Exploring The Relationship Between Locomotor Training And Bowel And Bladder Outcomes In Individuals With Spinal Cord Injury: A Scoping Review And Feasibility Study.

This thesis explored the relationship between locomotor training and bowel and bladder function in individuals with Spinal Cord Injury (SCI). Study 1 was a scoping review that identified and summarized literature describing the relationship between locomotor training and bowel/ bladder outcomes in individuals with SCI and identified research gaps in the existing literature on bowel/bladder outcomes during locomotor training. Results of the scoping review suggested there is evidence of a positive relationship between locomotor training and bowel/bladder outcomes, however, most of that evidence was not collected using clinical outcome measures. Study 2 evaluated the feasibility of using the Spinal Cord Injury (SCI)-Quality of Life (QOL) v1.0 Bowel and Bladder Dysfunction Scales to assess bowel/bladder changes in people with SCI participating in inpatient or outpatient physical rehabilitation. Results suggested that the SCI-QOLv1.0 Bowel and Bladder Dysfunction Scales were deemed mostly feasible to use by both inpatients and outpatients

The Efficacy of Electrical Stimulation and Conservative Physical Therapy in the Treatment of Female Genuine Stress Incontinence

The purpose o f this study was to determine which of three treatment strategies was most effective in the treatment of female genuine stress incontinence (GSI). Nine females ages 41-86, diagnosed with GSI, were included in the study. Subjects were randomly assigned to one of three groups, one received electrical stimulation twice a week for 15 minutes; another received electrical stimulation three times a week for thirty minutes; and a control group receiving no electrical stimulation. All groups received identical instruction in Kegel pelvic floor muscle exercises, with the assistance of audio and visual biofeedback. Each treatment was evaluated on five criteria: a stress test, digital manual muscle test of the pelvic floor, periometry measurement of pelvic floor strength, Incontinence Impact Questionnaire score, and Urogential Distress Inventory score. The data were analyzed using a Kruskal-Wallis 1-Way ANOVA, which computed a mean rank for each method according to the change it caused in the dependent variables, and a Pearson’s Correlation Coefficient analysis, to reveal any significant relationships among the variables. Although some important relationships did emerge, none of the results of this study were shown to be statistically significant

Doctor of Philosophy

dissertationPelvic floor disorders (PFD) affect one in four women in the United States. Elevated intra-abdominal pressure (IAP) during daily activity or strenuous physical activity has been identified as a risk factor in the prevalence of PFD. However, the relationship between IAP and physical activity remains poorly understood. Despite the lack of scientific evidence, clinicians oftentimes prescribe long-term activity restrictions to urogynecologic postoperative patients to minimize IAP, which is thought to lessen the load on the pelvic floor. Since many health benefits are associated with exercise, it is necessary to understand how IAP changes with activity in order to reduce risk to the pelvic floor while allowing women to be physically active. Current methods of measuring IAP include invasive catheters in the vagina, rectum, bladder, or stomach that are tethered to laboratory equipment and have been shown to have poor dynamic response. These characteristics limit the potential for tracking IAP during daily physical activity away from the clinic. The objectives of this research were to determine how intra-abdominal routine that may be adapted for postsurgical patients. Three phases of this work included (1) development of a wireless gel-filled intravaginal pressure sensor to accurately track intra-abdominal pressure, (2) testing the newly developed intravaginal sensor in benchtop and in vivo settings to determine the utility of sensors in real-world deployments, and (3) using the wireless intravaginal pressure sensor to characterize IAP during exercise and, based upon results, create a low intra-abdominal pressure routine that can be used to exercise while minimizing pressure load on the pelvic floor

Enhancing self-efficacy and pelvic floor muscle exercise adherence through sEMG biofeedback : a randomised study

Background Pelvic floor muscle exercises are a recommended first-linetreatment for stress urinary incontinence (SUI) in women (NICE, 2006). Pooradherence to pelvic floor muscle exercises (PFME) is a recognised problemwhich has the potential to compromise successful treatment (Bø, 1995;Alewijnse et al., 2001). Biofeedback is thought to help motivate PFMEpractice but so far this has not been evaluated in a randomised study.Aim This study tests the hypothesis that use of clinic-based sEMGbiofeedback improves women’s motivation to exercise (PFME adherence) byincreasing pelvic floor muscle exercise self-efficacy, an important construct inpelvic floor muscle exercise adherence behaviour.Method After ensuring that they are able to make an informed decision toparticipate, a sample of sixty women referred for physiotherapy treatment ofSUI between December 2008 and February 2010, gave consent to participatein the study. They were randomised into one of two groups. Thirty onewomen received clinic-based sEMG biofeedback in addition to the usual care,twenty nine received the usual care. Each participant attended clinic twice in athree month treatment period. Women were also asked to adhere to a dailyhome exercise programme (HEP). The primary outcome was pelvic floormuscle exercise self-efficacy. PFME self-efficacy and HEP adherence, wereassessed by means of self-completed questionnaires.Results Ten women dropped out of the study before completion. Bothgroups improved on all outcomes, but no significant difference was foundbetween the groups in terms of self-efficacy levels or exercise adherencerates. PFME recall was more accurate in the intervention group receivingclinic-based sEMG biofeedback. A positive and significant relationship wasconfirmed between PFME self-efficacy and PFME adherence. These findingsare discussed in respect to the concept of self-efficacy and behaviouralchange.xixiiConclusion In the short term, clinic-based sEMG biofeedback does notincrease PFME self-efficacy or HEP practice beyond that achieved throughinstruction using vaginal palpation. These findings refute the belief thatmonitoring with sEMG biofeedback improves self-efficacy or women’smotivation to adhere to a HEP, but does suggest that biofeedback may be auseful adjunct to teaching PFME

Psychosocial Characteristics of Children with and Without Toileting Dysfunction

Toilet training is a stressful time for parents and families; however, pediatric providers are often uncertain of how to guide parents through this period because of limited systematic research in this area. The current study investigated the role of timing and method of toilet training, use of physician and community resources, and parent and child psychosocial variables to better understand normative toilet training and clarify the role of family, parent, and child characteristics in the toilet training process. The literature regarding early childhood development and normative toileting was reviewed, followed by a discussion of voiding dysfunction and relevant psychosocial and cultural patterns. Participants included 437 community parents (77% female, 82% White, 69% married) of children (48% female) between the ages of two- and six-years-old. A subclinical sample (n=27) and matched controls who did not experience toilet training challenges were identified from within the larger community sample. Data were gathered through an online retrospective survey including measures of demographics, family functioning, child behavior, child temperament, parenting style, parent stress, and open-ended questions about toilet training decisions and resources. Qualitative results indicated that parents used numerous methods of toilet training and half of parents did not consult their child’s primary care provider during the process. Most children were toilet trained by three-years-old. Five latent groups of children were identified in the current sample. Classes differed primarily along child behavior symptoms, temperamental activity, negative parenting behaviors, household conflict, and reported use of child-centered toilet training. The subclinical sample had significantly higher ADHD symptoms and were described as slightly more emotionally labile than the matched non-clinical group. The results of this study indicate that family-system variables likely influence how children are toilet trained. These findings support further consideration of the recommendations provided to parents prior to beginning their child’s toilet training and highlight the need for additional attention to the family system during this process