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Pilot Study of Home-Based EMG Biofeedback for Dysfunctional Voiding in Children
Israel P. Nosnik, MD, Dawn Diaz-Saldano, RN, MSN, CPNP, Jennifer Schreiber, RN, MSN, CPNP, Susan Moylan, RN, MSN, CPNP, Katie Gawerecki, RN, MSN, CPNP, Elizabeth B. Yerkes, MD.
Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.

Background: Office-based pelvic floor training using EMG biofeedback is an established part of treatment of dysfunctional voiding (DV) in children; however adherence is frequently compromised by its time and resource intensive nature, frequent office visits to reinforce proper exercise technique and poor adherence to the home training and reinforcement regimen. To address these shortcomings, we developed a home-based pelvic floor training EMG biofeedback program to improve adherence and reduce the number of office visits needed. We report our initial experience with home-based EMG biofeedback for the treatment of DV.
Methods: Patients with a diagnosis of DV as defined by an active pelvic floor during voiding on uroflowmetry/EMG were offered home-based EMG biofeedback if they were unable to complete our office-based biofeedback protocol due to geographic or scheduling constraints. All patients were started on behavior modification and treatment for bladder and bowel dysfunction as indicated. Patients were taught pelvic floor relaxation exercises using a commercially available, portable, audio biofeedback device. They were instructed to perform daily 10 minutes sessions of pelvic floor relaxation exercises with audio biofeedback at home for 12 weeks. Patients or parents recorded daily usage in a diary. Clinical voiding symptoms were documented at each clinic visit. A quiet pelvic floor during voiding on the post treatment uroflowmetry/EMG was considered successful treatment.
Results: A total of 11 patients age 5-17 years old underwent home-based biofeedback. Upon starting home-based biofeedback, 7/11 had either daytime or nighttime wetting and 5/11 had previously had a UTI. 10 of the 11 patients completed treatment. Resolution of DV as defined by quiet pelvic floor activity on uroflowmetry/EMG was seen in 8 of the 10 patients. All 8 patients with resolution reported completing their pelvic floor exercises using the EMG biofeedback device at least 4 days per week. 4 of 8 patients with resolution had improvement of their wetting or no further UTIs. Of the patients who failed, one was non-adherent to the protocol and one was unable to be trained to use the device at home.
Conclusion: To our knowledge, this series is the first reported experience with home-based pelvic floor training in children using EMG biofeedback. Our pilot study suggests that home-based EMG biofeedback for pelvic floor training in children with DV may be an alternative to office-based biofeedback training. Prospective studies are planned to assess the comparative effectiveness of home-based biofeedback protocols.

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