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In The Name Of God

In The Name Of God. Electrotherapy Methods in Pelvic Floor Disorders. Afsaneh Dadarkhah M.S of Pt. Electrotherapy Methods. Electrical Stimulation Biofeedback Therapy Electromagnetic Stimulation Therapy. Electrical Stimulation (E.S). Electrical Stimulation History.

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In The Name Of God

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  1. In The Name Of God

  2. Electrotherapy Methods in Pelvic Floor Disorders Afsaneh Dadarkhah M.S of Pt

  3. Electrotherapy Methods • Electrical Stimulation • Biofeedback Therapy • Electromagnetic Stimulation Therapy

  4. Electrical Stimulation(E.S)

  5. Electrical Stimulation History • 1952:Bors described the influence of E.S on the pudendal nerves. • 1963:Caldwell developed electrodes that were permanently implanted into the pelvic floor & controlled by radiofrequency. • 1976:Suhel provided new methods for no implantable prineal stimulation. • 1991:Godec & associates first described the use of no implanted stimulators specifically for bladder inhibition.

  6. Electrical StimulationTechniques • Long term (chronic , weak) E.S • Short term (acute , strong) E.S • Acute Maximal Functional E.S • Maximum Pelvic Floor E.S

  7. Basic Principals & Mechanism of E.S

  8. Electrical Stimulation is an effective treatment for stress incontinence and urge incontinanence. This technique uses natural pathways and micturation reflexes. E.S is commonly used to improve function of 1)urethral sphincteric mechanism 2)Levator ani muscles 3)External anal sphincter

  9. E.S increases the number & strength of slow-twitch fibers, improving resting urethral closure. • E.S restore the inhibition effect (urge incontinence) • E.S increases the bulk of the levator ani muscle & the proportion of fast-twitch fibers & thus the ability of muscles to respond to a sudden increase in intra abdominal pressure

  10. E.S Pulse Wave Forms • Biphasic Coupled Pulses • Monophasic Square Pulses • Biphasic Square Pulses • Monophasic Coupled spike Pulses

  11. To Minimize Electrochemical Reaction • Electrode-mucosa interface , biphasic or alternating pulses • Small electrodes & high charge densities • Low frequency • Bidirectional pulses

  12. Frequency of E.S in Incontinence • Low Frequency (5-10 Hz) Sustained • High Frequency (20-50 Hz) • Slow Twitch muscle fiber fires at 10-20 Hz • Fast Twitch muscle fiber fires at 30-60 Hz • Current Frequencies greater than 40 Hz induce fatigue • Frequencies of approximately 30 Hz induce tetanized smooth contraction • The Best frequency: Frequencies about 10-40 Hz in 250-500msec activate fast & slow twitch fibers

  13. Chronic Stimulation • Chronic stimulation (30 days) may increase the relative number of slow twitch fibers.(Probably by helping to transform fast twitch fiber to slow unit)

  14. Duty Cycle • Ratio of stimulus time to rest time • Typical Duty Cycle: 1/2 • Weakness or neurological impairment:1/3

  15. Conventional E.S • Conventional E.S is applied to limit and avoid discomfort and muscle fatigue

  16. Other Methods of E.S • Faradism: Maximal stimulus & short bursts • Interferential Therapy: Two interfering medium-frequency that product low frequency stimulation in the area of interest 1)Bipolar technique 2)Four electrodes technique

  17. Transcutaneus Electrical Nerve Stimulation (TENS) • Transcutaneus electrical Nerve Stimulation of acupuncture points may be used to inhibit detrusor activity • Surface electrodes are placed bilaterally over both tibial nerves or both common proneal nerves. (5cm over the medial malleous). • Parameters: Intensity:5-8 v Frequency:2-10Hz Pulse width:5-20msec

  18. Causes of Denervation of the Pelvic Floor • Vaginal Childbirth • Other Pelvic Trauma • Surgery • Aging

  19. Pudendal nerve latency is prolonged by vaginal delivery , vaginal surgery for prolapse. • To improve urethral closure innervation of the pelvic floor must exist • No effect can be expected in patients with complete lower motor neuron lesions. • After denervation injury E.S used to recondition muscle & facilitate sprouting of surviving motor axons

  20. Clinical Practice • Different Type of E.S 1) Office Therapy 2) Home Treatment Program

  21. Intra Vaginal Stimulation Dehghan FM,PT,Ph.D

  22. Different Available Probes • Standard two-ring vaginal probe • Tampon two-ring vaginal probe • Inflatable intravaginal probe • Intraanal probe • Disposable probe • Two-channel vaginal & anal insertion probe

  23. Special Conditions that Affect the Choice of Probe • Vaginal Size (depth 4-12 cm) & shape • Vaginal angle (10-40 degree) & quality of the levator ani (thin or thick fibers) • Type & degree of vaginal wall descent

  24. Home Treatment Program • Low frequency (10-20Hz) Urge incontinence • High frequency (35-50Hz) Stress incontinence

  25. Selection of Patients • Urinary incontinence & Pelvic floor dysfunction • Unsuccessful P.F.M training as a first line treatment

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