The use of JOGO Digital Therapeutic (DTx) for Female Dysfunctional Voiding: A Case Study
Dysfunctional Voiding (DV) is a disorder with poor coordination between the bladder muscle and the urethra, characterized by dyssynergic striated sphincter activity. It can present at any age with a spectrum of storage and voiding symptoms that may resemble florid neurogenic bladder. JOGO Digital Therapeutic (DTx) is an innovative wireless tablet-based system that uses electromyographic biofeedback (EMG BF) sensory inputs in combination with conventional physical therapy (PT) to improve mobility and functional abilities of patients with neuro-muscular conditions.
A 40-years old female patient with symptoms of dysfunctional voiding came for pelvic floor relaxation physiotherapy (PFRPT) with the use of JOGO Digital Therapeutic (DTx) Biofeedback System. She had frequent urge to void (every half an hour), inability to void fully and severe spasm of the pelvic floor muscles (the tone of the muscles was strong, hypertonic). Also, she reported severe pain, rated 8-9/10, by Visual Analogue Scale (VAS) associated with the pelvic floor muscles palpation. The electromyography reading of pelvic floor muscles performed by JOGO DTx was 20 mV at the start of the treatment.
A thorough pelvic floor internal examination was performed at the beginning and at the end of the treatment. We assessed pelvic floor muscles’ contraction strength, tone, spasm and symptom reproduction to palpation. For the contraction strength, we used the quantification such as absent, weak, normal, or strong. For the assessment of symptom reproduction to palpation, Visual Analogue Scale (VAS) was used ( 0 is no pain and discomfort and 10 is unbearable pain and discomfort). The presence of any spasm were also noted. Resting tone of pelvic floor muscles was measured by JOGO Digital Therapeutic Electromyography System and quantified as hypertonic, normal or hypotonic. After the examination and the assessment, the patient started receiving one hour once weekly JOGO DTx relaxation therapy on top of conventional physiotherapy, in the course of 8 weeks, as of February 11th, 2018. Conventional physiotherapy included relaxation exercises, external and internal stretching, external and internal massage, yogic postures on a yoga mat, home exercise program for pelvic contractions. Also, patient was educated on having a bladder habit training diary, as well as on pelvic floor muscles anatomy and functioning.
At the end, after 8 weeks of JOGO DTx relaxation therapy on top of conventional physiotherapy, JOGO DTx transvaginal pelvic floor muscle relaxation reading was 3mv (at the start was 20mV). The tone of the pelvic floor muscles at the start of the treatment was strong ( hypertonic) and at the end of the 8th week was normal. The presence of moderate spasm was noted at the start and the absence at the end. The patient reported pain/discomfort 8-9/10 in VAS scale at the start of treatment, and 0/10 at the end of the 8th week. The frequency of urge to void was every half an hour, at the start of treatment, and every three to four hours, at the end of treatment. Patient was able to void the bladder fully at the end of treatment, unlike at the start.
The outcome in the form of complete recovery following JOGO DTx intervention on DV opens the field for further research in DV and other types of urinary dysfunctions. Further studies are in process to keep evaluating the development of this technology.
Alejandra Nava Nava MD(1), Jelena Otasevic, MD(2), Gary Krasilovsky, PhD(3), Uma Venketesa DPT(4), Meera Ragavan MD(5). 1. The University of Texas MD Anderson Cancer Center, Houston, TX 2. The School of Medicine, University of Belgrade 3. Hunter College, New York, NY 4. JOGO Health, New Jersey, USA 5. South Manchester University Teaching Hospitals, UK.
1. Yuan-Ming Liaw, Et al. Biofeedback Pelvic Floor Muscle Training for Voiding Dysfunction and Overactive Bladder. Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan. Incont Pelvic Floor Dysfunct 2007; 1:13-15 2. Digital therapeutics for neuromuscular conditions (n.d). retrieve from https://www.jogohealth.com/ 3. Pelvic Floor Physical Therapy in the Treatment of a Patient with Interstitial Cystitis, Dyspareunia, and Low Back Pain. A case Report; Cozean, Nicole PT, DPT, WCS, CSCS; Journal of Women’s Health Physical Therapy: January/April 2017 - Volume 41 - Issue 1 - p 19–27; doi: 10.1097/JWH.0000000000000062 4. Physical Therapist Interventions for Voiding Dysfunction and Pelvic Pain: A Retrospective Case Series, Figuers, Carol C. PT, EdD; Amundsen, Cindy L. MD; Weidner, Alison C. MD; Hendricks, Colleen K. DPT; Holladay, Christina L. DPT Journal of Women's Health Physical Therapy: May/August 2010 - Volume 34 - Issue 2 - p 40–44; doi: 10.1097/JWH.0b013e3181e8fd1c, Research Reports