The exercise will be performed under the supervision of a physiotherapist, twice a week for 8 weeks. After the correct position is established, participants will be instructed to slowly inhale through their nose and focus on feeling the breath move from top to bottom (cranial to caudal). They will be asked to hold their breath for a few seconds, then exhale slowly through pursed lips. Additionally, they will be reminded not to push only their abdomen upward while inhaling, but to feel the intra-abdominal pressure expanding evenly in all directions (360 degrees). This exercise will be performed in 3 sets of 10 repetitions.

No invasive procedures will be performed. The physiotherapist will begin with external palpation of the perineal area to teach correct pelvic floor contractions without using accessory muscles. Once the patient masters this, animation-supported biofeedback exercises will start. If relaxation is insufficient, biofeedback will first target muscle relaxation.

Using the NeuroTrac Myoplus Pro4 device, surface electrodes will be placed at 2 and 7 o'clock on the perineum, and the reference electrode on the right thigh. Exercises will start in a lying position and progress to sitting and standing as control improves. Each session will last about 20 min, with 2-5 s contractions followed by 5-10 s relaxations.

In our study, in addition to the standard protocol, virtual reality-supported video game-based balance exercises will be performed twice a week for 8 weeks. Each session will include a 5-minute warm-up, 20 minutes of balance exercises, and a 5-minute cool-down period. All sessions will follow the same protocol, with identical game order and duration. Each game will be played for approximately 5 minutes, and the number of repetitions for each game will vary depending on the participant's performance level.

As a therapeutic tool, the Wii console, Wii Fit Plus game disc, and Wii Balance Board will be used. The selected exercise games will include Hula Hoop Plus, Penguin Slide, Soccer Heading, Table Tilt, Tightrope Walk, Ski Jump, and Step Up.

Our study will include exercises aimed at improving core stabilization, dynamic neuromuscular control, and pelvic mobility. Exercise selection will be tailored to individual needs, and the number of repetitions and duration will be adjusted based on the participant's progress. Preferred exercises will include movements such as bridge, dead bug, bilateral arm and leg lift, bear position, cat-camel, and pelvic clock.

The bladder diary is one of the most valuable tools designed to assess lower urinary tract symptoms in daily clinical practice due to its simplicity and low cost. According to the standardization published by the International Children's Continence Society (ICCS), a minimum of 48-hour bladder diary should be completed when evaluating a child with lower urinary tract dysfunction (LUTD). The bladder diary includes data such as voiding frequency and volume, fluid intake, and drinking habits. In this diary, the child's voiding frequency, voided volume, fluid intake, and any episodes of daytime urinary incontinence will be recorded. Fluid intake and voided volume will be documented in milliliters (mL), and voiding duration will be recorded in seconds (s). Additionally, the child's sensation of urgency while voiding will be noted using categorical descriptors such as "none," "mild," "moderate," or "severe."

Surface electromyography (sEMG) is a reliable and non-invasive method used to assess the function of the pelvic floor muscles by detecting motor unit action potentials and evaluating muscle contractions in real time. In our study, pelvic floor muscle activation of all participating children will be assessed by a physiotherapist using the NeuroTrac MyoPlus Pro4 device. All measurements will be conducted by the same physiotherapist.

Prior to the measurement, children will be asked to completely empty their bladder. To prevent cross-talk, two surface electrodes will be placed on the perineal region at the 2 o'clock and 7 o'clock positions, and the reference electrode will be placed on the right thigh.

Children will first be instructed on the correct contraction techniques, focusing on ventral and cranial pelvic floor muscle activation. Subsequently, each child will undergo a "Work-Rest Assessment" protocol lasting a total of 55 seconds using the same device.

This is one of the most commonly used assessment tools and has been adapted into Turkish. It was first developed and published in 2005 by Akbal and colleagues. This questionnaire is designed to identify lower urinary tract symptoms (LUTS) and assess the severity of these symptoms.

The first 13 questions evaluate symptoms such as daytime urinary incontinence, enuresis, daily voiding frequency, and constipation, while the 14th question assesses the impact of these symptoms on the individual's quality of life. The total score of the questionnaire ranges from 0 to 35.

According to research, a score of 8.5 or higher has been reported to detect lower urinary tract dysfunction with 90% sensitivity. A higher total score indicates more severe voiding dysfunction. In a study conducted by Tuygun et al., it was suggested that the DVSS may serve as a highly sensitive and non-invasive indicator that should be used before proceeding to invasive methods.

PIN-Q is the first continence-specific quality of life scale developed for the pediatric population. It was specifically designed for children and adolescents by Bower in 2006. The Turkish validity and reliability study of the questionnaire was conducted by Hanımeli R. in 2011.

Originally, the PIN-Q consisted of 28 items across seven domains, including social relationships, self-esteem, family relationships, body image, independence, mental health, and the treatment process. In later studies, these domains were consolidated into two main groups: Internal (15 items) and External (5 items), reducing the total number of questions to 20.

The questionnaire can be completed by children within 5 to 15 minutes. Each item is scored from 0 (never) to 4 (always), and the total score ranges from 0 to 80. Higher scores indicate lower quality of life. The physiotherapist will read the questions to the children, and parents will leave the room to prevent influence.

The Berg Balance Scale (BBS) was adapted for children in 2003 by Franjoine and colleagues and renamed the Pediatric Berg Balance Scale (PBBS). The Turkish validity and reliability study of the scale was conducted by Erden et al. in 2020. The PBBS consists of 14 items, each scored from 0 to 4, with a maximum total score of 56.

A score between 0-20 indicates balance impairment, 21-40 reflects an acceptable balance level, and 41-56 suggests good balance ability. In the PBBS, the original BBS items have been reorganized in a functional sequence from easier to more difficult movements. The duration of static postures has been shortened and instructions simplified to suit children. During the assessment, a stopwatch will be used to measure time, a measuring tape to define distances, a chair with back and arm support for sit-to-stand tests, a step for stair-climbing assessment, and a small ball for the object-pickup test.

The Bosu ball, with its unstable half-sphere shape, challenges postural control and is used as an effective tool for balance assessment, especially in children. Unstable surfaces activate the somatosensory system, adding extra demand on balance mechanisms and providing a valuable test condition for evaluating postural stability. Wallace et al. (2024) demonstrated that the Bosu ball significantly increases the center of gravity height compared to other devices, resulting in a wider and faster sway range.

In our study, to assess dynamic balance with higher sensitivity, all participants will perform a single-leg standing test on the Bosu ball under both eyes-open and eyes-closed conditions, and the durations will be recorded in seconds.

Although there is no definitive consensus on the evaluation of core stabilization, various assessment methods exist to measure components such as endurance, flexibility, motor control, strength, and function. Among the components of core stabilization, endurance tests are considered the most reliable measures, followed by flexibility, strength, motor control, and functional tests.

In our study, we will assess static endurance, which is one of the core stabilization components. Following the protocols developed by McGill et al., four fundamental core endurance tests will be applied. The purpose of these tests is to evaluate individuals' ability to maintain specified static positions for as long as possible. The tests include the trunk flexor test, trunk extensor test, and side plank tests for both sides.

The Exercise Enjoyment Scale-8 is a unidimensional assessment tool consisting of 8 items designed to measure individuals' level of enjoyment during exercise. Using a bipolar scoring method ranging from 1 to 7, the scale evaluates participants' enjoyment, motivation, focus, and emotional responses throughout the exercise process.

The scale was adapted into Turkish by Soylu et al. in 2023, with its strong psychometric properties confirmed. Its brevity and practical applicability make it suitable for use in large participant groups. This scale is an important tool for assessing the psychological effects of exercise and motivational processes.