Occupational Therapy Role in Addressing Urinary Incontinence for Children with Incomplete Spinal Cord Injury through Biofeedback, a Case Series

Research Objectives: 1. To discuss the potential benefits of the use of biofeedback for urinary incontinence for children with incomplete spinal cord injury.
2. To describe the role of occupational therapy in managing bladder dysfunction for children with spinal cord injury.
3. To identify and compare outcome measures utilized for children with spinal cord injury.

Design: Retrospective Case Series

Setting: hospitalized care - pediatric inpatient rehabilitation, occupational therapy

Participants: Three pediatric patients admitted to the inpatient rehabilitation unit of a large pediatric hospital following acute admission with newly acquired spinal cord injury.

Interventions: In addition to standard occupational therapy care, biofeedback was utilized as a treatment tool for bladder management. Two occupational therapists utilized the Prometheus EMYO 200 biofeedback system for training of contraction and relaxation of the pelvic floor. Each patient participated in biofeedback with a range of 2-4 sessions with the treatment period of 30 minutes.

Main Outcome Measures: - WeeFIM (bladder management)
- Activity Measure for Post-Acute Care '6-clicks' (AM-PAC) (daily activities, toileting)
- Pediatric Spinal Cord Injury Activity Measures (PEDI-SCI AM) (Daily Routines)
- intermittent catheterizations required per day
- bladder scans required per day

Results: No adverse events occurred. Across all three patients, catheterization frequency and post-residual void volume decreased after biofeedback. Data gathered from the AM-PAC, PEDI-SCI and WeeFIM showed overall improvements in scores for admission to inpatient rehabilitation (IPR) to discharge from IPR and at 3-months follow up. PEDI-SCI scores improved for two out of three patients from admission to discharge. The average improvement of pre biofeedback to discharge scores for the PEDI-SCI was 9.33. Using the AM-PAC, each child rated toileting as needing total assistance prior to initiating biofeedback. Following biofeedback, at discharge from IPR they reported their assist level as a little or none.

Conclusions: A multimodal approach including biofeedback to addressing neurogenic bladder in patients with incomplete spinal cord injury may improve patients' independence with toileting and bladder management.

Author(s) Disclosures: The authors have no conflicts of direct interest.