Poster 306: Female Urinary Incontinence: Results of Intensive Pelvic Floor Rehabilitation 10 Years...
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Poster 306 Female Urinary Incontinence: Results of Intensive Pelvic Floor Rehabilitation 10 Years Later. Paolo Di Benedetto, MD (Physical Medicine and Rehabilitation, Udine, Italy); Arianna Coidessa, PT; Cristina Delneri, MD. Disclosures: P. Di Benedetto, None. Objective: To assess pelvic floor rehabilitation (PFR) re- sults 10 years after an intensive PFR program. Design: Follow-up study. Setting: Rehabilitation institute. Participants: 202 women affected by urinary incontinence (UI) received intensive PFR treatment as outpatients in 1996 and 1997. Interventions: Patients have been contacted by telephone and required to answer a questionnaire intentionally built up to investigate the symptom changes immediately after PFR (that included pelvic floor muscle training, biofeedback and functional electrical stimulation variously associated), the execution of the self training and the present symptoms. Main Outcome Measures: ICIQ-UI Short Form ques- tionnaire (Italian version) and symptomatologic questionnaire were answered both before and after PFR. The data collected have been worked out by the variance analysis, the Kruskal Wallis test, the Mann-Whitney U and the Wilcoxon test. Results: 153 (75.74%) of the 202 women treated 10 years before have taken part in the follow up study. As far as the symptom changes after the therapy are concerned, 128 pa- tients (84.20%) have reported an improvement immediately after intensive PFR. 94 patients (63.10%) continued the self training at the end of intensive PFR and only 20 (13.07%)continued it nowadays. The comparison of the data (symptomatologic questionnaire answered both before in- tensive PFR - mean 4.47; range 2-6 - and 10 years later - mean 4.01; range 2-6 ) is not statistically significant (Wilcoxon test P .0744). The mean score of ICIQ-UI Short Form ques- tionnaire was 9.15 (DS 5.84; range 0-21). Conclusions: Intensive PRF provides short term signifi- cant improvement of UI; 10 years later such improvement is not preserved. This fact is closely related to the small amount of patients that have regularly carried on the self training. Keywords: Rehabilitation, Urinary incontinence, Pelvic floor rehabilitation, Follow up. Poster 307 Intrathecal Baclofen Withdrawal After Pump Refill: Two Cases of Catheter Puncture: A Case Report. Linda E. Krach, MD (University of Minnesota, Min- neapolis, MN); Supreet Deshpande, MD. Disclosures: L. E. Krach, Medtronic, Inc.,Consulting fees or other remuneration Medtronic, Inc.,Research grants Program Description: The 2 patients, a 20-year-old and a 15-year-old, both with quadriparetic CP and mixed tone had their tone successfully managed with ITB. Both devel- oped signs of ITB withdrawal within hours of pump refill. Radiographs did not reveal any catheter problem, catheter access port aspiration was successful and the reservoir was emptied and refilled. Both had some improvement after programming an ITB bolus. One had pump pocket fluid. However, as symptoms continued it was opted to surgically explore the pump/catheter systems. Intraoperatively it was noted that the pump catheter in both patients ran across the front of the pump and the surgeon could see a leak point from the catheter about 11 cm from the point where the catheter connected to the pump in 1 patient and in the other noted a leak 9 cm from pump when flushing the catheter. After catheter repair, symptoms resolved. One patient’s tone was controlled on approximately 50% of the presurgery ITB dose and the other returned to his pre-withdrawal dose. Setting: Pediatric specialty hospital. Results: It appears that the catheter was punctured at the time of pump refill. Discussion: Often when signs of ITB under-delivery are noted after pump refill it is assumed that there was an error in programming or in the concentration of the drug used for the refill. Puncture of the catheter is a rare, but possible, reason for the development of withdrawal post-refill. Conclusions: Palpate over the pump prior to refill in case the catheter can be appreciated in thin patients. Also consider catheter puncture as a possible cause of ITB withdrawal, especially if fluid is noted in the pump pocket. Keywords: Rehabilitation, Dystonia, Spasticity, Intrathe- cal baclofen. Poster 308 Non-Invasive Monopolar Capacitive-Coupled Radiofrequency (mcRF): Histological Impact on Tendons and Ligaments. Terry L. Whipple, MD (Orthopaedic Research of Virginia, Richmond, VA). Disclosures: T. L. Whipple, Alpha Orthopaedics, Inc., Stock options or bond holdings Alpha Orthopaedics, Inc., Research grants Objective: To determine if mcRF is capable of activating the chain of events of the wound healing response (WHR), in tendons and ligaments, as evidenced by heating profiles and histological findings. Design: Human cadaveric specimens were obtained and treated noninvasively with mcRF (AT2, Alpha Orthopaedics, Hayward CA). Temperatures on the targeted structures were recorded utilizing Fluoroptic thermometers (Luxtron Corpo- ration, Santa Clara, CA) and validated software (TrueTemp, Luxtron Corporation, Santa Clara, CA). Histological out- comes under regular and polarized light were analyzed for changes in the appearance of the collagen based structure. Setting: Orthopaedic Research of Virginia (ORV). Participants: The present study was based on cadaver specimens. Interventions: mcRF was delivered while establishing S237 PM&R Vol. 1, Iss. 9S, 2009
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Transcript of Poster 306: Female Urinary Incontinence: Results of Intensive Pelvic Floor Rehabilitation 10 Years...
Poster 306
Female Urinary Incontinence: Results ofIntensive Pelvic Floor Rehabilitation 10 YearsLater.Paolo Di Benedetto, MD (Physical Medicine andRehabilitation, Udine, Italy); Arianna Coidessa, PT;Cristina Delneri, MD.
Disclosures: P. Di Benedetto, None.Objective: To assess pelvic floor rehabilitation (PFR) re-sults 10 years after an intensive PFR program.Design: Follow-up study.Setting: Rehabilitation institute.Participants: 202 women affected by urinary incontinence(UI) received intensive PFR treatment as outpatients in 1996and 1997.Interventions: Patients have been contacted by telephoneand required to answer a questionnaire intentionally built upto investigate the symptom changes immediately after PFR(that included pelvic floor muscle training, biofeedback andfunctional electrical stimulation variously associated), theexecution of the self training and the present symptoms.Main Outcome Measures: ICIQ-UI Short Form ques-tionnaire (Italian version) and symptomatologic questionnairewere answered both before and after PFR. The data collectedhave been worked out by the variance analysis, the KruskalWallis test, the Mann-Whitney U and the Wilcoxon test.Results: 153 (75.74%) of the 202 women treated 10 yearsbefore have taken part in the follow up study. As far as thesymptom changes after the therapy are concerned, 128 pa-tients (84.20%) have reported an improvement immediatelyafter intensive PFR. 94 patients (63.10%) continued the selftraining at the end of intensive PFR and only 20(13.07%)continued it nowadays. The comparison of the data(symptomatologic questionnaire answered both before in-tensive PFR - mean 4.47; range 2-6 - and 10 years later - mean4.01; range 2-6 ) is not statistically significant (Wilcoxon testP � .0744). The mean score of ICIQ-UI Short Form ques-tionnaire was 9.15 (DS 5.84; range 0-21).Conclusions: Intensive PRF provides short term signifi-cant improvement of UI; 10 years later such improvement isnot preserved. This fact is closely related to the small amountof patients that have regularly carried on the self training.Keywords: Rehabilitation, Urinary incontinence, Pelvicfloor rehabilitation, Follow up.
Poster 307
Intrathecal Baclofen Withdrawal After PumpRefill: Two Cases of Catheter Puncture: ACase Report.Linda E. Krach, MD (University of Minnesota, Min-neapolis, MN); Supreet Deshpande, MD.
Disclosures: L. E. Krach, Medtronic, Inc.,Consulting feesor other remuneration Medtronic, Inc.,Research grantsProgram Description: The 2 patients, a 20-year-old anda 15-year-old, both with quadriparetic CP and mixed tone
had their tone successfully managed with ITB. Both devel-oped signs of ITB withdrawal within hours of pump refill.Radiographs did not reveal any catheter problem, catheteraccess port aspiration was successful and the reservoir wasemptied and refilled. Both had some improvement afterprogramming an ITB bolus. One had pump pocket fluid.However, as symptoms continued it was opted to surgicallyexplore the pump/catheter systems. Intraoperatively it wasnoted that the pump catheter in both patients ran across thefront of the pump and the surgeon could see a leak point fromthe catheter about 11 cm from the point where the catheterconnected to the pump in 1 patient and in the other noted aleak 9 cm from pump when flushing the catheter. Aftercatheter repair, symptoms resolved. One patient’s tone wascontrolled on approximately 50% of the presurgery ITB doseand the other returned to his pre-withdrawal dose.Setting: Pediatric specialty hospital.Results: It appears that the catheter was punctured at thetime of pump refill.Discussion: Often when signs of ITB under-delivery arenoted after pump refill it is assumed that there was an error inprogramming or in the concentration of the drug used for therefill. Puncture of the catheter is a rare, but possible, reasonfor the development of withdrawal post-refill.Conclusions: Palpate over the pump prior to refill in casethe catheter can be appreciated in thin patients. Also considercatheter puncture as a possible cause of ITB withdrawal,especially if fluid is noted in the pump pocket.Keywords: Rehabilitation, Dystonia, Spasticity, Intrathe-cal baclofen.
Poster 308
Non-Invasive Monopolar Capacitive-CoupledRadiofrequency (mcRF): Histological Impacton Tendons and Ligaments.Terry L. Whipple, MD (Orthopaedic Research ofVirginia, Richmond, VA).
Disclosures: T. L. Whipple, Alpha Orthopaedics, Inc.,Stock options or bond holdings Alpha Orthopaedics, Inc.,Research grantsObjective: To determine if mcRF is capable of activatingthe chain of events of the wound healing response (WHR), intendons and ligaments, as evidenced by heating profiles andhistological findings.Design: Human cadaveric specimens were obtained andtreated noninvasively with mcRF (AT2, Alpha Orthopaedics,Hayward CA). Temperatures on the targeted structures wererecorded utilizing Fluoroptic thermometers (Luxtron Corpo-ration, Santa Clara, CA) and validated software (TrueTemp,Luxtron Corporation, Santa Clara, CA). Histological out-comes under regular and polarized light were analyzed forchanges in the appearance of the collagen based structure.Setting: Orthopaedic Research of Virginia (ORV).Participants: The present study was based on cadaverspecimens.Interventions: mcRF was delivered while establishing
S237PM&R Vol. 1, Iss. 9S, 2009
