Children with nocturnal enuresis have posture and balance disorders.
BACKGROUND
Integration of the neuromuscular system is required for maintaining balance and adequate voiding function. Children with enuresis have delayed maturation of the motor cortex, with changes in the sensory and motor systems. Along with various alterations, including the genetic, hormonal, behavioral, and sleep disturbances, and neuromotor and sensory deficits associated with nocturnal enuresis (NE) in children and adults, a consistent alteration in the posture of children with NE has been observed in the current practice. Because posture and the balance control system are strongly connected, this study aimed to investigate posture and balance in children and teenagers with NE.


METHODS
A total of 111 children with enuresis were recruited to the enuretic group (EG) and 60 asymptomatic children made up the control group (CG). The participants were divided into two age subgroups: (A) 7-11 years old, N = 77 for EG/A, N = 38 for CG/A; and (B) 12-16 years old, N = 34 for EG/B, N = 22 for CG/B. Balance was assessed using an electronic force plate (100 Hz) to calculate the area of the center of pressure (COP) displacement. The COP is the point that results from the action of vertical forces projected onto the force plate. Sensory integration was analyzed using a 60-s trial with the subject standing under four conditions: (1) eyes open, stable surface; (2) eyes closed, stable surface; (3) eyes open, unstable surface; (4) eyes closed, unstable surface. Posture was assessed by placing reflective anatomical landmarks on the anterior superior iliac spine, the posterior superior iliac spine, the greater trochanter, and lateral malleolus. A photograph was taken while the subject stood quietly. The angles were obtained from landmark connections using software to assess the following posture variables: pelvic ante/retroversion and pelvic ante/retropulsion.


RESULTS
The EG showed a greater area of COP displacement compared with the CG under all four sensory conditions and both subgroups, except for EG/B in condition 3. Regarding posture, EG showed higher pelvic anteversion angles than CG.


CONCLUSIONS
Enuretic children showed forward inclination of the pelvis and had worse balance compared with control children.
Department of Physiotherapy, Communication Science & Disorders, Occupational Therapy, University of Sao Paulo, School of Medicine, Sao Paulo, Brazil. Electronic address: rita.pavione@hc.fm.usp.br.
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Pavione Rodrigues Pereira
Pediatric Nephrology Unit, Instituto da Criança do Hospital das Clínicas, University of Sao Paulo, School of Medicine, Sao Paulo, Brazil.
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Nascimento Fagundes
Pediatric Nephrology Unit, Instituto da Criança do Hospital das Clínicas, University of Sao Paulo, School of Medicine, Sao Paulo, Brazil.
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Surry Lebl
Pediatric Sleep Laboratory, Instituto da Criança do Hospital das Clínicas, University of Sao Paulo, School of Medicine, Sao Paulo, Brazil.
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Azevedo Soster
Pediatric Urology Unit, Hospital das Clínicas, University of Sao Paulo, School of Medicine, Sao Paulo, Brazil.
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Machado
Pediatric Nephrology Unit, Instituto da Criança do Hospital das Clínicas, University of Sao Paulo, School of Medicine, Sao Paulo, Brazil.
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Koch
Department of Physiotherapy, Communication Science & Disorders, Occupational Therapy, University of Sao Paulo, School of Medicine, Sao Paulo, Brazil.
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Tanaka
D000293:Adolescent; D002648:Child; D003430:Cross-Sectional Studies; D006801:Humans; D053206:Nocturnal Enuresis / Q000150:complications*; D004856:Postural Balance; D012678:Sensation Disorders / Q000150:complications*
Nocturnal enuresis; Physiotherapy; Postural balance; Posture