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Determine the Relationship Between Abdominal Muscle Strength, Trunk Control and Urinary Incontinence in Children with Diplegic Cerebral Palsy

Burcu Talu




Purpose: The aim of this study is to determine the relationship between abdominal muscle strength, trunk control and urinary incontinence in children with diplegic cerebral palsy.
Materials and methods: The current study had a cross-sectional design using analytical study as well as an observational research model. Fifty children between the ages of 5 and 18 years who were diagnosed with diplegic clinical type of cerebral palsy were included in this study using improbable-random sampling method. After patients' demographic information were obtained, Dysfunctional Voiding and Incontinence Symptoms Score Questionnaire (DVISS), Dysfunctional Voiding Symptom Score (DVSS), the manual muscle test of the muscles, Trunk Control
Test (TCT) and Trunk Control Measurement Scale (TCMS) were completed in order to evaluate trunk control. Also, Gross Motor Function Classification System (GMFCS) was performed in order to define the functional level.
Results: In this study, a highly correlated negative relationship was found between DVISS and DVSS scores with muscle abdominal strength, TCMS and TCT. In addition, a highly correlated positive relationship was found between both GMFCS and DVISS and GMFCS and DVSS.
Conclusion: This is the first study that describes the effect of trunk control and muscle strength on urinary incontinence in children with diplegic cerebral palsy. This study showed that there is a correlation between trunk control, muscle strength and urinary incontinence.


Butler RJ, Heron J. The prevalence of infrequent bedwetting and nocturnal enuresis in childhood. A large British cohort. Scand J Urol Nephrol. 2008;42:257-64.

Gannotti ME, Fuchs RK, Roberts DE, Hobbs N, Cannon IM. Health benefits of seated speed, resistance, and power training for an individual with spastic quadriplegic cerebral palsy: A case report. J Pediatr Rehabil Med. 2015;8:251-7.

Panjabi MM. The stabilizing system of the spine. Part I. Function, dysfunction, adaptation, and enhancement. J Spinal Disord. 1992;5:383-9.

Burti JS, Hacad CR, Zambon JP, Polessi EA, Almeida FG. Is there any difference in pelvic floor muscles performance between continent and incontinent women? Neurourol Urodyn.


Park H, Han D. The effect of the correlation between the contraction of the pelvic floor muscles and diaphragmatic motion during breathing. J Phys Ther Sci. 2015;27:2113-5.

Sapsford R. Rehabilitation of pelvic floor muscles utilizing trunk stabilization. Man Ther. 2004;9:3-12.

Hides JA, Stanton WR, McMahon S, Sims K, Richardson CA. Effect of stabilization training on multifidus muscle cross-sectional area among young elite cricketers with low back pain. J Orthop Sports Phys Ther. 2008;38:101-8.

Ors AO, Irkilata HC, Kibar Y, Zor M, Korgalı E, Dayanc M. Noninvasive Evaluation of the Children With Lower Urinary Tract

Dysfunction. Turkish Journal of Urology. 2008;34:203-8.

Dirim A, Aygun YC, Bilgilisoy UT, Durukan E. Prevalence and associated factors of daytime lower urinary tract dysfunction in

students of two primary schools of Turkey with different socioeconomic status. Turkiye Klinikleri Journal of Urology. 2011;2:1-6.

Akbal C, Genc Y, Burgu B, Ozden E, Tekgul S. Dysfunctional voiding and incontinence scoring system: quantitative evaluation

of incontinence symptoms in pediatric population. J Urol. 2005;173:969-73.

Yuksel S, Yurdakul AC, Zencir M, Corduk N. Evaluation of lower urinary tract dysfunction in Turkish primary schoolchildren: an epidemiological study. J Pediatr Urol. 2014;10:1181-6.

Parlak Demir Y, Yıldırım SA. Reliability and validity of Trunk Control Test in patients with neuromuscular diseases. Physiotherapy theory and practice. 2015;31:39-44.

Ozal C, Günel MK. Spastik serebral palsili çocuklarda gövde kontrolü ile fonksiyonel mobilite ve denge arasındaki ilişkinin incelenmesi. Journal of Exercise Therapy and Rehabilitation. 2014;1:01-8.

Gonca A, GÜNEL MK. Serebral palsili çocuklarda nörogelişimsel tedaviye dayalı gövde eğitiminin gövde kontrolüne etkisi. Journal of Exercise Therapy and Rehabilitation. 2015;2:79-85.

Mitteregger E, Marsico P, Balzer J, van Hedel HJ. Translation and construct validity of the Trunk Control Measurement Scale in children and youths with brain lesions. Res Dev Disabil. 2015;45-46:343-52.

Gunel MK, Mutlu A, Tarsuslu T, Livanelioglu A. Relationship among the Manual Ability Classification System (MACS), the Gross Motor Function Classification System (GMFCS), and the functional status (WeeFIM) in children with spastic cerebral palsy. European journal of pediatrics. 2009;168:477-85.

Neumann P, Gill V. Pelvic floor and abdominal muscle interaction: EMG activity and intraabdominal pressure. Int Urogynecol J Pelvic Floor Dysfunct. 2002;13:125-32.

Peschers UM, Gingelmaier A, Jundt K, Leib B, Dimpfl T. Evaluation of pelvic floor musclestrength using four different techniques. Int Urogynecol J Pelvic Floor Dysfunct.


Fowler CJ, Griffiths DJ. A decade of functional brain imaging applied to bladder control. Neurourol Urodyn. 2010;29:49-55.

Wright AJ, Fletcher O, Scrutton D, Baird G. Bladder and bowel continence in bilateral cerebral palsy: A population study. J Pediatr Urol. 2016;12:383-8.

Joinson C, Heron J, Butler R, et al. A United Kingdom population-based study of intellectual capacities in children with and without soiling, daytime wetting, and bedwetting. Pediatrics. 2007;120:308-16.

Fergusson DM, Horwood LJ, Shannon FT. Factors related to the age of attainment of nocturnal bladder control: an 8-year

longitudinal study. Pediatrics. 1986;78:884-90.

von Wendt L, Simila S, Niskanen P, Jarvelin MR. Development of bowel and bladder control in the mentally retarded. Dev Med

Child Neurol. 1990;32:515-8.

Jansson U-B, Hanson M, Hanson E, Hellström A-L, Sillén U. Voiding pattern in healthy children 0 to 3 tears old: A longitudinal study. The Journal of urology. 2000;164:2050-4.

Roncesvalles MN, Schmitz C, Zedka M, Assaiante C, Woollacott M. From egocentric to exocentric spatial orientation: development of posture control in bimanual and trunk inclination tasks. J Mot Behav. 2005;37:404-16.

Sapsford RR, Hodges PW, Richardson CA, Cooper DH, Markwell SJ, Jull GA. Coactivation of the abdominal and pelvic floor muscles during voluntary exercises. Neurourol Urodyn. 2001;20:31-42.

Reid CJ, Borzyskowski M. Lower urinary tract dysfunction in cerebral palsy. Arch Dis Child. 1993;68:739-42.

Sapsford RR, Hodges PW. Contraction of the pelvic floor muscles during abdominal maneuvers. Arch Phys Med Rehabil.


DOI: http://dx.doi.org/10.22037/uj.v0i0.4043


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