电刺激在尿失禁治疗中之技巧及运用精品课件.ppt

電刺激在尿失禁治療中之技巧及運用 陳怡靜 中山醫學大學 物理治療學系 講師 中山醫學大學附設醫院 物理治療師 Types of Incontinence Stress incontinence Urge incontinence Mixed incontinence Reflex incontinence Overflow incontinence Treatment for Urinary Incontinence Federal Agency for Health Care Policy and Research (AHCPR), 1996 Behavioral treatment Pharmacologic treatment Surgical treatment Behavioral Therapy Bladder retraining Pelvic muscle rehabilitation – PMEs, PMEs and bladder inhibition augmented by biofeedback therapy, PMEs augmented with vaginal weight training, and pelvic floor electrical stimulation Physiological Effects Improvement of reinnervation of partly denervated PFMs by encouraging axonal sprouting. Muscle strength is increased in a similar manner to voluntary exercise. Electrically elicited contractions can target and train type 2 (fast-twitch) fibers effectively. Electrical Stimulation Increase awareness of the PFM Teach effective PFM exercise Increase peri-urethral pressure Inhibit detrusor contraction Electrical Parameters Frequency: --10 Hz or less in the treatment of bladder instability. --10-50 Hz in treatment of weakened pelvic floor muscle. Electrical Parameters Intensity: maximal tolerated level Electrical Parameters On/off ratio (duty cycle): 1:1 or 1:2 Transcutaneous Electrical Stimulation Percutaneous Tibial Nerve Stimulation Transvaginal electrical stimulation for female urinary incontinence A prospective, double-blind, randomized clinical trial 49% of women with detrusor instability who used an active electrical device were cured ( stable on provocative cyctometry). no statistically significant change in the percentage with detrusor instability in the sham device group (control group). Brubaker L et al: Am J Obstet Gynecol 1997; 177(3): 536-540 Intravaginal stimulation randomized trial Electrical stimulation is safe and at least as effective as anticholinergic therapy in the treatment of urge urinary incontinence. Smith JJ: J Urol 1