Effect of Different Rehabilitation Treatment Methods on Patients with Postpartum Pelvic Floor Dysfunction Based on fNIRS Observation
Objective To observe the correlation between oxyhemoglobin(HbO2)concentration changes and brain region acti-vation under different treatment methods using functional near-infrared(fNIRS),providing objective evaluation indicators and analy-sis basis for the clinical research of postpartum pelvic floor rehabilitation.Methods A total of 40 patients with postpartum pelvic floor dysfunction(PFD)treated at Dushu Lake Hospital Affiliated to Soochow University from January to June 2023 were selected and randomly divided into 4 groups:pure Kegel group,electrical stimulation group,magnetic stimulation group,and electromagnetic combination group,with 10 cases in each group.The pure Kegel group performed Kegel training for 30 minutes each time,3 times a week;the electrical stimulation group received biofeedback electrical stimulation for 20 minutes each time,with a frequency of 5-50 Hz,and 5 minutes of Kegel training before and after each treatment;the magnetic stimulation group received pelvic floor magnet-ic stimulation for 20 minutes each time,and 5 minutes of Kegel training before and after each treatment;the electromagnetic combi-nation group received alternating electrical stimulation and pelvic floor magnetic stimulation treatment for 20 minutes each time,and 5 minutes of Kegel training before and after each treatment.All four groups were treated for one course of 10 sessions.Before and after treatment,pelvic floor prolapse was assessed by pelvic floor anatomy indicators,surface electromyographic values of the pelvic floor muscles were assessed by EMG,and HbO2 concentration changes and activation in different brain regions were observed using fNIRS.Results After treatment,the mobility of bladder neck in the pure Kegel group improved compared with that before treat-ment(P<0.05),and the urethral rotation angle and levator ani fissure area improved to some extent(P<0.05).The electrical stimula-tion,magnetic stimulation and electromagnetic combination groups all showed improvements in pelvic floor anatomical indicators compared with those before treatment(P<0.05),and further inter-group comparison showed that the improvement in the electromag-netic combination group after treatment was significantly better than the other three groups(P<0.05).After treatment,the surface electromyography ralues of pelvic floor muscle in the pure Kegel group showed significant improvement in pre-resting potential(P<0.05)and the endurance contraction(P<0.05)compared to those before treatment.The pre and post resting potentials,and flick,tonic and endurance contractions the surface electromyography ralues of pelvic floor muscle in the electrical stimulation,magnetic stimu-lation and electromagnetic combination groups all improved(P<0.05).Further inter-group comparison showed that the the surface electromyography ralues of pelvic floor muscle in magnetic stimulation group showed better improvements in pre-rest and post-rest stages than the pure Kegel group and the electrical stimulation group(P<0.05).The improvement of flick contraction,tonic contrac-tion and endurance contraction the surface electromyography ralues of pelvic floor muscle in the electromagnetic combination group was better than that in the other three groups(P<0.05).Compared with that before treatment,the oxygen concentration of HbO2 in L-PMC regional electrical stimulation group and magnetic stimulation group increased after treatment(P<0.05).After treatment,the oxygen concentration of HbO2 in L-PMC regional electromagnetic combination group increased(P<0.05).The oxygen concen-tration of HbO2 in the L-SMC regional magnetic stimulation group increased after treatment(P<0.05).After treatment,the network efficiency of the electromagnetic combination group increased(P<0.05).Compared with the electrical stimulation group,the differ-ence of HbO2 blood oxygen concentration in the R-PMC regional magnetic stimulation group was larger(P<0.01).Compared with the electrical stimulation group,the difference of HbO2 blood oxygen concentration in the R-SMC regional electromagnetic combina-tion group was larger(P<0.05).Compared with the magnetic stimulation group,the difference of network efficiency in the electromag-netic combination group increased(P<0.05).Conclusion The electromagnetic combination treatment regimen strengthens the involvement of the right hemisphere,enhances the synergistic efficiency between multiple functional brain regions,and is more con-ducive to enhancing pelvic floor contractility and reducing pelvic floor anatomical abnormalities.Clinically,it is recommended to use electromagnetic stimulation treatment more often,which contributes to the brain functional connectivity in the motor area.
pelvic floor disordersKegel trainingpelvic floor magnetic stimulationbiofeedback electrical stimulationfunc-tional near infrared spectroscopy
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