My Close Encounter
With The Electric Chair
By John D. Perry, PhD
For several months I’ve waited patiently for the opportunity to get “zapped” by the newest gadget in the incontinence arsenal, the magnetic-coupled electric chair from NeoControl™. The inventors call it “ExMI”, short for “Extracorporeal Magnetic Innervation”, but that’s merely a fancy marketing term; it is just a highly adjustable gigantic electromagnet that one sits on for 20 minutes to tone up the pelvic muscles. I finally got to try The Chair at an exhibit at the recent International Continence Society meeting in Denver.
In a nutshell, the new device is simply elegant. The primary marketing claim is its simplicity. I was invited to sit, fully clothed, in an ordinary-looking slightly-padded upright chair, while the magnet did its thing. I didn’t have to pay attention — I could carry on a conversation, or even read a book or magazine. In fact, patients don’t even need to give their name to the therapist; all information about you and your treatment plan is pre-programmed into your own computer-chip-card that is inserted in a slot on the front of the control device, which sits next to the chair. Everything happens automatically. (The only exception is that I was required to first remove my hip pocket wallet; the magnet will wipe out all credit cards in its range.)
When the machine started, I suddenly felt my pelvic muscles twinge and then contract, without any conscious action on my part. In fact, I couldn’t even resist. Depending on the settings programmed into your card, the device will contract, hold, and release your muscles at pre-programmed (and fully adjustable) intervals. The intensity can be varied from barely noticeable to extreme (which feels like you’ve just been tackled around the hips on the football field). I had to be careful to sit directly over the magnet; slide down, and I found my buttocks contracting; sit back too far, and my adductors made my legs twitch.
I am pleased to offer my professional opinion: It works. It really does grab your muscles right through your clothing and make them contract, even against your will. In fact, it feels exactly the same as directly-applied electrical stimulation electrodes do. Therein lies the rub.
Granted that The Chair forces your muscles to contract involuntarily exactly as advertised; but does that mean it will cure your incontinence? Unfortunately, for all its elegance and simplicity, and despite it’s high cost, The Chair is no more effective in curing incontinence than inexpensive, directly-applied electrical stimulation.
Both salesmen and professional papers about NeoControl report improvement rates of about 80% of patients (who get at least 50% better), which is about typical for electrical stimulation results (and less than half as good as for biofeedback). According to data on their website, in one study (ICS, Monaco, 1998) patient leaks went from 2.3 per day before therapy to 0.8 per day after. In another study (AUA, Dallas, 1999), leaks went from 3.3 a day to 1.7 per day after. These rates correspond to “Burgio-type” symptom reduction rates of 65% and 48% respectively — compared with 85-94% reductions obtained by Burgio for biofeedback. Worse yet, an after-therapy rate of “about 1 or 2 leaks per day” is still considered “incontinent” by ICS standards.
The advertising claims made by NeoControl may yet evoke an official response from the Food and Drug Administration. For example, a webpage entitled “What is NeoControl” states “Unlike any other therapy, NeoControl exercises all the muscles of the pelvic floor to rebuild strength and endurance, reestablishing bladder control.” But that is simply a false claim; both direct electrical stimulation and biofeedback do the same thing.
NeoControl claims that it works by “rebuilding muscles” through involuntary exercise, but there is considerable professional dispute about the relative importance of the muscles themselves in establishing continence control. Many physiotherapists, such as Kari Bo of Norway, believe that exercise of the entire neurological pathway — brain to cord to muscles and back again — is what results continence through better control of the existing muscles. Patients doing voluntary exercise show improvement sooner than would be expected if we had to wait for the muscles themselves to be strengthened, she argues.
The superior results of biofeedback over either direct or coupled stimulation may result from the more complete exercise of the entire neurological pathway when making voluntary contractions. The superiority of biofeedback over unmonitored voluntary exercise may result from the greater efficiency of that exercise with feedback.
Currently there is a well-funded international advertising campaign to get a magnetic chair into every urologist’s office. But when patients discover they are still having one or two leaks per day, the sound and fury will subside. Or they will quietly admonish patients to “do you Kegels every day”.
Eventually, the manufacturers may find an even more lucrative market putting coin-operated magnetic chairs in airport waiting rooms and even on commuter rail trains, where, in the absence of medical claims, no FDA regulation is required or possible.
Yet to be explored, at least in public, is the effect of adjusting pelvic muscle contraction parameters to more closely resemble those of sexual activities. What happens, we wonder, when the “frequency” dial is set to match the “0.8 second” involuntary orgasmic contractions reported by Masters and Johnson? Woody Allen may have been premature.