Observation On The Therapeutic Effect Of Acupuncture Combined With Transcranial Direct Current Stimulation Of Foot Motor Sensory Area In Patients With Urinary Incontinence After Stroke

Objective:To observe the clinical effect of acupuncture combined with transcranial direct current stimulation of foot movement sensation area on patients with urinary incontinence after stroke.Pelvic floor electrophysiology was used to evaluate the changes of pelvic floor electromyography in patients with urinary incontinence after stroke,and combined with related scales to evaluate bladder function and quality of life in patients with urinary incontinence after stroke.Methods:Eighty-one patients who met the inclusion criteria were randomly divided into three groups: acupuncture group,transcranial direct current group and combined stimulation group.All the three groups received basic treatment(routine treatment of internal diseases + routine acupuncture of stroke + rehabilitation training);acupuncture group selected acupoints of urinary incontinence to acupuncture Guanyuan,Zhongji,Shenshu and bladder Shu;In the transcranial direct current stimulation group,foot motor sensory area was stimulated by transcranial direct current stimulation,while in the combined stimulation group,Guanyuan,Zhongji,Shenshu and bladder Shu were acupuncture at the same time.Before the first treatment and four weeks after treatment,the bladder function and electrophysiological changes of pelvic floor were analyzed by International Consultation on Incontinence Questionnaire short form(ICI-Q-SF)and Incontinence Quality of Life Questionnaire(I-QOL)and pelvic floor EMG evaluation.Results:(1)The change of the mean amplitude of rapid contraction of pelvic floor myoelectric fast muscle(II type)fibers: compared with those before treatment,the contraction amplitude of fast muscle fibers in the three groups increased after 4 weeks of treatment(all P<0.05).Comparison between groups: after 4 weeks of treatment,there was no significant difference in the amplitude of rapid contraction of fast muscle fibers among the three groups(all P > 0.05).(2)The change of the mean amplitude of fiber tension contraction of pelvic floor myoelectric complex muscle(I&II type): compared with those before treatment,the changes of contraction amplitude of com Prehensive muscle fibers in the three groups were improved after 4 weeks of treatment(all P<0.05).Comparison between groups: after 4 weeks of treatment,the amplitude of contraction of comprehensive muscle fibers in the combined stimulation group was significantly higher than that in the acupuncture group and transcranial direct current group(P<0.05),but there was no significant difference between the acupuncture group and the transcranial direct current group(P>0.05).(3)Results of mean changes of endurance contraction amplitude of pelvic floor electromyography slow muscle(I type)fibers: compared with that before treatment,the contractile amplitude of slow muscle fiber in the three groups increased 4 weeks after treatment(all P>0.05).Comparison between groups: after 4 weeks of treatment,the amplitude of slow muscle fiber contraction in the combined stimulation group was significantly higher than that in the acupuncture group and transcranial direct current group(all P<0.05),but there was no significant difference between the acupuncture group and the transcranial direct current group(P>0.05).(4)Analysis of the score results of the scale: four weeks after treatment,the scores of International Consultation on Incontinence Questionnaire short form(ICI-Q-SF)and Incontinence Quality of Life Questionnaire(I-QOL)were improved in all groups(all P<0.05).After 4 weeks of treatment,the scores of the ICI-Q-SF and I-QOL scales in the combined stimulation group were significantly greater than those in the acupuncture group and transcranial direct current group,but there was no significant difference between the acupuncture group and the transcranial direct current group.Conclusion:All the three groups could improve the muscle strength,endurance and coordination between the pelvic floor muscles,improve the degree of urinary incontinence,and improve the ability of daily living,but acupuncture combined with transcranial direct current stimulation played a more significant role in improving the endurance of slow muscle fibers,coordinating the activities of muscle groups and improving the degree of urinary incontinence.