Comparison of the efficiency of transcutaneous electrical nerve stimulation and manual therapy techniques in children with cerebral palsy with lower urinary system dysfunction

Our study was conducted to investigate and compare the effectiveness of Transcutaneous Electrical Nerve Stimulation (TENS) and Manual Therapy modalities on LUTS in children with cerebral palsy (CP) with lower urinary tract dysfunction (LUTD). 54 children with CP whose Voiding Disorders Symptom Score (VDSS) score of 8.5 and above were included in the study. Children were randomized to the TENS (TG; n=27) and Manual Therapy (MG; n=27) groups. TENS, abdominal, colon, and friction massages at 10 Hz, 10-25mA, respectively, were applied to TG and MG for 12 weeks, 2 times a week for 20 minutes, a total of 24 sessions. Evaluations were made with, VDSS, Pediatric Incontinence Quality of Life Scale (PINQ), bladder diary, and Bristol Stool Scale (BSS). Demographic characteristics of the groups showed homogeneous distribution (p>0.05;Table 1). In both groups, VDSS and PINQ values decreased after treatment, but the decrease in TG was statistically significant in the evaluation made between groups (p=0.001;p<0.01). According to bladder diary data, functional bladder capacity increased in both groups after treatment, and no statistically significant difference was found between the groups (p=0.683; p>0.05). The frequency of voiding decreased in both groups after treatment, but no statistically significant difference was found between the groups (p=0.208;p>0.05). The children's daily incontinence episodes decreased in both groups after the treatments. In the comparison between the groups, the decrease in TG was found to be statistically significant (p=0.037;p<0.05). According to BGS, the rate of children with Type-1 and Type-2 stool types with constipation before treatment was 48.1% in MG and TG, while this rate was 29.62% and 11.1% after treatment, respectively has fallen. Parasacral TENS and manual therapy applications provided a significant improvement in LUTS, constipation, and quality of life. We think that it would be valuable to add physiotherapy practices covering bladder and bowel problems to the rehabilitation programs of children with CP. Keywords: Neurogenic Bladder, Urinary İncontinence, Constipation, Neuromodulation, Massages