Abstract：
BACKGROUND: Neurological defects in children with cerebral palsy (CP) not only affect their motor skills but also lead to bladder and bowel problems. Although most children with CP have achieved urinary control, more than 50% of cases experience lower urinary tract symptoms (LUTS). Common LUTS complaints observed in CP include delayed toilet training, urinary incontinence, increased frequency of urination, urgency, urinary hesitancy, and recurrent urinary tract infections.
OBJECTIVE: This study aimed to prospectively evaluate and compare the effectiveness of two different physiotherapy approaches, sacral Transcutaneous Electrical Nerve Stimulation (TENS) and massage, on lower urinary tract dysfunction in children with CP.
METHODS: A total of 54 children with CP who had the Dysfunctional Voiding Scoring System (DVISS) of 8.5 or higher were included in the study. Children were randomized to the TENS (TG; n = 27) and Manual Therapy (MG; n = 27) groups. TENS application was performed 2 sessions in a week for 20 min for a total of 12 weeks. The electrodes used during the application were adhered bilaterally to the parasacral region (S2-S4). 4 electrodes of 5 × 5 cm were used. Classical bowel massage was applied to the MG with the friction massage technique twice a week for 12 weeks. Manual therapy applications were performed in the form of abdominal, colon, and friction massage, twice a week for 20 min by the physiotherapist. Massage was applied to the abdominal region between the lower subcostal border and the anterior superior iliac spine. Questionnaires were applied before and after treatment interventions: DVISS, functional bladder capacity (FBC), frequency of voiding, and urinary incontinence episodes evaluated by bladder diary, Bristol Gaita Scale, and Pediatric Incontinence Quality of Life Scale (PIN-Q) used.
RESULTS: The decrease in the episodes of incontinence was higher in the TG (p = 0.037; p < 0.05). FBC increased after treatment in both groups, but there was no statistically significant difference between the groups (p = 0.683; p > 0.05). Manual therapy was more effective in improving constipation symptoms. In both groups, DVISS and PIN-Q values decreased after treatment, but the decrease in TG was statistically significant in the evaluation made between groups (p = 0.001; p < 0.01).
CONCLUSIONS: Both parasacral TENS and massage provided a significant improvement in LUTS, constipation, and quality of life but TENS showed a bigger improvement. We suggest adding these interventions to the treatment of bladder and bowel problems in CP children.
OBJECTIVE: This study aimed to prospectively evaluate and compare the effectiveness of two different physiotherapy approaches, sacral Transcutaneous Electrical Nerve Stimulation (TENS) and massage, on lower urinary tract dysfunction in children with CP.
METHODS: A total of 54 children with CP who had the Dysfunctional Voiding Scoring System (DVISS) of 8.5 or higher were included in the study. Children were randomized to the TENS (TG; n = 27) and Manual Therapy (MG; n = 27) groups. TENS application was performed 2 sessions in a week for 20 min for a total of 12 weeks. The electrodes used during the application were adhered bilaterally to the parasacral region (S2-S4). 4 electrodes of 5 × 5 cm were used. Classical bowel massage was applied to the MG with the friction massage technique twice a week for 12 weeks. Manual therapy applications were performed in the form of abdominal, colon, and friction massage, twice a week for 20 min by the physiotherapist. Massage was applied to the abdominal region between the lower subcostal border and the anterior superior iliac spine. Questionnaires were applied before and after treatment interventions: DVISS, functional bladder capacity (FBC), frequency of voiding, and urinary incontinence episodes evaluated by bladder diary, Bristol Gaita Scale, and Pediatric Incontinence Quality of Life Scale (PIN-Q) used.
RESULTS: The decrease in the episodes of incontinence was higher in the TG (p = 0.037; p < 0.05). FBC increased after treatment in both groups, but there was no statistically significant difference between the groups (p = 0.683; p > 0.05). Manual therapy was more effective in improving constipation symptoms. In both groups, DVISS and PIN-Q values decreased after treatment, but the decrease in TG was statistically significant in the evaluation made between groups (p = 0.001; p < 0.01).
CONCLUSIONS: Both parasacral TENS and massage provided a significant improvement in LUTS, constipation, and quality of life but TENS showed a bigger improvement. We suggest adding these interventions to the treatment of bladder and bowel problems in CP children.
摘要：
背景：脑瘫（CP）儿童的神经系统缺陷不仅会影响他们的运动技能，还会导致膀胱和肠道问题。尽管大多数患有CP的儿童已经实现了泌尿控制，超过50％的病例出现下尿路症状（LUTS）。CP中常见的LUTS投诉包括厕所训练延迟，尿失禁,排尿频率增加，紧迫性,泌尿犹豫，和复发性尿路感染。
目的：本研究旨在前瞻性评估和比较两种不同的物理治疗方法的有效性，骶骨经皮神经电刺激（TENS）和按摩，CP患儿下尿路功能障碍的研究.
方法：本研究共纳入了54名功能失调排尿评分系统（DVISS）为8.5或更高的CP患儿。儿童被随机分为TENS（TG；n=27）和手动治疗（MG；n=27）组。TENS应用每周进行2次，共20分钟，共12周。在施加过程中使用的电极双侧粘附到骶骨旁区域(S2-S4)。使用4个5X5cm的电极。使用摩擦按摩技术对MG进行经典的肠道按摩，每周两次，持续12周。手动治疗应用以腹部的形式进行，结肠,和摩擦按摩，理疗师每周两次，持续20分钟。按摩应用于肋下边界和髂前上棘之间的腹部区域。在治疗干预前后应用问卷调查：DVISS，功能性膀胱容量（FBC），排尿的频率，通过膀胱日记评估尿失禁发作，布里斯托尔·盖塔量表，和使用的小儿失禁生活质量量表（PIN-Q）。
结果：尿失禁发作的减少在TG中更高（p=0.037；p<0.05）。两组患者治疗后FBC均升高,组间差异无统计学意义(p=0.683;p>0.05)。手法治疗对改善便秘症状更有效。在这两组中,治疗后DVISS和PIN-Q值下降，但在组间评价中,TG的降低具有统计学意义(p=0.001;p<0.01)。
结论：骶骨旁TENS和按摩均能显著改善LUTS，便秘,和生活质量，但TENS显示出更大的改善。我们建议将这些干预措施添加到CP儿童的膀胱和肠道问题的治疗中。
目的：本研究旨在前瞻性评估和比较两种不同的物理治疗方法的有效性，骶骨经皮神经电刺激（TENS）和按摩，CP患儿下尿路功能障碍的研究.
方法：本研究共纳入了54名功能失调排尿评分系统（DVISS）为8.5或更高的CP患儿。儿童被随机分为TENS（TG；n=27）和手动治疗（MG；n=27）组。TENS应用每周进行2次，共20分钟，共12周。在施加过程中使用的电极双侧粘附到骶骨旁区域(S2-S4)。使用4个5X5cm的电极。使用摩擦按摩技术对MG进行经典的肠道按摩，每周两次，持续12周。手动治疗应用以腹部的形式进行，结肠,和摩擦按摩，理疗师每周两次，持续20分钟。按摩应用于肋下边界和髂前上棘之间的腹部区域。在治疗干预前后应用问卷调查：DVISS，功能性膀胱容量（FBC），排尿的频率，通过膀胱日记评估尿失禁发作，布里斯托尔·盖塔量表，和使用的小儿失禁生活质量量表（PIN-Q）。
结果：尿失禁发作的减少在TG中更高（p=0.037；p<0.05）。两组患者治疗后FBC均升高,组间差异无统计学意义(p=0.683;p>0.05)。手法治疗对改善便秘症状更有效。在这两组中,治疗后DVISS和PIN-Q值下降，但在组间评价中,TG的降低具有统计学意义(p=0.001;p<0.01)。
结论：骶骨旁TENS和按摩均能显著改善LUTS，便秘,和生活质量，但TENS显示出更大的改善。我们建议将这些干预措施添加到CP儿童的膀胱和肠道问题的治疗中。
