Int Urogynecol J DOI 10.1007/s00192-015-2698-5

IUJ VIDEO

Virtual reality: a proposal for pelvic floor muscle training Simone Botelho 1,2 & Natalia Miguel Martinho 1 & Valéria Regina Silva 1,2 & Joseane Marques 1,2 & Leonardo C. Carvalho 1 & Cássio Riccetto 2

Received: 20 January 2015 / Accepted: 17 March 2015 # The International Urogynecological Association 2015

Abstract Introduction and hypothesis This video’s proposal was to present one of the pelvic floor muscle (PFM) training programs, used in our research, that we designed as a virtual reality intervention protocol and investigated its effects on PFM contractility. Methods Two clinical, controlled and prospective studies were conducted, one with 19 nulliparous women without urinary symptoms, who were evaluated by both electromyography and digital palpation (DP) and another with 27 postmenopausal women with mixed urinary symptoms (assessed by both ICIQ UI-SF and ICIQ-OAB), evaluated by vaginal dynamometry and DP, with a total of 46 women in both studies.

This protocol was designed so that the participant would play a video game, seated on a pressure base platform, while commanding it through her pelvic movements. Using a virtual reality game, five activities were performed during 30 min, twice a week, with a total of 10 sessions. Results A significant increase in PFM strength was found in both the nulliparous (p=0.0001) and the postmenopausal (p= 0.0001) groups of women, as ascertained by DP. A significant increase in postmenopausal women’s muscle strength and endurance assessed by dynamometry (p=0.05) and a concomitant decrease in their urinary symptoms, were observed. Conclusion This virtual reality program promoted an increase in PFM contractility and a decrease in postmenopausal urinary symptoms.

This study was presented in the Podium Video Session at the 44th Annual Meeting of the International Continence Society in Rio de Janeiro- Brazil, 2014

Keywords Virtual reality exposure therapy . Pelvic floor . Electromyography . Muscle strength dynamometer . Digital palpation . Urinary symptoms

Study conducted by the UroFisioterapia Laboratory of the Course of Physiotherapy (Nursing School) of the Federal University of Alfenas (UNIFAL/MG)—Alfenas, Minas Gerais, Brazil Electronic supplementary material The online version of this article (doi:10.1007/s00192-015-2698-5) contains supplementary material. This video is available to watch on http://springerlink.com/. Please search for this article by the article title or DOI number, and on the article page click on ‘Supplementary Material’. * Simone Botelho [email protected] 1

Course of Physiotherapy, Nursing School, Federal University of Alfenas (UNIFAL-MG), Building A, Room 107-D, Av. Jovino Fernandes Sales, 2600—Santa Clara, Alfenas, MG CEP: 37130-000, Brazil

2

Department of Surgery/Faculty of Medical Sciences, State University of Campinas (UNICAMP), São Paulo, Brazil

Introduction The use of both didactic and ludic means could be a useful tool toward the population’s awareness of the importance of preventing and treating pelvic floor dysfunction. Currently, virtual reality has been used within scientific fields [1] and is defined as an interactive experience based on a tridimensional computer system. It is a simple, low-cost movement simulator that allows sensorial feedback in addition to the participant’s interaction through enjoyable and adequate therapeutic sessions that are suitable for her condition [2–4]. Thus, our proposal was to design an intervention protocol for pelvic floor muscle training by virtual reality and to investigate its effects on PFM contractility.

Int Urogynecol J Fig. 1 Study population surface electromyography (SEMG)

Materials and methods Design and participants Two clinical, controlled and prospective studies were conducted. The first one, called study 1, was carried out with 19 nulliparous women without urinary symptoms, who were evaluated by both electromyography and digital palpation. The second one, called study 2, was performed with 27 postmenopausal women with mixed urinary symptoms (assessed by both the International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form, ICIQ UI-SF [5], and the International Consultation on Incontinence Questionnaire Overactive Bladder, ICIQ-OAB [6]), who had been evaluated using vaginal dynamometry and digital palpation, with a total of 46 women in both studies, as shown in Fig. 1. The participants were selected from the university extension project called Woman Health Attention (PREAE n.2026), which promotes women’s health activities in patients from the public health network in the city of Alfenas/MG, and was

Table 1 Pelvic floor muscle contractility in the nulliparous women group, assessed by digital palpation and electromyography, pre- and post-treatment

Nulliparous women (n=19)

approved by the Federal University of Alfenas (UNIFAL/ MG, Brazil). These studies received ethical approval from the regional ethics review board (protocols: CAAE: 19625113.5.0000.5404—study 1 [7]/CAEE 0306.0.213.00007—study 2 [8]) and all participants gave their informed and written consent according to the Declaration of Helsinki, before the initial assessment. Assessment methods Digital palpation During digital palpation, which was used in both studies, the examiner introduced the index and middle fingers, 2–3 cm into the vaginal introitus, performing an abduction movement, while the patient was asked to perform a maximum contraction of the PFM, lifting inward and squeezing around the fingers [9]. The muscle strength was graded according to the Modified Oxford Grading Scale (0–5 points) [9].

Digital palpation Pre-training

Mean (SD) p value* Power** Effect size**

Electromyography Post-training

Pre-training

Post-training

3.1

3.4

45.7

45.2

(±0.9)

(±0.8)

(±15.9)

(±23.1)

0.0001 0.2 0.3

0.79 0.05 0.03

The table presents the pelvic floor contractility pre- and post-training as the mean (standard deviation), accompanied by the p value (*Wilcoxon test; p

Virtual reality: a proposal for pelvic floor muscle training.

This video's proposal was to present one of the pelvic floor muscle (PFM) training programs, used in our research, that we designed as a virtual reali...
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