Comparison of Transcutaneous Electrical Nerve Stimulation and Manual Therapy in Children With Cerebral Palsy
Condition: Bladder Dysfunction; Bowel Dysfunction; Cerebral Palsy; Neurogenic Bladder; Neurogenic Bowel
MeSH terms: Intestinal Diseases; Neurogenic Bowel; Cerebral Palsy; Urinary Bladder, Neurogenic
Study type: Interventional

Summary: 
      There are many studies in the literature on healthy children with lower urinary tract
      dysfunction (LUTD), but there are limited number of studies in children with cerebral palsy
      (CP) with LUTD.

      This study aim to contribute to the literature by examining the effectiveness of
      transcutaneous electrical nerve stimulation (TENS) and abdominal massage in the treatment of
      children with CP with LUTD and comparing the superiority of the two treatment methods to each
      other.
    

Detailed description: 
      CP represents a group of chronic, non-progressive motor disorders characterized by impaired
      voluntary movement resulting from prenatal developmental abnormalities or perinatal or
      postnatal central nervous system damage.

      The location and extent of neurological damage are important in determining motor and mental
      disabilities and the severity of the disease. Children with CP can also be affected by other
      medical disorders such as seizures, mental retardation, hearing, vision and communication
      problems. The prevalence of CP is approximately 2-3 per 1000 live births. Dysfunctional bowel
      and urinary dysfunction problems can often accompany CP due to motor, mental, cognitive,
      sensory and other neurological disorders. Severe motor disorders and/or additional cognitive
      deficits lead to the development of neurogenic lower urinary tract symptoms. Accoring the
      data obtained during the outpatient clinic visits, it was determined that most of the
      children with CP had LUTD complaints such as incontinence, sense of urgency, difficulty
      urinating, urinary retention and urinary tract infections. These urological problems affect
      approximately one-third of children with CP, and the prevalence of dysfunctional voiding
      symptoms such as pollakisuria, incontinence or urinary tract infections is estimated to be
      more than 30% in the population.

      TENS therapy is classified as a neuromodulation therapy. In the last few years, it has been
      shown in the literature TENS gives positive results in the treatment of urinary symptoms.

      Abdominal massage, which is one of the manual therapy techniques; the anterior abdominal wall
      reduces abdominal muscle tension, increases local circulation, facilitates digestion and
      stimulates gastric acid secretion, stimulates colonic movements by providing peristaltic
      stimulation. It is a classical massage method that includes clockwise manual movements over
      the area where the colon is located. In abdominal massage, by manually applying pressure from
      the anterior abdominal wall, the digestive organs are compressed between the fingers and the
      posterior abdominal wall and peristaltic stimulation is created. Hence, stool is pushed from
      the colon into the rectum. In addition, abdominal massage reduces the severity of
      constipation symptoms by reducing abdominal bloating and treating trigger points in the
      abdominal muscles.

      This study aim to contribute to the literature by examining the effectiveness of TENS and
      abdominal massage in the treatment of children with CP with LUTD and comparing the
      superiority of the two treatment methods to each other.
    

Intervention name(s): TENS; Massage
Intervention type(s): Device; Other
Intervention description(s): In the study, CE certified tens device with Biolito brand, which is used specifically for incontinence treatment, will be used. The electrodes used during the intervention will be placed to the parasacral region (S2-S4). While the current is given, the power of the device will be gradually increased in 1 mA intervals. The lower value of the stimulation will be 10 mA and the upper value will be 25 mA, and the treatment will be continued with any value that the child can tolerate in this range.; The massage will be applied to the abdominal area between the subcostal lower border and the anterior superior of the spina iliaca. Massage techniques are as follows: Abdominal patting, colon patting, colon kneading, colon patting again, abdominal patting again. It will be advanced with deep abdominal strokes, then the starting point will be returned with transverse superficial strokes for the transversus abdominis muscle and oblique superficial strokes for the rectus abdominis muscle, and these strokes will be repeated 3 times each, a total of 6 times. Afterwards, 3 times column brushing, 3 times column kneading and 3 times column plastering will be done, respectively. At the end, a total of 6 abdominal strokes will be performed for both the transversus abdominis and oblique abdominal muscles as in the beginning.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Children between the ages of 5-18, diagnosed with CP with LUTD who met the inclusion criteria will be included in the study. Sample size of the study is calculated as 54. All evaluations of the participants will be done by the specialist physiotherapist who made the evaluations would not know which treatment method was applied to the participants and would be a blind evaluator.
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Neuromodulation therapy; Urinary incontinence; Constipation; Voiding disorder; Abdominal massage