Incontinence is a very prevalent problem that can have a devastating effect on lifestyle. It is reported to affect one in four women, middle-aged or older and 50% of those in nursing homes. Muscle re-education, using biofeedback techniques, is a safe and highly effective treatment option when performed by a physio-therapist or nurse trained in these techniques.
Female incontinence problems are most often due to a muscular dysfunction which is effectively and permanently corrected with biofeedback therapy.
The successful clinic will offer a total-care program for incontinence related concerns, including a range of therapy approaches and outcome measures. Biofeedback therapy is the principal component in a comprehensive program of multiple behavioral therapies, consisting of behavioral counseling, an internal examination, muscle recruitment training, muscle strengthening exercises and motivational support.
Biofeedback and E-Stim Therapy
The techniques are built around training for correct muscle recruitment, strengthening and relaxation using surface electromyography (sEMG) which is a technique for measuring and monitoring muscle function. For many patients, the effectiveness can be enhanced further by electrical muscle stimulation (E-Stim). The methods are similar in concept to the sEMG biofeedback and E-Stim treatments which are widely used in many other areas of rehabilitation. For incontinence therapy, the instruments are equipped with appropriate sensors to access the pelvic muscles. Biofeedback allows the patient to find and control the correct muscles. Muscle stimulation produces fast and direct muscle strengthening, increases the nerve population and benefits the urethral tissue.
The sEMG instruments include high quality miniature pre-amplifiers which are located close to the sEMG sensors. This produces a high quality, reliable signal which is free of interference and is ideal for training. Portable biofeedback units can be used either in stand-alone mode or while coupled with a computer system. The computer can be an important part of the therapy program for ensuring rapid progress. This is because of its large bright visual display, its ability to show progress trends and its printed graphical and numerical reports. The clinical software is menu driven with built-in training protocols. It is easy to learn and fast to use. The protocol and patient selection are both set up prior to the patient session. During therapy, you can therefore project your full attention to the patient for achieving the best results.
For most patients, biofeedback is the preferred treatment approach rather than drugs or surgery. The majority of patients will find that biofeedback therapy is successful. Surgery is usually not a permanent cure when the underlying problems of muscle control, weakness and spasm are not addressed with effective therapy.
The approach is one of active patient participation, which usually is
accepted enthusiastically by patients. The patient is empowered to
control and facilitate her own progress. The patient can watch a
display showing evidence of the dysfunctional patterns of muscular
recruitment. This nearly always leads to high motivation for
success. Motivation is further enhanced in subsequent sessions by
showing the progress attained. At the end of the series of
sessions, when objectives are met, the end-point of therapy is clearly
shown by a printout of the sEMG pattern before and after treatment.
This objective data greatly facilitates communication with referring
physicians as well as authorization and payment flow from any insurance
companies or other payers.
||The correct use of biofeedback instrumentation is key to achieving successful outcomes. The instruments are used by the continence therapist in performing a full medical program of functional assessments, pelvic floor therapy and progress monitoring. The proportion of successful outcomes is very high. With better muscular control, the patient maintains continence by continuing to practice simple exercises, if needed, which will sustain muscle tone. These are usually a shortened version of the same exercises that have been learned in the biofeedback therapy program.|
As well as the obvious and dramatic benefits for the patient, there are significant financial rewards for the provider:
In a public hospital or chronic care facility, each incontinent patient produces an enormous continuing expense for the absorbables and nursing care. The cost of setting up and running the biofeedback program is recovered very quickly. The funds expended to set up the program will produce overall cost savings in a few months. This is because of the large reduction in patient care expense and the overall positive motivational effect. Superior patient care is an added bonus. With biofeedback therapy, experience has shown that most of the patients receiving treatment will again become fully continent.
In private practice, the high unfulfilled demand for incontinence services means a fast financial return from the initial training and equipment costs. The treatments are very much appreciated by patients and are highly rewarding for the continence therapists.
College of Physical Therapists of Alberta - Standards of Practice
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