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Biofeedback training for lower urinary tract symptoms: factors affecting efficacy.

J Urol. 2009 Oct;182(4 Suppl):2050-5

Authors: Drzewiecki BA, Kelly PR, Marinaccio B, Borer JG, Estrada CR, Lee RS, Bauer SB

PURPOSE: Biofeedback therapy is a valuable modality in children with dysfunctional voiding. However, it is unclear what factors contribute to the outcome. To define who may or may not benefit from biofeedback therapy we reviewed our experience with this treatment. MATERIALS AND METHODS: We retrospectively reviewed the charts of 77 children referred between July 2005 and September 2008 for biofeedback therapy. An MR 20 Synergy trainer (Prometheus Group, Dover, New Hampshire) provided nonanimated and animated biofeedback. Uroflowmetry was performed at the start and end of each session. A total of 67 females and 10 males with a mean age of 9.0 years (range 4.8 to 18.2) comprised the cohort group. The primary referral diagnosis was nonfebrile urinary tract infection in 52 patients (67.5%), daytime and nighttime wetting in 47 (61%), voiding postponement in 14 (18.2%) and daytime incontinence in 10 (13%). Children were categorized by an outcome of success, improvement or failure. Results were analyzed using the chi-square, Fisher exact probability and Student t tests. RESULTS: Success, improvement and failure were achieved in 22 (26.8%), 29 (37.7%) and 26 cases (33.7%), respectively. Age and gender were not statistically significant predictors of outcome. A median of 3.0 sessions (range 1 to was administered. Children with 3 or greater sessions were more likely to succeed (p <0.005). The improvement in urinary tract infections was statistically significant (p <0.001). Of 37 children 20 (54%) transformed a staccato voiding pattern to a normal one on uroflowmetry. CONCLUSIONS: Biofeedback therapy can be effective in children with dysfunctional voiding and urinary tract infection. Children with a staccato voiding pattern may require a minimum of 3 visits to improve the voiding pattern. Children who complete 3 sessions are more likely to succeed.

PMID: 19695584 [PubMed - indexed for MEDLINE]

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Editorial comment.

J Urol. 2009 Oct;182(4 Suppl):2055; discussion 2055

Authors: Palmer LS

PMID: 19695618 [PubMed - indexed for MEDLINE]

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Successful treatment for giggle incontinence with biofeedback.

J Urol. 2009 Oct;182(4 Suppl):2062-6

Authors: Richardson I, Palmer LS

PURPOSE: Giggle incontinence is the involuntary and often unpredictable loss of urine during giggling or laughter in the absence of other stress incontinence. The pathophysiology is unclear, urodynamics are seldom helpful, and the efficacy of timed voiding and pharmacotherapy is limited. We postulated that improving sphincter tone and muscle recruitment using biofeedback techniques might be helpful in children with giggle incontinence. MATERIALS AND METHODS: The charts of 12 patients with giggle incontinence were reviewed. Giggle incontinence severity, voiding patterns, associated symptoms and medical history including prior treatment were reviewed. Children were evaluated with uroflowmetry-electromyography and ultrasound measurement of post-void residual urine. They were assessed by the ability to isolate, contract and relax perineal muscles. They were taught Kegel exercises and instructed to perform them at home between weekly-biweekly sessions. Clinical success was characterized as a full or partial response, or nonresponse as defined by the International Children’s Continence Society. RESULTS: The 10 females and 2 males were 6 to 15 years old. Only 1 child had a partial response to first line therapy with timed voiding and bowel management. Seven children were treated with anticholinergic agents and/or pseudoephedrine with a partial response in 3. The 9 children with refractory giggle incontinence underwent biofeedback with a median of 4.5 sessions per child (range 2 to 8). The 6 patients who underwent 4 or more sessions had a full response that endured for at least 6 months and the 3 with fewer than 4 sessions had a partial response. CONCLUSIONS: Patients with giggle incontinence can heighten external urinary sphincter awareness and muscle recruitment using biofeedback techniques. Treatment with education and pharmacotherapy only led to a partial response in some cases. Biofeedback supplemented this treatment or avoided pharmacotherapy when at least 4 sessions were performed. Biofeedback therapy should be incorporated in the treatment algorithm for giggle incontinence in children and it should be considered before pharmacotherapy.

PMID: 19695635 [PubMed - indexed for MEDLINE]

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Editorial comment.

J Urol. 2009 Oct;182(4 Suppl):2066

Authors: Carr MC

PMID: 19695636 [PubMed - indexed for MEDLINE]

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Clinical symptoms of major depression are associated with the intensity dependence of auditory event-related potential components.

Psychiatry Res. 2009 Sep 30;169(2):139-43

Authors: Linka T, Sartory G, Gastpar M, Scherbaum N, Müller BW

The intensity (loudness) dependent amplitude change (IDAP) of the auditory event-related potential (ERP) has been shown to be associated with the outcome of treatment with selective serotonin reuptake inhibitors in major depression. The purpose of the present study is to evaluate associations between clinical symptoms of major depression and the IDAP as an indirect indicator of cortical serotonergic function. We assessed 40 in-patients suffering from a major depressive episode (DSM-IV) prior to antidepressant treatment. Psychometric characteristics of depression were assessed by means of psychiatric rating scales (CGI, HDRS, HAMA, STAI and BDI) and evaluated for associations with auditory evoked P1, N1, P2 as well as P1/N1 and N1/P2 peak to peak amplitude slopes. Our data revealed a positive correlation of the intensity dependent N1 amplitude slope with the degree of certain somatic symptoms of depression: loss of appetite and weight, insomnia, and sexual dysfunction. The results of our study might contribute to a more specific clinical basis in the differential indication of serotonergic versus noradrenergic antidepressants.

PMID: 19700202 [PubMed - indexed for MEDLINE]

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The effect of ADHD symptoms on performance monitoring in a non-clinical population.

Psychiatry Res. 2009 Sep 30;169(2):144-8

Authors: Herrmann MJ, Saathoff C, Schreppel TJ, Ehlis AC, Scheuerpflug P, Pauli P, Fallgatter AJ

Recent studies suggested deficits in error processing in patients with Attention Deficit Hyperactivity Disorder (ADHD), but some inconsistencies are still present. Using the ADHD screening questionnaire, the Adult ADHD Self-Report Scale, we investigated the association between the amount of inattention and hyperactivity/impulsivity symptoms in a non-clinical population of healthy students (n=56) and the neural correlates of error processing measured with event-related potentials. We found reduced amplitudes of error-positivity (Pe) with increasing symptoms of inattention, but no correlation with error-related negativity. These results suggest that attention deficits reduce the conscious evaluation of an error as reflected by reduced Pe amplitudes.

PMID: 19700203 [PubMed - indexed for MEDLINE]

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Paws, claws, loving companions: pet therapy and children.

Beginnings. 2009;29(3):4-5

Authors: Hines ME

PMID: 19718923 [PubMed - indexed for MEDLINE]

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Lady Liberty goes to jail.

Beginnings. 2009;29(3):12-3

Authors: Kendall M

PMID: 19718926 [PubMed - indexed for MEDLINE]

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Observations on hearing aid users’ strategies for controlling the level of their own voice.

J Am Acad Audiol. 2009 Sep;20(8):503-13

Authors: Laugesen S, Nielsen C, Maas P, Jensen NS

BACKGROUND: Evidence suggests that hearing-aid users have difficulties with own-voice level control, most likely because their auditory feedback is affected by hearing-aid amplification. PURPOSE: The purpose of this study was to investigate how changes to auditory feedback affect the voice level of hearing-aid users. RESEARCH DESIGN: A correlational study was set up to investigate the relation between voice level and hearing-aid amplification. STUDY SAMPLE: Seven hearing-impaired speakers participated. All were experienced hearing-aid users. DATA COLLECTION AND ANALYSIS: The speakers projected their voice to a passive listener across different speaker-listener distances and with different prescriptions of gain in an experimental hearing aid. For each combination of conditions, produced voice level and self-perceived voice level was measured. These data were subjected to an analysis of variance assuming a mixture of random and fixed effects. In addition, all speakers took part in interviews. RESULTS: Three speakers reacted to the changes in auditory feedback in agreement with previous experiments with normal-hearing speakers: they compensated by changing produced voice level. In contrast, the voice levels in the other four speakers were largely unaffected by the changes to auditory feedback. A secondary observation was that while all speakers increased their voice level with distance, the two subgroups produced different growth rates of vocal level versus distance. CONCLUSIONS: It is hypothesized that the speakers in the former subgroup relied on auditory feedback for solving the experimental task, whereas the latter subgroup had developed an own-voice level-control strategy based on proprioceptory feedback, possibly because they have lost faith in their auditory feedback mechanism, which indeed is changed by both hearing loss and hearing-aid amplification. Comparison to “target” voice levels suggests that proprioceptory feedback is less effective than auditory feedback for achieving adequate level-distance growth rate.

PMID: 19764170 [PubMed - indexed for MEDLINE]

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Nicotine replacement therapy during pregnancy: recommended or not recommended?

J Obstet Gynaecol Can. 2009 Aug;31(8):744-7

Authors: Osadchy A, Kazmin A, Koren G

Smoking during pregnancy increases the risks of maternal and fetal complications and adverse neonatal outcomes, and it remains a significant health problem. Although pregnancy is often a strong motivator for smoking cessation, many pregnant women continue to smoke. Effective smoking cessation strategies for use during pregnancy are therefore clearly needed. Behavioural support provided by prenatal smoking cessation programs is safe and effective during pregnancy, but it generates a relatively modest reduction in smoking cessation rates. Nicotine replacement therapy (NRT), in conjunction with behavioural support, may offer an effective alternative to help pregnant women quit smoking. This suggestion is based on the convincing research evidence for the effectiveness of NRT in the general population. There is no consensus, however, on whether or not care providers should recommend NRT during pregnancy because of persistent concerns about its safety and effectiveness. We reviewed the data on the safety and effectiveness of NRT and on the possible physiological reasons for NRT’s low effectiveness in pregnant women, and conclude that it is prudent to advise pregnant women who smoke 5 cigarettes or fewer per day to use behavioural support, and not NRT, to help them quit. Pregnant women with a moderate or high level of addiction may use NRT under the supervision of their physician. A combination of cognitive-behavioural therapy and counselling with NRT is the most effective strategy to achieve smoking cessation during pregnancy.

PMID: 19772709 [PubMed - indexed for MEDLINE]

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