Pelvic floor muscle retraining for pediatric voiding dysfunction using interactive computer games.

PURPOSE: We evaluated a new noninvasive outpatient method of pelvic muscle retraining in children using computer game assisted biofeedback. MATERIALS AND METHODS: All patients in whom voiding dysfunction was confirmed by history, uroflowmetry-electromyography and voiding cystourethrography were enrolled in a pelvic floor muscle retraining program. Patients received a pretreatment, mid treatment and posttreatment survey instrument documenting subjective improvement, including the frequency of diurnal enuresis, nocturnal enuresis, constipation and encopresis. Pretreatment and posttreatment simultaneous uroflowmetry surface electrode electromyography was performed and post-void residual urine volume was determined in all patients. RESULTS: A total of 8 boys and 33 girls 5 to 11 years old (mean age 7.2) completed therapy and were available for evaluation. These patients completed 2 to 11 (average 6) hourly treatment sessions. Followup was 3 to 15 months (average 7). At the midterm evaluation improvement in nocturnal enuresis was reported by 57% of the patients, diurnal enuresis by 84%, constipation by 83% and encopresis by 91%. End treatment evaluation revealed improvement in nocturnal enuresis by 90% of patients, diurnal enuresis by 89%, constipation by 100% and encopresis by 100%. Uroflowmetry-electromyography patterns improved in 42% of the patients and post-void residual urine decreased in 57%. Comparison of initial to end recorded millivoltage pelvic floor muscle values demonstrated that 56% of the patients had lower resting tone at the beginning of the session after completing therapy and 78% had improved contracting tone after performing Kegel exercises, as proved by increased microvoltage values. Initial uroflowmetry-electromyography revealed certain categories of cases, including a flattened voiding curve with a hyperactive pelvic floor and low post-void residual urine in 40%, a flattened voiding curve with a hyperactive pelvic floor and high post-void residual urine in 40%, a staccato voiding curve with a hyperactive pelvic floor and low post-void residual urine in 3%, and a staccato voiding curve with a hyperactive pelvic floor and high post-void residual urine in 17%. Of the girls 91% presented with the classic spinning top deformity on voiding cystourethrography. A total of 22 patients presented with a significant history of recurrent urinary tract infections, and infection developed in 3 during treatment and followup. Vesicoureteral reflux in 14 patients resolved during treatment in 3, reimplantation was performed in 1 and 10 are still being observed. CONCLUSIONS: A program of conservative medical management with computer game assisted pelvic floor muscle retraining resulted in significant subjective improvement in continence, constipation and encopresis as well as objective improvement in uroflowmetry-electromyography, post-void residual urine volume and the microvoltage value of pelvic floor muscles in the majority of patients with dysfunctional voiding.

Comparison of pulmonary gas exchange measurements between incremental and constant work exercise above the anaerobic threshold.

STUDY OBJECTIVES: To compare arterial blood gas (ABG) and pulmonary gas exchange variables (alveolar-arterial oxygen pressure difference [P(A-a)O2] and physiologic dead space to tidal volume ratio [VD/VT]) measured during incremental exercise test (IET) and constant work (CW) exercise at a matched oxygen uptake (VO2). DESIGN: A comparison of IET and CW variables was accomplished using patient data from clinical referrals for cardiopulmonary exercise testing and control data not reported from a previous study. SETTINGS: El Paso, Tex, located at an altitude of 1,270 m (barometric pressure, 656 mm Hg). PARTICIPANTS: Sixteen patients with dyspnea on exertion/exercise intolerance and nine normal subjects were evaluated above the anaerobic threshold (AT); seven patients were also studied below the AT. INTERVENTIONS: Participants had a maximal IET followed in 1 h by a 5-min CW test. Arterial blood samples were obtained from a radial catheter every other minute during IET and during minute 5 of CW. Cardiopulmonary measurements were obtained using an automated system in a breath-by-breath fashion (60-s averaging). RESULTS: Above the AT, no differences were observed in normal subjects between IET and CW at a matched VO2 in the following: PaO2 (79 vs 79 mm Hg); arterial oxygen saturation (SaO2) (94% vs 94%); P(A-a)O2 (16 vs 16 mm Hg); and VD/VT (0.09 vs 0.09) (mean values). Similarly, no differences were observed in patients above the AT in PaO2 (69 vs 68), SaO2 (90 vs 90), and VD/VT (0.24 vs 0.23). PaCO2 was 2 mm Hg higher (36 vs 34) in normal subjects and in patients (34 vs 32) during IET. A significant (p<0.05), albeit clinically unimportant, difference was also observed in P(A-a)O2 (28 vs 29) in patients. No statistically significant differences were observed below the AT between IET and CW for any of the variables measured. CONCLUSIONS: These data demonstrate the reliability of ABG and pulmonary gas exchange variables measured during 1-min IET for clinical use in patients and normal subjects. However, PaCO2 tends to be slightly higher during IET vs CW.

Correlations between two short cognitive tests and a WISC-III short form using a sample of adolescent inpatients.

A new short form of the WISC-III was examined with a clinical adolescent sample (N = 30) and the short form estimate of WISC-III Full Scale IQ also served as the criterion for validating two brief cognitive measures, the Kaufman Functional Academic Skills Test (K-FAST) and the K-SNAP. Data supported the brevity of the WISC-III short form and the criterion-related validity of both the K-FAST and and Kaufman Short Neuropsychological Assessment Procedure (K-SNAP).

Comparison of cardiopulmonary responses to forward and backward walking and running.

Backward running has long been used in sports conditioning programs and has recently been incorporated into rehabilitative settings as a method of increasing quadriceps strength while decreasing the joint compressive forces about the knee. Although backward locomotion has been studied kinetically, the metabolic cost of backward walking and/or running has not to our knowledge been previously characterized. Oxygen consumption and other cardiopulmonary variables were measured under constant speed exercise during backward and forward walking at 107.2 m.min-1 and during backward and forward running at 160.8 m.min-1. Peak oxygen consumption (VO2peak) was also measured during maximal incremental backward and forward running. VO2, HR, and blood lactate were significantly higher (P < 0.001) during backward walking and running than during forward walking and running. During backward walking and backward running, subjects exercised at 60% and 84% of their forward VO2peak, respectively. In conclusion, for a given speed, backward locomotion elicits a greater metabolic demand and cardiopulmonary response than forward locomotion. In general, these data suggest that while undergoing rehabilitation, an injured athlete may continue to exercise using backward walking/running at an intensity sufficient enough to maintain cardiovascular fitness levels.

Effects of simulated altitude and exercise upon ECGs of young black men.

Twenty-five healthy black men between 17 and 21 years of age were evaluated. Their resting and exercise electrocardiograms were recorded at simulated sea level and at a simulated altitude of 4,000 m. Sea level exercise caused a reduction in the amplitudes of R waves and a lowering of J points. Exercise at a simulated altitude of 4,000 m caused a lowering of the J point in several leads and a reduction of the R wave amplitude in lead aVF. Hypoxia caused a reduction in the amplitudes of the T waves and a lowering of the J points in several leads. These effects of exercise and altitude, to a great extent, eliminated the appearance of "early repolarization," which is very common among young black men.