生理回饋於骨盆底肌肉運動之運用

The Role of Biofeedback in Teaching Pelvic Floor Muscle Exercises

蔡娟秀(Chuan-Hsiu Tsai)

《中華民國泌尿科醫學會雜誌》 13卷1期 (2002/03) Pp. 1-7

https://doi.org/10.7024/JUAROC.200203.0001

摘要

自從凱格爾（Kegel）在1948年提出持續密集訓練骨盆底肌肉可改善產後婦女因骨盆鬆弛所引起的各項問題以來，骨盆底肌肉運動（pelvic floor muscle exercise）便被應用於治療輕至中度的尿失禁。雖然凱格爾在報告骨盆底肌肉運動時，便十分詳盡的報導了運動的分期、各期的訓練重點、生理回饋法的使用及居家練習的重要性，臨床常見的指導方法仍以口頭指導居多。由於大部分骨盆底鬆弛的婦女，並無法正確的收縮骨盆底肌肉；因此骨盆底肌肉運動應包含生理回饋的輔助練習。生理回饋可以將不易察覺的生理活動，透過機器或器材，轉換成較易被個案理解及判讀的訊號。在骨盆底肌肉上常用的生理回饋法共有六種：（1）指診法；（2）陰道椎體訓練法；（3）膀胱壓力法；（4）陰道壓力法；（5）直腸壓力法；及（6）表面肌電圖法。每一種方法都有其優缺點，在使用的選擇上可用（1）準確性；（2）穩定性；（3）可近性；及（4）臨床適用性來加以評估。在臨床上有關於生理回饋的成效報告指出：生理回饋法輔助之骨盆底肌肉運動對治療尿失禁的成效約在60至100%之間；而比較單純口頭指導與生理回饋法輔助之骨盆底肌肉運動成效的研究上，結果則十分分歧。由於運動處方各異，用的生理回饋法也不同，因此生理回饋法對骨盆底肌肉訓練的效果仍有待更多的研究。綜言之，生理回饋輔助的骨盆底肌肉運動可以有效的輔助病人訓練骨盆底肌肉，加強病人的控尿能力，在臨床上可以依病人的不同的情況，選擇適合的生理回饋方法，加強骨盆底肌肉運動對婦女尿失禁之療效。

關鍵字

尿失禁 ； 運動治療 ； 行為治療 ； 生理回饋

並列摘要

In 1948, Dr. Kegel first introduced an intensive pelvic floor muscle exercise training program to reduce urinary incontinence episodes among a population of postpartum women with pelvic floor relaxation. Since then, pelvic floor muscle exercises have been used for managing mild to moderate urinary incontinence. While Kegel's original study has reported a detailed exercise regimen, including exercise stages, training goals, use of biofeedback, and the importance of in-home training, current clinical practice tends to consist of 1-time only verbal instructions. This change might be limiting the effectiveness of pelvic floor muscle exercises. Many women with pelvic floor relaxation problems are unable to isolate pelvic floor muscle movement and fail to recognize pelvic floor muscle activity during initial visits. Thus, biofeedback-assisted instructions are helpful due to biofeedback's capability to translate an unrecognizable biological signal into interpretable information.
Currently, 6biofeedback methods are available for pelvic floor muscle exercise training: (1) digital biofeedback; (2) a vaginal cone; (3) cystometry biofeedback; (4) perineometer biofeedback; (5) an anorectal manometer; and (6) surface electromyography biofeedback. There are pros and cons for each method, and clinical utilization should be based on the following criteria: (1) accuracy; (2) stability; (3) accessibility; and (4) clinical applicability. Recent studies have reported that the effectiveness of biofeedback-assisted pelvic floor muscle exercise training can reduce urinary incontinence episodes from 60 to 100%; while diverse results have emerged when comparing verbally and biofeedback assisted pelvic muscle training. More clinical controlled studies are needed to determine the role of biofeed-back assisted instruction in pelvic floor muscle exercise training.

並列關鍵字

urinary incontinence ； exercise therapy ； behavioral therapy ； biofeedback