Electromyographic characteristics of pelvic floor muscles in women with stress urinary incontinence following sEMG-assisted biofeedback training and Pilates exercises.

The aim of this study was to compare the effect of pelvic floor muscle training with surface electromyographic (sEMG) biofeedback (BF group) and Pilates exercises (P group) on the bioelectrical activity of pelvic floor muscles in women with stress urinary incontinence. The other aim aim was to compare changes in voiding diaries and scores on quality of life questionnaire against baseline values and between the groups. Women in the BF group (n = 18) participated in pelvic floor muscle training with sEMG biofeedback; the P group (n = 13) participated in basic level Pilates workouts. Both protocols were continued for eight weeks. Voiding diary, quality of life and electromyographic characteristics of the pelvic floor muscles were assessed at the three-time points: at baseline, after eight weeks' training, and at month six post-training. The sEMG activity of the pelvic floor muscles was tested during five trials in two positions. There was no marked improvement in bioelectrical activity of the pelvic floor muscles during contraction following training with sEMG biofeedback or Pilates exercises. Following eight weeks of sEMG biofeedback training, a decrease was noted in resting bioelectrical activity of pelvic floor muscles and during relaxation after sustained contraction but only in supine-lying. No such effect was observed in the Pilates group. In the BF group, the number of incontinence episodes after end of treatment (timpepoints: 1vs. 2) and at six month follow-up (timpepoints: 1vs. 3) decreased by 68.5% and 89.3%, respectively. The respective values in the P group were 78.6%, and 86.4%. The intergroup differences did not reach the level of statistical significance. As regards the quality of life, the questionnaire demonstrated that Pilates exercises had significantly better effects compared to biofeedback training both at the end of the eight-week exercise program and (p = 0.003) and at six month follow-up (p = 0.0009). The International Consultation on Incontinence Questionnaire-Short Form (ICIQ- SF) showed comparable efficacy of Pilates exercises and training with sEMG biofeedback. Intragroup improvements in micturition frequency, incontinence (leakage) episodes, and nocturia frequency were comparable. Alleviation of urinary incontinence symptoms was comparable in both groups, whereas the improvement in the quality of life was more notable in the Pilates group. The obtained results failed to demonstrate the superiority of any of the two methods regarding the bioelectrical activity of pelvic floor muscles in patients with stress urinary incontinence.

A Randomized, Controlled Clinical Study to Assess the Effect of Anodal and Cathodal Electrical Stimulation on Periwound Skin Blood Flow and Pressure Ulcer Size Reduction in Persons with Neurological Injuries.

The use of electrical stimulation (ES) should be considered for treating nonhealing pressure ulcers (PUs), but optimal ES wound treatment protocols have yet to be established. A randomized, controlled, double-blind clinical study was conducted to evaluate the effects of cathodal and anodal high-voltage monophasic pulsed current (HVMPC) on periwound skin blood flow (PSBF) and size reduction of Stage 2 to Stage 4 PUs of at least 4 weeks' duration. Persons >18 years of age, hospitalized with neurological injuries, at high risk for PU development (Norton scale <14 points; Waterlow scale >15 points), and with at least 1 Stage 2 to Stage 4 PU were eligible to participate in the study. Persons with necrotic wounds, osteomyelitis, electronic or metal implants in the PU area, PUs in need of surgical intervention, acute wound inflammation, diabetes (HBA1c >7%), diabetic neuropathy, cancer, and/or allergies to standard wound treatments were excluded. Patients were randomly assigned to 1 of 3 groups: anodal (AG), cathodal (CG), or placebo (PG) ES. All groups received individualized PU prevention and standard wound care. In the PG, sham ES was applied; the AG and CG were treated with anodal and cathodal HVMPC, respectively (154 µs 100 Hz; 360 µC/second; 1.08 C/day), 50 minutes per day, 5 days per week, for a maximum of 8 weeks. PSBF was measured using laser Doppler flowmetry at baseline, week 2, and week 4, and wound surface area measurements were obtained and analyzed using a digitizer connected to a personal computer. Data analysis utilized the maximum-likelihood chi-squared test, the analysis of variance Kruskal-Wallis test, the Kruskal-Wallis post-hoc test, and Spearman's rank order correlation. Nonlinear approximation based on exponential function was used to calculate treatment time needed to reduce the wound area by 50%. In all tests, the level of significance was set at P ≤.05. Of the 61 participating patients, 20 were in the AG (mean age 53.2 ± 13.82 years), 21 in the CG (mean age 55.67 ± 17.83 years), and 20 in the PG (mean age 52.5 ± 13.18 years). PUs (baseline size range 1.01 cm2 to 59.57 cm2; duration 4 to 48 weeks) were most frequently located in the sacral region (73.77%) and classified as Stage 3 (62.29%). PSBF at week 2 was significantly higher in the AG and CG than in the PG (P <.05). Week 4 differences were not statistically significant. Wound percentage area reduction calculated at week 8 for the AG (64.10% ± 29.22%) and CG (74.06% ± 23.23%) were significantly different from PG ulcers (41.42% ± 27.88%; P = .0391 and P = .0024, respectively). In both ES groups, PSBF at week 4 and percent wound surface area reductions between weeks 4 and 8 were positively correlated, but only the AG correlation was statistically significant (P = .049). In this study, both ES modalities improved blood flow and wound area reduction rate. Studies examining optimal ES treatment times for healing to occur, the effect of comorbidities and baseline wound variables on ES outcomes, and the nature of the relationship between blood flow and healing are necessary.

The Efficacy of Pressure Ulcer Treatment With Cathodal and Cathodal-Anodal High-Voltage Monophasic Pulsed Current: A Prospective, Randomized, Controlled Clinical Trial.

BACKGROUND: Studies show that anode and cathode electrical stimulation (ES) promotes the healing of wounds, but specific protocols for both electrodes are not available. OBJECTIVE: To compare the effectiveness of cathodal versus cathodal+anodal ES in the treatment of Category II-IV pressure ulcers (PrUs). DESIGN: Prospective, randomized, controlled, clinical study. SETTING: Three nursing and care centers. PATIENTS: Sixty-three participants with PrUs were randomly formed into a cathodal ES group (CG: N = 23; mean age of 79.35; SD 8.48), a cathodal+anodal ES group (CAG: N = 20; mean age of 79.65; SD 11.44) and a placebo ES group (PG: N = 20; mean age of 76.75; SD 12.24). INTERVENTION: All patients were treated with standard wound care and high-voltage monophasic pulsed current (HVMPC; twin-peak impulses; 154 µs; 100 pps; 0.25 A; 250 µC/s) for 50 minutes per day, 5 times a week, for 6 weeks. The CG, CAG, and PG received, respectively, cathodal, cathodal+anodal, and sham ES through electrodes placed on a moist gauze pad. The treatment electrode was placed on the wound, and the return electrode was positioned on healthy skin at least 20 cm from the PrU. MEASUREMENTS: Measurements were made at baseline, and after each of the 6 weeks of treatment. Primary outcome was percentage wound surface area reduction at week 6. RESULTS: Wound surface area decreased in the CG by 82.34% (95% confidence interval [CI] 70.06-94.63) and in the CAG by 70.77% (95% CI 53.51-88.04). These reductions were significantly greater than in the PG (40.53%; 95% CI 23.60-57.46). The CG and CAG were not statistically significantly different regarding treatment results. LIMITATIONS: The time of treatment proved insufficient for PrUs to close. CONCLUSIONS: Cathodal and cathodal+anodal HVMPC similarly reduced the area of Category II-IV PrUs.

Bioelectrical activity of the pelvic floor muscles after 6-week biofeedback training in nulliparous continent women.

PURPOSE: The aim of the study was to evaluate the effects of a 6-week sEMG-biofeedback-assisted pelvic floor muscle training program on pelvic floor muscle activity in young continent women. METHODS: Pelvic floor muscle activity was recorded using a vaginal probe during five experimental trials. Biofeedback training was continued for 6 weeks, 3 times a week. Muscle strenghtening and endurance exercises were performed alternately. SEMG (surface electromyography) measurements were recorded on four different occasions: before training started, after the third week of training, after the sixth week of training, and one month after training ended. RESULTS: A 6-week sEMG-biofeedback-assisted pelvic floor muscle training program significantly decreased the resting activity of the pelvic floor muscles in supine lying and standing. The ability to relax the pelvic floor muscles after a sustained 60-second contraction improved significantly after the 6-week training in both positions. SEMG-biofeedback training program did not seem to affect the activity of the pelvic floor muscles or muscle fatigue during voluntary pelvic floor muscle contractions. CONCLUSIONS: SEMG-biofeedback-assisted pelvic floor muscle training might be recommended for physiotherapists to improve the effectiveness of their relaxation techniques.

Evaluation of the Healing Progress of Pressure Ulcers Treated with Cathodal High-Voltage Monophasic Pulsed Current: Results of a Prospective, Double-blind, Randomized Clinical Trial.

OBJECTIVE: To investigate the effectiveness of high-voltage monophasic pulsed current (HVMPC) as an adjunct to a standard wound care for the treatment of Stage II and III pressure ulcers (PrUs). DESIGN: Prospective, randomized, double-blind, controlled clinical study. SETTING: Two nursing and care centers. PATIENTS: Patients with PrUs that did not respond to previous treatment for at least 4 weeks were randomly assigned to the electrical stimulation (ES) group (25 patients; mean age of 79.92 ± 8.50 years; mean wound surface area [WSA] of 10.58 ± 10.57 cm) or to the control group (24 patients; mean age of 76.33 ± 12.74 years; mean WSA of 9.71 ± 6.70 cm). INTERVENTIONS: Both the ES and control groups received standard wound care and respectively, cathodal HVMPC (154 microseconds; 100 pulses per second; 0.24 A; 250 µ/s) applied continuously for 50 minutes once a day, 5 times a week, or sham HVMPC. MAIN OUTCOME: Percentage area reduction over 6 weeks of intervention. MAIN RESULTS: In the ES group, there was a statistically significant decrease in WSA after 1 week of treatment (35% ± 30.5%) compared with 17.07% ± 34.13% in the control group (P = .032). After treatment, at week 6, percentage area reduction in the ES group was 80.31% ± 29.02% versus 54.65% ± 42.65% in the control group (P = .046). CONCLUSIONS: Cathodal HVMPC reduces the WSA of Stage II and III PrUs. The results are consistent with the results of other researchers who used HVMPC to treat PrUs.

The Impact of the Derotational Mobilization of Manual Therapy According to Kaltenborn-Evjenth on the Angle of Trunk Rotation in Patients with Adolescent Idiopathic Scoliosis--Pilot Study, Direct Observation.

BACKGROUND: The use of manual therapy in the treatment of scoliosis has been controversial. Scientific reports do not clearly indicate its effectiveness or harmfulness. The aim of this study was to determine the effectiveness of passive and active derotation techniques of manual therapy according to Kaltenborn-Evjent on the reduction of the angle of trunk rotation in patients with idiopathic scoliosis. MATERIAL AND METHODS: The study enrolled 33 female patients from the Department of Rehabilitation who were diagnosed with adolescent idiopathic scoliosis. The patients were divided into two groups according to the curve location (SRS classification). Group A consisted of 17 women, aged 14.±2.4 years, with single-curve scoliosis in the thoracolumbar segment and group B was composed of 16 women, aged 15±2.24 years, with double-curve scoliosis in the thoracic and lumbar segments. In both groups, the angle of trunk rotation, the magnitude of thoracic kyphosis and lumbar lordosis were measured twice, before and after each session of derotation techniques. RESULTS: Both groups demonstrated a positive impact of active and passive derotation techniques on the angle of trunk inclination. The greatest difference was observed after a session of active derotation in the patients with lumbar scoliosis. The angle of trunk rotation decreased on average by 4.5°±1.14°. No correlations were found between the curve angle values and the degree of thoracic derotation after the application of these techniques. CONCLUSION: Derotational mobilization techniques may be a valuable complement to scoliosis treatment methods as they increase their effectiveness.

[The venous ulcer therapy in use of the selected physical methods (Part 2)--The comparison analysis]. / Leczenie owrzodzen zylnych za pomoca wybranych metod fizykalnych (Czesc 2)--Badanie porównawcze.

UNLABELLED: The aim of the study was to evaluate the influence of a high voltage stimulation, sonotherapy and laser biostimulation on the process of healing of venous leg ulcers. MATERIAL AND METHODS: Four comparative groups--A, B, C and D--were made at a random from 92 patients with venous leg ulcers. The group A consisted of 26 patients, the group B--21 patients, the group C--21 patients, and the group D--24 patients. The patients in all comparative groups were treated pharmacologically. Ulcerations at the patients in the group A were additionally treated with the high voltage stimulation. However, ulcerations at the patients in the group B were treated with the sonotherapy. Ulcerations at the patients in the group C were treated with the laser biostimulation. Changes of the area, length, width and volume of the tissue defekt after above physical therapies were assessed. Changes of the pus decontamination and granulation processes were observed too. CONCLUSIONS: After treatment concluded, high voltage stimulation and ultrasound therapy had been more efficient at enhancing healing of venous leg ulcers than topical pharmacology. No significant effect of laser biostimulation on healing process was observed.

[The venous ulcer therapy in use of the selected physical methods--circumstances for clinical application]. / Leczenie owrzodzen zylnych za pomoca wybranych metod fizykalnych--przeslanki do stosowania klinicznego.

Venous ulcers are significant both surgical and dermatological problem. The chronic and recurrent natures of the disease require a search for new methods to improve treatment efficiency. Therefore, the attempts at using some physical methods are needed. The authors review the current literature on characteristics and biological effects of high voltage stimulation (HVS), ultrasound (sonotherapy) and laser biostimulation. Modern hypotheses (skin battery theory, cavitation, acoustic streaming, fotobiostimulation effect) explaining the mechanisms of applied physical factors arising in soft tissue healing process are presented too.

[Enhancing the healing of venous crural ulceration after surgical treatment with high voltage stimulation]. / Wspomaganie gojenia owrzodzen zylnych goleni po leczeniu chirurgicznym za pomoca elektrostymulacji wysokonapieciowej.

The objective of the study was to evaluate the influence of a high voltage stimulation on the process of healing of crural ulcerations after causal surgical treatment. Two comparative groups of patients, A and B, were made at random from patients with venous crural ulcers, who had been earlier operated by Babcock' method. The group A consisted of 12, and the group B--13 patients. The patients in two comparative groups were treated pharmacologically. Ulcerations at the patients in the group A were additionally treated with the high voltage stimulation. Changes of the area, length, width, and volume of the tissue defect after the high voltage stimulation were assessed. Weekly changes of the above parameters were determined as well. After the therapy there was a statistically significant decrease of the total and pus-covered areas, length, width and volume of ulcerations in both groups, while there was no statistically significant difference--except pus-covered areas--between the groups observed. Only the reduction of pus-covered area in the group A was statistically significantly faster than in the group B.

[High voltage stimulation for enhanced healing of venous ulcers]. / Elektrostymulacja wysokonapieciowa we wspomaganiu gojenia owrzodzen troficznych.

Venous ulcers are significant both surgical and dermatological problem. This article discusses research findings and the clinical use of high voltage stimulation (HVS) in ulceration repair. Practical treatment decisions involving types of electrical impulses, polarity, electrode placement and other parameters are discussed. The article also summarizes recent knowledge on characteristics and biological effects of HVS application.