetry, voided volume, postvoiding residue (PVR) and total bladder volume/age-adjusted normal bladder capacity (TBV/NBC) were recorded before and at the sixth month of the treatment. The mean age of 29 patients included in the study was 9.14±3.07 (6-15) years. Of patients, 16 were male (55.2%) and 13 were female (44.8%). Before biofeedback treatment the frequency of enuresis was 25.1±5.76 days/month, while after treatment this was calculated as 8.52±10.07 days/month. After treatment 8 patients (28.6%) achieved complete dryness. Twenty patients (69%), benefited from biofeedback (SBTG), while there were 9 patients (31%) in the USBTG group. There was no significant difference between the SBTG and USBTG groups in terms of age, body mass index and sex. The average bladder capacity of the patients increased from 215 mL to 257 mL after biofeedback treatment (p<0.001). The TBV/NBC value before treatment was 0.66, while after treatment it was 0.77 (p<0.001). There was a statistically significant difference between the SBTG and USBTG groups in terms of presence of MsE in mother, and both parents (p=0.001, p=0.016, respectively). Biofeedback therapy is a safe, simple, and minimally invasive treatment modality in children with MsE resistant to desmopressin treatment. This treatment, which was found to increase total bladder capacity, may be recommended for children with MsE when conventional desmopressin treatment fails.

The role of urinary nerve growth factor for the diagnosis and assessment of the biofeedback success in children with dysfunctional voiding

Dysfunctional voiding (DV) occurs in neurologically normal children who are not able to establish brain control on detrusor muscle contractions (DMCs). It is also reported to be the result of incorrect voiding habits during toilet training. Children contract pelvic floor muscles (PFMs) to suppress DMC and DV begins. Urinary nerve growth factor (uNGF) is necessary for the synthesis and regulation of neurotransmitters, development of dorsal root ganglia (sensory neurons), and development of sympathetic cells during embryonic and post-natal life. uNGF has also a role in the intracellular signal transduction in nerve cells towards the target organ. To our knowledge, no study has investigated the association between uNGF, biofeedback treatment and DV in children. The aim was to examine the potential effect of uNGF in the assessment of the effectiveness of biofeedback success in children with lower urinary tract disorders. Fifty-two children with the suspicion of DV and 48 children from a primary school reporting no urinary complaints were enrolled in this study from October 2010 to April 2013 in the Urology Department. uNGF levels were compared. The mean uNGF/creatinine (Cr) level was 0.23 ± 0.26 in the control group and 0.96 ± 0.88 in the DV group (p < 0.001). The mean uNGF/Cr levels in the DV group at baseline and at the end of biofeedback therapy at 6 and 12 months were 0.90 ± 0.78, 0.26 ± 0.32, and 0.40 ± 0.50, respectively (p < 0.001) (Figure). To our knowledge this study is the first to show the correlations between uNGF levels and biofeedback therapy in children with DV. Tissue NGF in 12 patients with overactive bladder (OAB)/detrusor overactivity and 15 healthy women was previously compared and it was suggested that there was no correlation between bladder tissue NGF and OAB. uNGF levels in the bladder in patients with interstitial cystitis and idiopathic sensorial urgency were evaluated previously, and uNGF levels reported. Similar to these reports, most of the previous studies handled uNGF in patients with diseases such as interstitial cystitis, OAB, urinary tract infections, urolithiasis, spinal cord injury, and prostate cancer, and found significantly higher uNGF levels. These studies were generally in adults. A previous study about uNGF comprised 40 children with OAB, in contrast to other studies. According to this study, 40 children diagnosed with OAB were administered anti-muscarinic therapy (oxybutynin 0.3-0.5 mg/kg/day). It was reported that uNGF/Cr levels of the OAB group were higher than control group. In the current study, we evaluated the uNGF difference in DV and the effect of biofeedback treatment on uNGF levels. uNGF levels were higher in children with DV and decreased after biofeedback therapy. uNGF levels could be used for the diagnosis and the assessment of biofeedback success in these children.

Comparison of Biofeedback Therapy in Children With Treatment-refractory Dysfunctional Voiding and Overactive Bladder

To evaluate and compare the effectiveness of biofeedback therapy (BF) in children with treatment refractory overactive bladder (OAB) and dysfunctional voiding (DV). This study was performed between April 2012 and March 2014. Patients with treatment refractory OAB and DV were included. All patients had 3months of BF. Patients' urologic system symptoms and uroflow parameters before BF and 3months after BF and response rates were compared. Forty-five patients completed the study. Significant improvement was seen in urinary tract infections, urge incontinence, fractionated voiding, constipation, voided volume, maximum flow rate (Qmax), average flow rate (Qave), and postvoiding residue for patients with DV and in urinary tract infection, frequency, urge incontinence, Qmax, Qave, voiding time, and postvoiding residue for patients with OAB. Overall, better results were observed in patients with DV. BF is an effective treatment modality in children with treatment refractory OAB and DV; however, patients with DV show better improvement.

Behavioural and physiological outcomes of biofeedback therapy on dental anxiety of children undergoing restorations: a randomised controlled trial

To explore the efficacy of biofeedback as possible alternative means of psychological behaviour guidance in children receiving dental restorations. Randomised clinical trial with a cross over design carried out on 40 children (19 boys and 21 girls) to determine the efficacy of biofeedback in reducing the dental anxiety through subjective and objective measures during restorative treatments under cotton roll isolation without administration of local analgesia. Highly anxious children with a minimum of five carious lesions were trained to lower their anxiety using biofeedback in five sessions within a 4-week interval, each session lasting for 45 min. After initial training, children were randomly divided into two groups and restorations were placed in four sequential therapeutic sessions with a 1-week interval and a follow-up visit 3 months later. First group received biofeedback in the second and third sessions; whereas the second group received biofeedback in the first and third sessions. Biofeedback therapy in children led to lower levels of anxiety in the initial appointments when assessed objectively, however the subjective methods of evaluation could not depict any statistically significant difference. Biofeedback can be used in the initial visits for dentally anxious children and the usage of simpler biofeedback machines for these appointments in dental setup is suggested.

Effect of Biofeedback Treatment on Spinning Top Urethra in Children with Voiding Dysfunction

Spinning top urethra (STU) deformity arises secondary to detrusor instability, leading to an increase in the intravesical pressure against a closed sphincter. We retrospectively analyzed the effect of biofeedback treatment on STU in children with dysfunctional voiding. A total of 121 patients with STU and voiding dysfunction were enrolled in this study. The patients divided into two groups. Group 1 (n = 49) were treated with simple bladder retraining with timed voiding, and group 2 (n = 72) were treated with biofeedback therapy. Voiding cystourethrography was performed 6 and 12 month later to determine the status of the STU after both therapies. The patient age range was 5 to 13 years (mean 8.1 +/- 1.9) in group 1 and 5 to 13 years (mean 8.2 +/- 1.7) in group 2. Group 1 consisted of 41 girls and 8 boys; group 2 consisted of 63 girls and 9 boys. Voiding cystourethrography revealed vesicoureteral reflux in 39 and 59 children in groups 1 and 2, respectively. The improvement rates of the biofeedback therapy in children with STU and vesicoureteral reflux were significantly greater than the children treated with timed voiding at 6 months and 1-year of follow-up. For children admitted to urology clinics with urinary infection or complaints thought to be an unstable urinary bladder, proximal urethral dilation called STU is detected at a high frequency. It should be remembered that this situation can be related to vesicoureteral reflux and urinary bladder instability. Biofeedback training is a simple, effective, and well-tolerated treatment modality for these children.

Assessment of the Effectiveness of Biofeedback Therapy in Children with Pelvic Floor Dyssynergia

Assessment of the Effectiveness of Biofeedback Therapy in Children with Pelvic Floor Dyssynergia

Utilidad de la manometría anorrectal para el diagnóstico y tratamiento de la encopresis

Biofeedback based on anomanometric techniques has been shown to be effective in the treatment of children with encopresis. The long-term efficacy of biofeedback and which variables of anorectal manometry (anorectal manometry) could help to establish biofeedback indications are currently the subject of debate. To identify which variables of anorectal manometry, in addition to symptoms, could be useful in deciding which patients could benefit from biofeedback therapy and to assess the outcome of this treatment. Anorectal manometry was performed in 88 patients, who were referred to our service complaining of soiling at least once a month for a minimum of 6 months after a period of normal continence of 1 year or more. The chronological and mental age of the patients was 4 years. All patients were otherwise in good health and had shown no response to medical treatment. The following variables were studied: anal canal profile, rectoanal inhibitory reflex (RAIR), continence reflex, rectal sensitivity, external anal sphincter (EAS) activity and defecatory maneuver. The patients were divided into two groups, according to clinical and anomanometric impairment, and the most affected patients (n = 41) underwent biofeedback therapy. The indications and outcome of biofeedback were assessed through clinical course and anorectal manometry. In the statistical analysis, the mean and standard deviation were calculated. The chi-squared test with Yates' correction was used to compare clinical and manometric qualitative parameters; Student's t-test was used to compare quantitative parameters; nonparametric tests consisted of the Mann-Whitney test and the Wilcoxon test was used for paired data. Patients treated with biofeedback therapy presented shorter anal canal, greater pressure in the rectal ampulla (P < 0.001), decreased pressure in the anal canal (P < 0.05), lesser distension of the EAS on provoking RAIR, lower presence of the continence reflex (P < 0.01), lower rectal sensitivity, and a worse response of the striated sphincteric muscle and of the defecatory maneuver (P < 0.001). Seventy-eight percent of the patients had a good response to biofeedback therapy. Pressure in the anal canal and rectal sensitivity improved (P < 0.001) with normality on straining in 11 out of 15 patients. These good results persisted in a long-term follow-up of 10 patients. Eight of 10 patients who did not undergo biofeedback therapy showed persistent encopresis (P < 0.001). Anorectal manometry detected disturbances, chiefly in the activity of the EAS, which are useful in indicating biofeedback therapy in children with secondary encopresis. Biofeedback therapy seems to produce favorable long-term results in the majority of the most severely affected patients.

New biofeedback therapy in children with encopresis: G. Iwata, N. Iwai, M. Nagashima, et al. Eur J Pediatr Surg 5:231–234, (August), 1995

New biofeedback therapy in children with encopresis: G. Iwata, N. Iwai, M. Nagashima, et al. Eur J Pediatr Surg 5:231–234, (August), 1995

New Biofeedback Therapy in Children with Encopresis

Biofeedback therapy was performed in 13 patients with encopresis using newly devised computerized equipment. The patients were children, aged 6 to 11 years, who had not responded to trials of conventional therapy with a mean follow-up period of three years and two months. The biofeedback therapy was effective in 12 of the 13 patients after one course of therapy. This positive results was attributed to the computerized equipment. The patients could more easily recognize how to squeeze their anal sphincters after seeing a colored ellipse representing sphincter pressure on a monitor. The results of anorectal manometry and electromyography (EMG) showed that biofeedback therapy improved the voluntary sphincter function and rectal sensation. Therefore, biofeedback therapy might be effective in patients with encopresis whose sphincter functions are intact.