Abstract General Information

Title

COMPARISON OF THE EFFECTS OF TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION AND MANUAL THERAPY TECHNIQUES ON LOWER URINARY SYSTEM DYSFUNCTIONS IN CHILDREN WITH CEREBRAL PALSY

Introduction and objective

Neurological defects in children with cerebral palsy(CP) not only affect their motor skills but also lead to bladder and bowel problems. Common lower urinary tract symptoms complaints observed in CP include delayed toilet training, urinary incontinence, increased frequency of urination, urgency, urinary hesitancy, and recurrent urinary tract infections. This study’s aim was to prospectively evaluate and compare the effectiveness of two different physiotherapy approaches, namely Transcutaneous Electrical Nerve Stimulation(TENS) applied to the sacral region and manual therapy modalities, on lower urinary tract dysfunction in children with CP.

Method

A total of 54 children with CP were randomized to the TENS(TG; n=27) and Manual Therapy(MG; n=27) groups. TENS performed S2-S3 dermatome, twice times a week for 12 weeks. On the other hand, classical bowel massage was applied to the MG with the friction massage technique twice a week for 12 weeks. Functional bladder capacity(FBC), frequency of voiding and urinary incontinence episodes, Bristol Gaita Scale are primary outcomes of the study. Also, Voiding Dysfunction Symtom Score(VDSS) and Pediatric Incontinence Quality of Life Scale(PIN-Q) are seconder outcomes of the study.

Results

There was no statistically significant difference in demographic characteristics between the groups, and they demonstrated a homogeneous distribution(P>0.05). 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 (P=0.001;P<0.01). An increase in defecation in the normal form and bowel movement frequency were observed in the MG after the treatment. In both groups, VDSS and PINQ values decreased after treatment, but the decrease in TG was statistically significant in the evaluation made between groups(P=0.001;P<0.01).

Conclusion

The application of parasacral TENS and manual therapy applications are seen as a non-invasive, inexpensive, and effective treatment that can be used to improve symptoms in the treatment of neurogenic bladder and bowel in children with CP.