S-3-02-03
Assessment and treatment of neurogenic bladder in stroke patients
Satoshi Takasaka (Tokyo Metropolitan Rehabilitation Hospital, Tokyo, Japan)
The urological examinations as evaluation of the condition with regard to ADL / dementia, recording in the urination chart, radiography in the urinary tract or the urodynamic examination have been conducted. At the same time, the around -the -clock cystometorography has been conducted to obtain file detailed evaluation of the vesical function in daily life. In the study on the findings of the brain CT scan and on urination disorder of 40 patients with cerebrovascular disorder, no significant correlation between the impaired region or area in the brain and the pattern of urination disorder was seen. As for the relation between urinary incontinence and FIM, the patients who acquired low points under the items of FIM recognition were likely to have urinary incontinence. The patients who require attention in the management of urination are those with residual urine and urinary incontinence, the female patients with urinary incontinence and those with the complication of severe dementia. We conduct the intermittent balloon catheter indwelling besides drag therapy as an urinary management in those patients and favorable results have been acquired such as the disappearance of urinary incontinence, decrease of diaper use or reduction of the nursing labor.
S-3-02-04
INTERACTIVE REHABILITATION PROGRAMME FOR URINARY INCONTINENCE.
Olavi Airaksinen, Pauliina Aukee, Paula Immonen and Jorma Penttinen.
Departments of Physical and Rehabilitation Medicine and Gynecology and Obstetrics, Kuopio University Hospital. 70210 Kuopio Finland.
Urinary incontinence is a widely prevalent problem that affects people of all ages and levels of physical health, both in healthcare settings and in community. Treatment of stress incontinence includes behavioral modification, pelvic floor exercises, biofeedback, various medications and surgery. Physiotherapy with electric stimulation of pelvic floor muscles and muscle exercises are the most famous rehabilitation procedures for incontinence. Biofeedback uses electronic or mechanical instruments to reply information to patients about their physiological activity. Auditory or visual display of this information forms the core of biofeedback procedures.
Usually there are used for muscle exercises, electrical stimulation and biofeedback therapies by intravaginal probe. In clinical use we have also electrodes in probe for measuring electrical activity of pelvic floor muscles. When exercises proves successful, and surgery is avoided, it is necessary for patient to be put on a maintenance program to avoid relapse. For self treatment we have developed an interactive rehabilitation programme, which consists intravaginal probe and microprosessor based measuring and data logging electronics. The system is self adapting for every training session. The patient will hear voice-controlled protocol by head phones and she will hear feedback of every training session immediately. After home training period the memory can down loaded to a computer. The progression of improvement of both right and left side activity of pelvic floor muscles can be seen. The next training protocol can be created based on this analysis.
This interactive rehabilitation programme helps the patients to concentrate the pelvic floor exercises and to continue and to maintain the progression of therapy. The compliance of self treatment by this type programme could be more effective than casual physiotherapy and exercises on out-patient clinics.
