Turkiye Klinikleri Journal of Health Sciences

.: REVIEW
Pelvik Taban Kas Eğitimi ve Sanal Gerçeklik
Pelvic Floor Muscle Training and Virtual Reality
Seda YAKIT YEŞİLYURTa, Nuriye ÖZENGİNa, Yeşim BAKARb
aFizyoterapi ve Rehabilitasyon AD, Bolu Abant İzzet Baysal Üniversitesi Kemal Demir Fizik Tedavi ve Rehabilitasyon Yüksekokulu, Bolu, TÜRKİYE
bFizyoterapi ve Rehabilitasyon Bölümü, İzmir Bakırçay Üniversitesi Sağlık Bilimleri Fakültesi,İzmir, TÜRKİYE
Turkiye Klinikleri J Health Sci. 2019;4(3):381-9
doi: 10.5336/healthsci.2018-64206
Article Language: TR
Full Text
ÖZET
Pelvik taban kasları (PTK), simfizis pubisten koksikse doğru genişleyen, çok katlı bir kas tabakasıdır. Pelvis içindeki pozisyonu bir trambolin gibi düşünülen bu yapı, pelvik açıklıklara (üretra, vajina ve anüs) yapısal destek verir. Ayrıca işeme, dışkılama, seksüel fonksiyon ve pelvik organların desteklenmesinden de sorumludur. Pelvik taban kaslarının ön, orta veya arka kompartmanlarının herhangi birinde meydana gelen bir patoloji; alt üriner sistem semptomları, bağırsak semptomları, prolapsus, seksüel fonksiyon ve ağrı ile ilişkili olan pelvik taban disfonksiyonuna (PTD) neden olmaktadır. PTD özellikle kadınları etkilemekte ve zaman içerisinde kasın yeniden eğitimini gerektirmektedir. PTD tedavi seçenekleri arasında cerrahi, medikal ve fizyoterapi ve rehabilitasyon yaklaşımları yer almaktadır. Fizyoterapi ve rehabilitasyonun amacı semptomları azaltmak, progresyonu önlemek, cerrahiyi önlemek ya da geciktirmek ve yaşam kalitesini arttırmaktır. Bu amaçlara ulaşmak için PTD tedavisinde uygulanan fizyoterapi ve rehabilitasyon yaklaşımları pelvik taban kas eğitimini (PTKE) içermektedir. PTKE; biofeedback, vajinal kon, foley kateter, tampon, üç boyutlu real time ultrasound ve sanal gerçeklik eğitimi ile birlikte uygulanabilir. Bu derleme, pelvik taban disfonksiyonunda; pelvik taban kas eğitimini ve bu eğitimde kullanılan yöntemleri tartışmaktadır. Ayrıca son dönemlerde oldukça popüler olan sanal gerçekliğin pelvik taban kas eğitimde uygulanabilirliğini ve avantajlarını vurgulamaktadır.

Anahtar Kelimeler: Sanal gerçeklik; pelvik taban; kadın sağlığı
ABSTRACT
Pelvic floor muscles (PFMs) are a layered muscle layer that expands symphysis pubis to coccyx. This structure, which is thought to be a tombolin in the pelvis, provides structural support to the pelvic openings (urethra, vagina and anus). It is also responsible for voiding, defecation, sexual functioning and supporting pelvic organs. A pathology that occurs in any of the anterior, middle, or posterior compartments of the pelvic floor muscles that cause pelvic floor dysfunction (PFD) associated with lower urinary tract symptoms, intestinal symptoms, prolapse, sexual function and pain. PFD is particularly affecting women and that require muscle re-education. Treatment options for PFD include surgery, medical and physiotherapy and rehabilitation approaches. Physiotherapy and rehabilitation are aimed at reducing symptoms, preventing progression, preventing or delaying surgery and improving quality of life. Physiotherapy and rehabilitation approaches for PTD include pelvic floor muscle training (PFMT). PFMT can be applied with biofeedback, vaginal cone, foley catheter, tampon, three-dimensional real time ultrasound and virtual reality training. This review suggests that in pelvic floor dysfunction; pelvic floor muscle training and methods used in this training. It also emphasizes the applicability and advantageous aspects of pelvic floor muscle training in the virtual reality, which has recently become quite popular.

Keywords: Virtual reality; pelvic floor; women's health
REFERENCES:
  1. Haslam J. Historical perspective of pelvic floor muscle training. Therapeutic Management of Incontinence and Pelvic Pain: Pelvic Organ Disorders. 2nd ed. London: Springer; 2007. p.85-8. [Crossref] 
  2. Kegel AH. Progressive resistance exercise in the functional restoration of the perineal muscles. Am J Obstet Gynecol. 1948;56(2):238-48. [Crossref] 
  3. Martinez PI. ICS updates on continence care: what's hot in physiotherapy after 80 years? Urology News. 2016;20(3):12-4.
  4. Hay-Smith J, Dean S, Burgio K, McClurg, Frawley H, Dumoulin C. Pelvic-floor-muscle-training adherence "modifiers": A Review of Primary Qualitative Studies-2011 ICS State-of-the-Science Seminar research paper III of IV. Neurourol Urodyn. 2015;34(7):622-31. [Crossref]  [PubMed] 
  5. Dumoulin C, Hay-Smith J, Mac Habee-Seguin G. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2010;(5):CD005654. [Crossref] 
  6. Chen SY, Tzeng YL. Path analysis for adherence to pelvic floor muscle exercise among women with urinary incontinence. J Nurs Res. 2009;17(2):83-92. [Crossref]  [PubMed] 
  7. Elliott V, de Bruin ED, Dumoulin C. Virtual reality rehabilitation as a treatment approach for older women with mixed urinary incontinence: a feasibility study. Neurourol Urodyn. 2015;34(3):236-43. [Crossref]  [PubMed] 
  8. Baran E. [Anatomy of the pelvis]. Akbayrak T, Kaya S, editorler. Kadin Sagliginda Fizyoterapi ve Rehabilitasyon. 1. Baski. Ankara: Hipokrat Kitabevi, Pelikan Kitabevi, Nisan Kitabevi; 2016. p.15-34.
  9. Demirturk F, Akbayrak T. [Physiotherapy and rehabilitation in urinary incontinence]. Karaduman A, Tunca OY, editorler. Fizyoterapi ve Rehabilitasyon. 1. Baski. Ankara: Hipokrat Kitabevi, Pelikan Kitabevi, Nisan Kitabevi; 2016. p.471-87.
  10. Sapsford R. Rehabilitation of pelvic floor muscles utilizing trunk stabilization. Man Ther. 2004;9(1):3-12. [Crossref] 
  11. Messelink B, Benson T, Berghmans B, Bo K, Corcos J, Fowler C, et al. Standardization of terminology of pelvic floor muscle function and dysfunction: report from the pelvic floor clinical assessment group of the International Continence Society. Neurourol Urodyn. 2005;24(4): 374-80. [Crossref]  [PubMed] 
  12. Bo K, Morkved S, Kampen MV. Pelvic ?oor and exercise science. Evidence-Based Physical Therapy for the Pelvic Floor: Bridging Science and Clinical Practice. 2nd ed. China: Churcill Livingstone; 2015. p.111-29. [Crossref] 
  13. Bo K. Urinary incontinence, pelvic floor dysfunction, exercise and sport. Sports Med. 2004;34(7):451-64. [Crossref]  [PubMed] 
  14. Bump RC, Hurt WG, Fantl JA, Wyman JF. Assessment of Kegel pelvic muscle exercise performance after brief verbal instruction. Am J Obstet Gynecol. 1991;165(2):322-9. [Crossref] 
  15. Bo K, Talseth T. Change in urethral pressure during voluntary pelvic floor muscle contraction and vaginal electrical stimulation. Int Urogynecol J Pelvic Floor Dysfunct. 1997;8(1): 3-7. [Crossref]  [PubMed] 
  16. Freeman RM. The role of pelvic floor muscle training in urinary incontinence. BJOG. 2004; 111 Suppl 1:37-40. [Crossref]  [PubMed] 
  17. Petros P. The integral system. Cent European J Urol. 2011;64(3):110-9. [Crossref]  [PubMed]  [PMC] 
  18. Davis K. Pelvic floor dysfunction: causes and assessment. Practice Nursing. 2010;21(7): 340-6. [Crossref] 
  19. Sora MC, Jilavu R, Matusz P. Computer aided three-dimensional reconstruction and modeling of the pelvis, by using plastinated cross sections, as a powerful tool for morphological investigations. Surg Radiol Anat. 2012;34(8): 731-6. [Crossref]  [PubMed] 
  20. Hakenberg OW. Editorial: pelvic floor dysfunction. Eur Urol. 2018;17(3):79. [Crossref] 
  21. Bo K, Talseth T, Vinsnes A. Randomized controlled trial on the effect of pelvic floor muscle training on quality of life and sexual problems in genuine stress incontinent women. Acta Obstet Gynecol Scand. 2000;79(7):598-603. [Crossref]  [PubMed] 
  22. Bo K. Pelvic floor muscle training in treatment of female stress urinary incontinence, pelvic organ prolapse and sexual dysfunction. World J Urol. 2012;30(4):437-43. [Crossref]  [PubMed] 
  23. Sar D, Khorshid L. The effects of pelvic floor muscle training on stress and mixed urinary incontinence and quality of life. J Wound Ostomy Continence Nurs. 2009;36(4):429-35. [Crossref]  [PubMed] 
  24. Martinho NM, Silva VR, Marques J, Carvalho LC, Iunes DH, Botelho S. The effects of training by virtual reality or gym ball on pelvic floor muscle strength in postmenopausal women: a randomized controlled trial. Braz J Phys Ther. 2016;20(3):248-57. [Crossref]  [PubMed]  [PMC] 
  25. Eskiyurt N. [Prophylaxis and exercises of the treatment of pelvic floor dysfunction]. Turkiye Klinikleri J Gynecol Obst-Special Topics. 2009;2(2):36-41.
  26. Kaya S, Akbayrak T, Demirtas N, et al. [Evidence review]. Akbayrak T, Kaya S, editorler. KNGF Kilavuzu: Stres Uriner Inkontinansi Olan Hastalarda Fizyoterapi. 1. baski. Ankara: Pelikan Kitabevi; 2015. p.11-77.
  27. Thuroff JW, Abrams P, Andersson KE, Artibani W, Chapple CR, Drake MJ, et al. EAU guidelines on urinary incontinence. Eur Urol. 2011;59(3):387-400. [Crossref]  [PubMed] 
  28. Bernards AT, Berghmans BC, Slieker-Ten Hove MC, Staal JB, de Bie RA, Hendriks EJ. Dutch guidelines for physiotherapy in patients with stress urinary incontinence: an update. Int Urogynecol J. 2014;25(2):171-9. [Crossref]  [PubMed]  [PMC] 
  29. FitzGerald MP, Kotarinos R. Rehabilitation of the short pelvic floor. II: Treatment of the patient with the short pelvic floor. Int Urogynecol J Pelvic Floor Dysfunct. 2003;14(4): 269-75. [Crossref]  [PubMed] 
  30. Levendoglu F. [Pregnancy and rehabilitation]. Beyazova M, editor. Fiziksel Tip ve Rehabilitasyon. 3. Baski. Ankara: Gunes Tip Kitapevleri; 2016. p.1745-60.
  31. Giggins OM, Persson UM, Caulfield B. Biofeedback in rehabilitation. J Neuroeng Rehabil. 2013;10:60. [Crossref]  [PubMed]  [PMC] 
  32. Vahtera T, Haaranen M, Viramo-Koskela AL, Ruutiainen J. Pelvic floor rehabilitation is effective in patients with multiple sclerosis. Clin Rehabil. 1997;11(3):211-9. [Crossref]  [PubMed] 
  33. Dannecker C, Wolf V, Raab R, Hepp H, Anthuber C. EMG-biofeedback assisted pelvic floor muscle training is an effective therapy of stress urinary or mixed incontinence: a 7-year experience with 390 patients. Arch Gynecol Obstet. 2005;273(2):93-7. [Crossref]  [PubMed] 
  34. Bo K. Pelvic floor muscle training is effective in treatment of female stress urinary incontinence, but how does it work? Int Urogynecol J Pelvic Floor Dysfunct. 2004;15(2):76-84. [Crossref]  [PubMed] 
  35. Faubion SS, Shuster LT, Bharucha AE. Recognition and management of nonrelaxing pelvic floor dysfunction. Mayo Clin Proc. 2012;87(2):187-93. [Crossref]  [PubMed]  [PMC] 
  36. Ehrenborg C, Archenholtz B. Is surface EMG biofeedback an effective training method for persons with neck and shoulder complaints after whiplash-associated disorders concerning activities of daily living and pain--a randomized controlled trial. Clin Rehabil. 2010;24(8):715-26. [Crossref]  [PubMed] 
  37. Peschers UM, Gingelmaier A, Jundt K, Leib B, Dimpfl T. Evaluation of pelvic floor muscle strength using four different techniques. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12 (1):27-30. [Crossref]  [PubMed] 
  38. Demirturk F, Yuksel I, Akbayrak T, Gunal A, Beksas S. Pelvic floor muscle strength in different age periods and investigation of the affecting factors. J Contemp Med. 2017;7(3): 254-64. [Crossref] 
  39. Clemens JQ, Nadler RB, Schaeffer AJ, Belani J, Albaugh J, Bushman W. Biofeedback, pelvic floor re-education, and bladder training for male chronic pelvic pain syndrome. Urology. 2000;56(6):951-5. [Crossref] 
  40. Aksac B, Aki S, Karan A, Yalcin O, Isikoglu M, Eskiyurt N. Biofeedback and pelvic floor exercises for the rehabilitation of urinary stress incontinence. Gynecol Obstet Invest. 2003;56 (1):23-7. [Crossref]  [PubMed] 
  41. Koh CE, Young CJ, Young JM, Solomon MJ. Systematic review of randomized controlled trials of the effectiveness of biofeedback for pelvic floor dysfunction. Br J Surg. 2008;95(9): 1079-87. [Crossref]  [PubMed] 
  42. Wang AC, Wang YY, Chen MC. Single-blind, randomized trial of pelvic floor muscle training, biofeedback-assisted pelvic floor muscle training, and electrical stimulation in the management of overactive bladder. Urology. 2004;63(1):61-6. [Crossref]  [PubMed] 
  43. Stupp L, Resende AP, Oliveira E, Castro RA, Girao MJ, Sartori MG. Pelvic floor muscle training for treatment of pelvic organ prolapse: an assessor-blinded randomized controlled trial. Int Urogynecol J. 2011;22(10):1233-9. [Crossref]  [PubMed] 
  44. Roongsirisangrat S, Rangkla S, Manchana T, Tantisiriwat N. Rectal balloon training as an adjunctive method for pelvic floor muscle training in conservative management of stress urinary incontinence: a pilot study. J Med Assoc Thai. 2012;95(9):1149-55.
  45. Orhan C, Akbayrak T, Ozgul S, Baran E, Uzelpasaci E, Nakip G, et al. Effects of vaginal tampon training added to pelvic floor muscle training in women with stress urinary incontinence: randomized controlled trial. Int Urogynecol J. 2019;30(2):219-29. [Crossref]  [PubMed] 
  46. Haddad JM, Ribeiro RM, Bernardo WM, Abrao MS, Baracat EC. Vaginal cone use in passive and active phases in patients with stress urinary incontinence. Clinics (Sao Paulo). 2011;66(5):785-91.
  47. Herbison GP, Dean N. Weighted vaginal cones for urinary incontinence. Cochrane Database Syst Rev. 2013;(7):CD002114. [Crossref] 
  48. Wilson PD, Herbison GP. A randomized controlled trial of pelvic floor muscle exercises to treat postnatal urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 1998;9(5):257-64. [Crossref]  [PubMed] 
  49. Pieber D, Zivkovic F, Tamussino K, Ralph G, Lippitt G, Fauland B. Pelvic floor exercise alone or with vaginal cones for the treatment of mild to moderate stress urinary incontinence in premenopausal women. Int Urogynecol J. 1995;6(1):14-7. [Crossref] 
  50. Chipchase LS, Thoirs K, Jedrzejczak A. The effectiveness of real time ultrasound as a biofeedback tool for muscle retraining. Phys Ther Rev. 2009;14:124-31. [Crossref] 
  51. Dietz HP, Wilson PD, Clarke B. The use of perineal ultrasound to quantify levator activity and teach pelvic floor muscle exercises. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12 (3):166-9. [Crossref]  [PubMed] 
  52. Whittaker JL, Thompson JA, Teyhen DS, Hodges P. Rehabilitative ultrasound imaging of pelvic floor muscle function. J Orthop Sports Phys Ther. 2007;37(8):487-98. [Crossref]  [PubMed] 
  53. Laver K, George S, Thomas S, Deutsch JE, Crotty M. Virtual reality for stroke rehabilitation. Stroke. 2012;43:20-1. [Crossref] 
  54. Bayraktar E, Kaleli F. [Virtual reality on commercial applications]. Akademik Bilisim. 2007;1-6.
  55. Onyesolu MO, Eze FU. Understanding virtual reality technology: advances and applications. In: Schmidt M, ed. Advances in Computer Science and Engineering. 1st ed. Rijeka, Shanghai: InTech; 2011. p.53-8.
  56. Bohil CJ, Alicea B, Biocca FA. Virtual reality in neuroscience research and therapy. Nat Rev Neurosci. 2011;12(12):752-62. [Crossref]  [PubMed] 
  57. Yang WC, Wang HK, Wu RM, Lo CS, Lin KH. Home-based virtual reality balance training and conventional balance training in Parkinson's disease: a randomized controlled trial. J Formos Med Assoc. 2016;115(9):734-43. [Crossref]  [PubMed] 
  58. Yilmaz Yelvar GD, Cirak Y, Dalkilinc M, Parlak Demir Y, Guner Z, Boydak A. Is physiotherapy integrated virtual walking effective on pain, function, and kinesiophobia in patients with non-specific low-back pain? Randomised controlled trial. Eur Spine J. 2017;26(2):538-45. [Crossref]  [PubMed] 
  59. Botelho S, Martinho NM, Silva VR, Marques J, Carvalho LC, Riccetto C. Virtual reality: a proposal for pelvic floor muscle training. Int Urogynecol J. 2015;26(11):1709-12. [Crossref]  [PubMed] 
  60. Pearl RK, Evenhouse R, Rasmussen M, Dech F, Silverstein JC, Prokasy S, et al. The virtual pelvic floor, a tele-immersive educational environment. Proc AMIA Symp. 1999;345-8.
  61. Ellington DR, Shum PC, Dennis EA, Willis HL, Szychowski JM, Richter HE. Female pelvic floor immersive simulation: a randomized trial to test the effectiveness of a virtual reality anatomical model on resident knowledge of female pelvic anatomy. J Minim Invasive Gynecol. 2018 Sep 12. Doi: 10.1016/j.jmig.2018.09.003. [Epub ahead of print]. [Crossref]  [PubMed] 

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"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com