Clinical research on the effects of Chinese herb fumigation and washing combined with electromyographic biofeedback on stroke patients with muscle cramp on limbs / 中国实用护理杂志

Objective We tried to observe the effects of Chinese herb fumigation and washing combined with electromyographic biofeedback on stroke patients with muscle cramp on limbs.Methods 84 patients who had muscle cramp on limbs were selected and divided into two groups randomly,namely the intervention group and the control group and both groups had 42 stroke patients.The intervention group was treated with routine treatment,Chinese herbal fumigation and washing and electromyographic biofeedback treatment.The control group received only routine treatment and electromyographic biofeedback treatment.We had compared and analyzed the Ashworth Spasticity Scale and the Daily Life Abihty Score (Barthel index) of the two groups at the time of the pre therapy,two weeks after the treatment and at the end of the treatment(after four weeks),respectively.Results There were no significant differences between the two groups in Barthel index,however,there were significant differences in Ashworth Spasticity Scale scores between the two groups four weeks after treatment,t=-3.84,P ＜ 0.05.Conclusions The effect of Chinese herb fumigation and washing combining with the electromyo-graphic biofeedback treatment is better than usage of the electromyographic biofeedback treatment alone on stroke patients with muscle cramp on limbs.

Biofeedback treatment in chronically constipated patients with dyssynergic defecation / Biofeedback aplicado al tratamiento de pacientes con estreñimiento crónico debido a defecación disinérgica

The aim of this study was to evaluate the effects of electromyographic biofeedback training in chronically constipated patients with dyssynergic defecation. With this purpose, ten patients (4 males, 6 females) with dyssynergic defecation unresponsive to dietary corrections and fibre supplements were selected and enclosed in the study on the basis of fulfilled the Rome III criteria for this functional gastrointestinal disorder. The study was carried out following a series of defined phases: clinical and psychophysiological assessment prior to the treatment (4 weeks), EMG-biofeedback treatment (8 sessions, two per week) and follow-up (4 weeks) one month later. In all phases, four clinical variables were assessed through selfmonitoring (frequency of defecations per week, sensation of incomplete evacuation, difficulty evacuation level, and perianal pain at defecation); moreover, psychophysiological measures were obtained through electromyography (EMG) of the external anal sphincter. Results show significant improvements in psychophysiological measures (EMGactivity during straining to defecate and anismus index), as well as in clinical variables. Biofeedback's benefits were maintained at the follow-up period.

El objetivo de este estudio fue evaluar los efectos del entrenamiento en biofeedback-EMG en pacientes con estreñimiento crónico debido a defecación disinérgica. Con este propósito, 10 pacientes (4 varones, 6 mujeres) con defecación disinérgica que no respondían a correcciones dietéticas y suplementos de fibra, fueron seleccionados e incluidos en el estudio sobre la base de cumplir los criterios Roma III para el diagnóstico de este trastorno funcional gastrointestinal. El estudio se llevó a cabo a lo largo de una serie de fases definidas: evaluación psicofisiológica y clínica previa al tratamiento (4 semanas), tratamiento por medio de biofeedback-EMG (8 sesiones, a razón de dos sesiones semanales) y seguimiento (4 semanas) un mes más tarde. En todas las fases, cuatro variables clínicas fueron evaluadas a través de autorregistro (frecuencia de defecaciones semanales, sensación de evacuación incompleta, nivel de dificultad de la evacuación y dolor perianal en la defecación); además, se obtuvieron medidas psicofisiológicas a través de electromiografía (EMG) del esfínter anal externo. Los resultados muestran mejoras significativas en las medidas psicofisiológicas (actividad-EMG durante el esfuerzo para defecar e índice de anismus), así como en las variables clínicas. Los beneficios del biofeedback se mantuvieron en el período de seguimiento.

Therapeutic evaluation of biofeedback treatment on ADHD with IVA-CPT multi-quotients / 中华行为医学与脑科学杂志

Objective To investigate the curative effect of biofeedback treatment on attention-deficit/hyperactivity disorder ( ADHD ) patients using integrated visual and auditory continuous performance test ( IVA-CPT).Methods 23 ADHD patients undertaked 20 times of EEG biofeedback treatment using VBFB-3000A facility.Their executive and attention quotients were measured before and after treatment by IVA-CPT.Results The pre-therapy full scale of response control and attention quotients of ADHD were 58.26 ± 32.9 and 54.43 ±34.01 respectively.After the therapy, all the quotients got improved (response control 99.3 ± 12.6, attention 84.1 ± 15.9 ) except for stamina and speed quotients both in visual and in auditory.Conclusion Shortterm EEG biofeedback treatment is one of effective methods for ADHD patients,especially for hyperactive cases.

Are There Anorectal Physiologic Factors Prior to Biofeedback Treatment for Constipation that Affect Compliance Rate?

PURPOSE: The most important factor for the success of biofeedback treatment of constipation is patients' enthusiastic participation and willingness to comply with the treatment protocol. The purpose of this study was to analyze differences among groups of patients classified according to the number of biofeedback sessions and to identify any anorectal physiological and clinical factors related with better compliance with biofeedback treatment. METHODS: From Aug. 2001 to July 2003, 80 patients who had undergone biofeedback treatment for constipation by a single therapist were classified into three groups according to the number of sessions: only one session (Group I, n=26), two or three sessions (Group II, n=27), and more than four sessions (Group III, n=27). We reviewed the clinical and the anorectal physiological characteristics retrospectively. RESULTS: The mean age was 39.1 (range, 8~77) years, and the mean duration of constipation was 7.7 (range, 0.5~30) years and mean frequency of defecation was 2.2 times/week. Patients' pretreatment use of laxatives was significantly lower in Group I (38.5 percent) than in Group II (70.4 percent) or Group III (51.9 percent) (P<0.05). There were no significant differences in anal manometric parameters (mean and maximal resting pressure, maximal squeezing pressure, sensitivity, and rectal capacity). In the cinedefecographic findings, the megarectum was significantly higher in Group III (58.3 percent) than in Group I (38.9 percent) or Group II (27.8 percent) (P=0.02), but other findings of anismus, rectocele, intussusception, and delayed emptying showed no significant differences. The cinedefecographic parameters (anorectal angle, perineal descent, anal canal length, and puborectalis length), were not significantiy different among the groups. CONCLUSIONS: We strongly recommend biofeedback treatment for constipation patients who abuse laxatives and/or for whom cinedefecography reveals megarectum.

The Clinical Characteristics and Outcomes of Biofeedback Treatment for Patients with Nonrelaxing Puborectalis Syndrome

PURPOSE: Biofeedback treatment is thought to be appropriate for patients with nonrelaxing puborectalis syndrome (NRPR). The aim of this study is to analyze the physiologic characteristics and to assess the outcomes of biofeedback treatment for patients with NRPR. METHODS: Forty-six (46) patients with NRPR were evaluated with anorectal physiologic studies, including colonic transit time (n=26), anorectal manometry (n=41), defecography (n=46), anal sphincter EMG (n=28), and colonoscopy or barium enema (n=33). The treatment consisted of a training program with EMG-based biofeedback for 30 minutes once a week and routine supportive care, including Kegel practice. RESULTS: The mean age was 52.8 years, and the sex ratio was 1 male to 0.6 female. A delayed colonic transit time was noted in 5 patients (19.26%). In the NRPR group, the maximal voluntary contraction and the mean squeezing pressure were higher than they were for other patients with pelvic outlet obstructive disease. Also, the perineal descents and the dynamic change of anorectal angle were shorter. Polyps were observed in 6 patients (18.2%), melanosis coli in 4 patients (12.1%), and diverticula in 3 patients (9.1%). The rectoanal inhibitory reflex (RAIR) was negative in 3 patients (7.3%). The patients underwent a mean of 4.0 sessions, and the mean follow-up was 7.4 months. Twenty-three (23) patients (82.1%) experienced improved of symptoms or EMG findings. The patients (17.9%) who did not improve had several abnormal findings: neuro-psychologic disease with delayed colonic transit time in 2 cases, negative RAIR in 2 cases, and melanosis coli in one case. CONCLUSIONS: We think that biofeedback training is an effective treatment for patients with NRPR. In addition, several factors, such as neuro-psychologic diseases, delayed colonic transit time, negative RAIR, or melanosis coli may influence the prognosis for biofeedback treatment, so further large-scaled studies will be needed to confirm these findings.

Clinical and Physiologic Study of Encopresis

The pathophysiology of pediatric encopresis has been incomprehensible. The current study was designed to assess its clinical and physiologic findings. Moreover, outcome of treatment was evaluated. METHODS: The clinical and functional findings of 18 patients (13 boys, 5 girls) were analyzed, retrospectively. Physiologic studies for cooperative child included anal manometry (n=12), cinedefecography (n=3), and PNTML (pudendal nerve terminal motor latency, n=1). For exclusion of the organic cause, barium contrast study was carried out in all case. Patients were categorized by leading symptom as constipation or incontinence. Physiologic findings and outcome of treatment were analyzed based on the categorized groups. Biofeedback therapy by using newly-developed anal sphincter control system (KONTINENCE CLINICAL(TM)) in my institute, was underwent a mean 4.1 (range, 2~12) sessions. The outcome was analyzed in the period of 5.4 (range, 1~33) months follow-up. RESULTS: Patients were categorized as having constipation (group I, n=12) or incontinence (group II, n=6) group. In the manometric parameters, there were no statistical differences between the values of the mean resting pressure (RP), the maximum RP, and the maximum voluntary contraction between group I and II. In the cinedefecography, 3 of group I patients revealed as having the pelvic floor dyssynergia. The findings of PNTML were not specific in group II (n=1). Regarding to the therapeutic outcome, 8 of 10 patients were cured or improved. CONCLUSIONS: There were no differences in the resting and squeeze profiles of manometric parameters between two groups. However, pelvic floor dyssynergia was identified in the cinedefecography of constipated group. Conventional and biofeedback treatment for encopretic children provides acceptable outcome.

The Comparison of the Effectiveness of Pelvic Floor Muscle Exercise and Biofeedback Treatment for Stress Incontinence in Korean Women / 간호학회지

This study evaluated the Comparison of the Effectiveness of Pelvic Floor Muscle exercise and Biofeedback treatment for Genuine Stress Incontinence I assigned 60 participants to 2 groups : 30 to the pelvic floor muscle exercise group and 30 to the biofeedback group. Treatment protocol lasted for 6 weeks. Peak pressure, and duration time of pelvic muscle contraction were evaluated by a perineometer. Lower urinary symptoms, sexual matter and life style scores were achieved by using Jackson's scale. The treatment efficacy of the pelvic floor muscle exercise is compared with the biofeedback group and the main results of the comparison are as follows: 1. Pelvic muscle contraction 1) The peak pressure in the biofeedback group was significantly increased(P=0.000). 2. The frequency and quantity of incontinence 1) The frequency of incontinence in the biofeedback group was significantly decreased(P=0.000). 2) The quantity of incontinence in the biofeedback group was significantly decreased(P=0.000). 3. The lower urinary symptoms Daily frequency(P=0.000), nocturia(P=0.000), urgency(P=0.000), bladder pain(P=0.000), unexplained incontinence(P=0.048), wearing protection(P=0.022), changing outer clothing(P=0.005), hesitancy(P=0.008), intermittent stream(P=0.000), abnormal strength of stream(P=0.004), retention(P=0.000), incomplete emptying(P=0.000), and inability to stop mid steam(P=0.006) of the lower urinary symptoms in the biofeedback group were significantly decreased. 4. The sexual matters The dry vagina(P=0.004) and pain during sexual intercourse(P=0.002) in the biofeedback group was significantly decreased. 5. The life style. The fluid intake restriction(P=0.007), affected daily task(P=0.003), avoidance of places & situation(P=0.003), interference in Physical activity(P=0.002), interference in relationship with other people(P=0.01), and feeling about the rest of life with urinary symptom(P=0.000) in the biofeedback group were significantly decreased. In conclusion, the biofeedback treatment was more effective than the pelvic floor muscle exercise in genuine stress incontinence.

The Comparison of the Effectiveness of Pelvic Floor Muscle Exercise and Biofeedback Treatment for Stress Incontinence in Korean Women / 간호학회지

This study evaluated the Comparison of the Effectiveness of Pelvic Floor Muscle exercise and Biofeedback treatment for Genuine Stress Incontinence I assigned 60 participants to 2 groups : 30 to the pelvic floor muscle exercise group and 30 to the biofeedback group. Treatment protocol lasted for 6 weeks. Peak pressure, and duration time of pelvic muscle contraction were evaluated by a perineometer. Lower urinary symptoms, sexual matter and life style scores were achieved by using Jackson's scale. The treatment efficacy of the pelvic floor muscle exercise is compared with the biofeedback group and the main results of the comparison are as follows: 1. Pelvic muscle contraction 1) The peak pressure in the biofeedback group was significantly increased(P=0.000). 2. The frequency and quantity of incontinence 1) The frequency of incontinence in the biofeedback group was significantly decreased(P=0.000). 2) The quantity of incontinence in the biofeedback group was significantly decreased(P=0.000). 3. The lower urinary symptoms Daily frequency(P=0.000), nocturia(P=0.000), urgency(P=0.000), bladder pain(P=0.000), unexplained incontinence(P=0.048), wearing protection(P=0.022), changing outer clothing(P=0.005), hesitancy(P=0.008), intermittent stream(P=0.000), abnormal strength of stream(P=0.004), retention(P=0.000), incomplete emptying(P=0.000), and inability to stop mid steam(P=0.006) of the lower urinary symptoms in the biofeedback group were significantly decreased. 4. The sexual matters The dry vagina(P=0.004) and pain during sexual intercourse(P=0.002) in the biofeedback group was significantly decreased. 5. The life style. The fluid intake restriction(P=0.007), affected daily task(P=0.003), avoidance of places & situation(P=0.003), interference in Physical activity(P=0.002), interference in relationship with other people(P=0.01), and feeling about the rest of life with urinary symptom(P=0.000) in the biofeedback group were significantly decreased. In conclusion, the biofeedback treatment was more effective than the pelvic floor muscle exercise in genuine stress incontinence.

Development of Second Stage Software in the Anal Sphincter Control System Based on the Anal Electromyography, and Investigation of Therapeutic Outcome of the Patients withChronic

To eliminate the inconvenient shortcomings of our formerly designed system for the biofeedback treatment, the development of second stage software was indispensable. PURPOSE: The aims of current study were to supplement the prototype software, and to improve the application software for the database management system. Moreover, we assessed the practical value and outcome of biofeedback therapy for the patients with functional evacuation disorders by using the upgraded system. METHODS: A new system was worked out a design to be composed of Windows based GUI (graphical user interface), DB (database) management software, and networking system. Main software performs a signal processing and a protocol making mode to train pelvic sphincter. DB program administers patient profiles and the recorded signal data. Networking system was designed to execute RS-232C serial communication of signal data with use of fast ethernet LAN networking. To affirm the reproducibility of signal display for the clinical practice, system was applied to 5 healthy volunteers. To evaluate the practical appraisal, system was applied to 27 patients with functional evacuation disorders who were undertaken anorectal physiologic tests. Patient groups were categorized as nonrelaxing puborectalis group (group I, n=17), incontinencegroup (group II, n=10). Overall patients were underwent a mean 3.7 (range, 2~10) sessions of biofeedback treatment, and the outcome was analysed in the period of 5.8 (range, 3~12) months follow-up. RESULTS: Signal data not having drift or noise were adequately processed and displayed in a real time. Specifically, data upload with use of multi-processing overay display function was appropriately embodied. Overall data and profiles of patients groups were safely saved, sorted, and reproduced by using the upgrading database management software. Regarding to the therapeutic outcomes, 63 percent of 27 overall patients (12 of 17 patients in group I, 5 of 10 patients in group II) were improved. The subjective symptoms of 2 patients in group I were recurred in a period of 3 months follow-up. CONCLUSIONS: Hardware and software functions of upgraded system were applicable to the Windows environment of personal computer. A developed system with second stage software made it possible to perform biofeedback treatment. Specifically, current results could be useful for the improvement of the motivation and patient's willingness in the self-learning process of biofeedback treatment.