End User Assessment of Urological Biofeedback Game Software

BACKGROUND AND SIGNIFICANCE

Medical and Biological:

LUTD is a common problem in children that can result in wetting during the day and night, frequent and urgent urination and urinary tract infections. In a subset of children, LUTD is the result of dis-coordination between pelvic floor and abdominal muscles. These children tend to contract their pelvic muscles rather than relax them during voiding. This abnormal contraction results in bladder changes that can result in incontinence. In most cases, understanding how to contract and relax the pelvic floor and abdominal muscles can help reduce LUTD symptoms. Identifying and learning how to utilize the pelvic floor without abdominal muscle activation is one of the most powerful effectors of bladder function.

The current LUTD Program at the investigator's institution includes a full history and physical exam followed by extensive education. If the patients do not improve they undergo additional evaluation with a renal pelvic ultrasound and simultaneous uroflowmetry and electromyography (EMG) study. Based on that evaluation a percentage of patients go on to receive biofeedback treatment. Biofeedback is typically recommended to patients who do not use the pelvic floor and abdominal muscles appropriately while voiding. The biofeedback treatment involves further education, standard biofeedback, and biofeedback computer games. In standard biofeedback, patients are made aware of their abdominal and pelvic floor muscle activity by a display that shows the abdominal and pelvic floor muscles' EMG activity. In the biofeedback computer games, patients control a variety of games with their pelvic floor and abdominal muscles. Both methods teach the patient how to locate the pelvic floor muscles and to isolate them while voiding. Biofeedback represents only one possible treatment plan for children with LUTD. Patients are analyzed prior to entering the biofeedback portion of the LUTD Program for compatibility with this treatment.

Several studies were conducted by McKenna and colleagues to assess the effectiveness of the biofeedback games on treating LUTD symptoms.The trials involved 41 and 160 children of varying ages that averaged out to be 7.2 and 8.5 years respectively. The games worked by acquiring feedback that represented a flexion of the pelvic floor and relaxation of the abdominal muscle. All of the children in the trials participated in approximately an hour of treatment per session that involved around 20 minutes of supervised gaming time. The 84% and 87% success rate in each trial showed that the method of using biofeedback paired with the video games is a viable option for the treatment of LUTD in children.