Syfte: Urininkontinens är ett folkhälsoproblem som berör åtminstone 500 000 svenskar.  Studiens syfte var att kartlägga sjukgymnastisk behandling med bäckenbottenträning, vid urininkontinens hos kvinnor, på primärvårdsnivå i Uppsala län. Metod: Studien hade en kvantitativ och deskriptiv design. Data samlades in via en webbenkät som skickades till alla sjukgymnaster på primärvårdsnivå i Uppsala, både offentligt anställda och privata sjukgymnaster med landstingsavtal. Resultat: 96 sjukgymnaster tillfrågades om deltagande i studien varav 65 besvarade enkäten (68 %). Drygt hälften av respondenterna behandlade med bäckenbottenträning. Antalet patienter som behandlades var lågt. Det var få patienter som remitterades från andra vårdgivare. Den vanligaste kontaktvägen var att patienten besökte sjukgymnast av andra orsaker och själv påtalade eller tillfrågades om urininkontinens. Det sjukgymnastiska omhändertagandet omfattade anamnes, information om bäckenbotten och knipteknik, praktisk träning samt muntlig utvärdering. Nära hälften av respondenterna önskade mer utbildning inom området.   Konklusion: Resultatet från studien visade att sjukgymnaster på primärvårdsnivå var en underutnyttjad resurs i behandlingen av urininkontinens hos kvinnor. I framtiden skulle ett utökat samarbete mellan sjukgymnaster och andra vårdgivare på primärvårdsnivå kunna ge effektivare patientflöden, så att fler kvinnor kan erbjudas behandling. För att möjliggöra detta behöver sjukgymnasterna själva informera lokalt om sin kompetens till berörda vårdgivare. Det behövs också utbildningsinsatser för att fler ska känna sig säkra i att behandla med BBT. / Objectives:  Urinary incontinence is a public health problem affecting at least 500 000 Swedes. The aim of this study was to conduct a survey examining physiotherapy treatment of pelvic floor muscle training, for urinary incontinence in women, at the primary care level in the county of Uppsala. Method:  The study had a quantitative and descriptive design. Data were collected with an online questionnaire that was sent to all physiotherapists with public contracts working at the primary care level in the county of Uppsala. Results:  96 physiotherapists were asked to participate in the study and 65 of them answered the questionnaire (68 %). More than half of the respondents gave treatment consisting of pelvic floor muscle training. The number of patients who received treatment was low. Few patients were referred by other health-care workers. The most common way for the patients to receive treatment was that they visited the physiotherapist because of other health problems and the subject of urinary incontinence came up. The treatment usually included medical history, information about the pelvic floor muscles, instructions on appropriate muscle contraction, practical training and verbal evaluation. Almost half of the respondents requested more education within the field. Conclusion:  The results from this study showed that physiotherapists at the primary care level were an underutilized resource in the treatment of women with urinary incontinence. In the future, improved cooperation between physiotherapists and other health-care workers at the primary care level would increase the number of women receiving treatment. To facilitate this outcome, physiotherapists need to engage in outreach activities to inform other health-care workers regarding their competence in this field. In addition, further education is required in order to help physiotherapists feel more confident in providing pelvic floor muscle training.

Due to the competitive nature of airline industry and the desire to minimise aircraft weight, there is a continual drive to develop lightweight, reliable and more comfortable seating solutions, in particular, a new generation slim economy seat. The key design challenge is to maximise the “living space” for the passenger, with strict adherence to the ‘Crash Safety Regulations’. Cranfield University is addressing the needs of airliners, seat manufactures and safety regulating bodies by designing a completely novel seat structure coined as “Sleep Seat”. A generous angle of recline (40 degree), movement of “Seat Pan” along the gradient, fixed outer shell of the backrest, and a unique single “Forward Beam” design distinguishes “Sleep Seat” form current generation seats. It is an ultra-lightweight design weighing 8kg (typical seat weight is 11kg). It has to sustain the static (CS 25.561) and dynamic (CS25.562) “Emergency landing” loads as specified by “Certification Specifications (CS). Apart from maintaining structural integrity; a seat-structure must not deform, which would impede evacuation, should absorb energy so that the loads transferred to Occupants are within human tolerance limits and should always maintain survivable space around the Occupant. All these parameters, which increase a life-expectancy in a ‘survivable’ crash, can be estimated using either experimental testing or virtual simulation tools such as “Finite Element Analysis (FEA). Design of the “Sleep Seat” is still in its conceptual phase and therefore experimental testing for all the design iterations involved is unrealistic, given a measure of the costs and timescales involved. Therefore focus of research is to develop practical and robust FE methodologies to assess static and dynamic performances of a seat-structure so as to compare different design concepts based on their strength, seat interface loads (a limit defined by strength of aircraft-floor), maximum deformations and cross-sectional forces ... [cont.].

But: L’attention semble avoir un impact sur le fonctionnement des muscles périnéaux.Matériels : L’activité électromyographique (EMG) du sphincter anal externe (SAE) a été receuillie au cours d’effort de contractions périnéales volontaires et reflexe (provoquées par la toux) réalisées en réponse à un stimulus au marteau reflexe chez des femmes volontaires saines avec et sans épreuve de charge cognitive (ECC). Le temps de réaction (RT1) correspondant à la latence entre le stimulus et le début d’activité EMG du SAE lors d’une contraction périnéale volontaire, le RT3, correspondant au temps de latence entre le début d’activité EMG du SAE et le début d’activité EMG des muscles intercostaux externes (ICE) lors d’un effort de toux, ont été mesurés. Après randomisation (1/2) 13 femmes ont bénéficié d’une rééducation en double tache (cognitivo-musculaire) et 26 femmes constituaient le groupe témoin. Ces mêmes paramètres ont été enregistrés avant et apres rééducation dans les deux groupes.Resultats: Une ECC provoque un allongement du RT1 par un facteur 3,98 (p<0,001). Une ECC entrainne une diminution de 29% de la contraction périnéale réflexe: RT3 était respectivement de -80.00 ms sans ECC contre -56,7 ms en cas d’ECC (r=0,7, p=0,0045). Dans le groupe « rééducation » le RT1 en présence d’une ECC passait de 461,1 à 290,7 ms (r=0,6, p=0,006) contre 370 à 343 ms dans le groupe témoin (r=0,9, p=NS). Le RT3 dans le groupe « rééducation » en absence d’une ECC passait de -68,5 à -127,8 ms (r=1,9, p=0,03) et en présence d’une ECC de -42,6 ms à -59,3 ms (r=1,4, p=0,04). Conclusion: Une rééducation specifique corrige les effets provoqués par une ECC sur la contraction périnéale. / Aims: Attention may be involved in pelvic floor muscles (PFM) Methods: The electromyographic (EMG) activity of the external anal sphincter (EAS) was recorded on healthy female volunteers, during voluntary and involuntary (induced by cough) PFM contraction, elicited by local stimulation, combined (or not) with a mental Distraction Task (DT). Reaction time (RT1), ie. the latency between stimulus and the onset of EAS EMG activity, RT3, ie. the latency between the onset of EAS EMG activity and the onset of External intercostal muscle (EIC) (cough) were measured. Following randomisation (2/1) 13 volunteers underwent dual task cognitive (an attentional test and PFM exercises) rehabilitation program and 26 were the control group (no specific instruction). RT1 and RT3 were recorded before and after the program in both group.Results: The mental distraction task led to a 3.98 times greater reaction time between stimulus and EAS EMG activation (RT1), (p<0.001). DT led to a 29% shorter anticipation of the involontary PFM contraction: RT3 were respectively -80.00 ms without a DT versus -56.67 ms with a DT (r=0.7, p=0.004). In the rehabilitation group RT1 in DT conditions decreased from 461.1 ms to 290.7 ms (r=0.6, p=0.006)vs 370 to 343 ms in the control group (r=0.9, p=NS). In the study group RT3 without a DT increased from −68.5 ms to −127.8 ms (r=1.89, p = 0.03) and from 42,6 ms to -59,3 ms with a DT (r= 1.4, p=0.04).Conclusions: A specific dual task rehabilitation can prevent the effect of DT on PFM contraction characteristics.

Urinary incontinence is defined as the involuntary escape of urine that is objectively demonstrable and causes social and hygienic problems. It is a common problem, that is in its results also important medical, social and economical defect. The object of the research of this work was a group of woman patients with the stress form of urinary incontinence, that was instruated by Kegel's or Mojžíšová's methods in home exercises. The goal of this thesis was to influence contractility, power and tense of pelvic floor muscles and to evaluate the effect of the chosen methods. Objectively the results of the work don't demonstrate change of assessed parameters, but it has came to subjective improvement of urinary incontinence's symptoms and differences in kineziological investigation. Powered by TCPDF (www.tcpdf.org)

This dissertation describes the analytical research as part of a comprehensive research program to develop a new floor anchorage system for seismic resistant design, termed the Inertial Force-limiting Floor Anchorage System (IFAS). The IFAS intends to reduce damage in seismic resistant building structures by limiting the inertial force that develops in the building during earthquakes. The development of the IFAS is being conducted through a large research project involving both experimental and analytical research. This dissertation work focuses on analytical component of this research, which involves stand-alone computational simulation as well as analytical simulation in support of the experimental research (structural and shake table testing). The analytical research covered in this dissertation includes four major parts: (1) Examination of the fundamental dynamic behavior of structures possessing the IFAS (termed herein IFAS structures) by evaluation of simple two-degree of freedom systems (2DOF). The 2DOF system is based on a prototype structure, and simplified to represent only its fundamental mode response. Equations of motions are derived for the 2DOF system and used to find the optimum design space of the 2DOF system. The optimum design space is validated by transient analysis using earthquakes. (2) Evaluation of the effectiveness of IFAS designs for different design parameters through earthquake simulations of two-dimensional (2D) nonlinear numerical models of an evaluation structure. The models are based on a IFAS prototype developed by a fellow researcher on the project at Lehigh University. (3) Development and calibration of three-dimensional nonlinear numerical models of the shake table test specimen used in the experimental research. This model was used for predicting and designing the shake table testing program. (4) Analytical parameter studies of the calibrated shake table test model. These studies include: relating the shake table test performance to the previous evaluation structure analytical response, performing extended parametric analyses, and investigating and explaining certain unexpected shake table test responses. This dissertation describes the concept and scope of the analytical research, the analytical results, the conclusions, and suggests future work. The conclusions include analytical results that verify the IFAS effectiveness, show the potential of the IFAS in reducing building seismic demands, and provide an optimum design space of the IFAS.

AB Furhoffs Rostfria grundades i Skövde 1899 för att tillverka kannor och kittlar i koppar. Idag tillverkar de produkter i rostfritt stål för bland annat VVS-system, storkök och diskbänkar för hemmamiljö. Tillverkningen sker i Skövde med en maskinpark som är anpassad för produktion i rostfritt stål. Då kraven från marknaden går åt mer hygieniska golvrännor och konkurrenterna fokuserar på att marknadsföra denna typ av produkt, vill Furhoffs leda denna utveckling. Examensarbetets mål är att utveckla en golvränna som är anpassad för områden som har extra höga krav på hygien för att undvika spridning av smittor. Detta kan vara livsmedelsindustri, storkök, sjukhus eller laboratorier. Golvrännan ska även vara säker att använda i en industri där tyngre trafik förekommer och då är det ett krav att locket ska klara en belastning på 12 500 kg.  För att anpassa produkten till användaren utfördes intervjuer på ett större mejeri, en livsmedelsindustri och en restaurang. Även en observation utfördes på restaurangen för att observera hur rengöringsprocessen av produkten gick till. Informationen från dessa besök resulterade i användarbehov som tillsammans med krav från Furhoffs låg till grund för hur golvrännan senare utvecklades. Golvrännans olika komponenter: brunn med vattenlås, ränna, lock och silkorg, utvecklades var för sig för att sedan anpassas till varandra. Utförda tester och en kostnadsanalys låg till grund för de konceptval som togs. Flödet av vatten och bortforslande av avfall testades för att välja ut den mest optimala profilen på rännan. För att veta om golvrännan är säker att använda i de tänkta miljöerna utfördes belastnings-, halk- och flödestester på locket. Den slutliga produkten är anpassad för Furhoffs tillverkningsmetoder. Golvrännan uppfyller de krav som ställts och är anpassad för miljöer med höga krav på hygien. Resultatet från examensarbetet kommer att ligga till grund för den hygienränna som kommer att tillverkas av Furhoffs. / AB Furhoffs Rostfria was founded in Skövde in 1899 to produce pots and cauldrons in copper. Today´s production is focused on products for HVAC (heating, ventilation and air conditioning) as well as for restaurant kitchens and customized products. The production is located in Skövde with machines suited for processing stainless steel. Demands from the market as well as Furhoff´s competitors are focusing on hygienic floor drain gutters. Because of this, Furhoffs wants to be the leading company of this kind of development. This project aims to develop a floor drain gutter that is suitable for environments with high requirements of hygiene to prevent spreading of diseases. These environments can be food factories, laboratories, hospitals and restaurant kitchens. The product needs to be safe to use in industries where traffic from heavy vehicles occur. This means that the product must withstand a load of 12 500 kg. To adjust the product to fit the user, interviews were performed in a large dairy, a food factory and in a restaurant. An observation was also performed in the restaurant to observe the cleaning process of a floor drain gutter. The information from the user study resulted in a list of needs. These, combined with demands from the company, formed the product specification. This specification was the basis for how the product later was developed. The components of the floor drain gutter, gully with a stench trap, gutter, cover and strainer basket, was developed separately and adapted to each other. Tests and cost analysis were performed to make well-founded concept choices. Water flow and removal of waste was tested to choose the most optimal gutter profile. To make sure the floor drain gutter is safe to use in the intended environment, load tests, slip tests and tests of flow rates were made.    The final product is adjusted for Furhoff´s production methods. The floor drain gutter fulfils the requirements and is suitable for environments with high hygiene demands. The result from this thesis will be used for further development of Furhoff´s future floor drain gutter.

Orientadores: Simone Botelho Pereira, Cássio Luís Zanettinni Riccett / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-27T01:20:14Z (GMT). No. of bitstreams: 1 Silva_ValeriaRegina_M.pdf: 1669073 bytes, checksum: 323991e89ad6dee82fb3e930b3074e31 (MD5) Previous issue date: 2015 / Resumo: Introdução: A literatura recente tem investigado o efeito do treinamento abdominopélvico (TAP) como meio de prevenção e tratamento das disfunções do assoalho pélvico. Neste contexto, exercícios que promovam o treinamento muscular de forma global estão sendo explorados na pesquisa clinica. No presente estudo foram utilizados dois protocolos de TAP: um por meio de cinesioterapia e outro por meio de realidade virtual, a fim de investigar a interação dos músculos do compartimento abdominopélvico e, consequentemente, o comportamento dos músculos do assoalho pélvico (MAP) e Transverso do Abdômen (Tra) associado ao Obliquo Interno (OI), nas situações de contração voluntaria máxima (CVM), e de coativação. Objetivos: Investigar a atividade elétrica dos músculos do assoalho pélvico (MAP) e dos músculos abdominais (Tra/OI) frente a dois protocolos de treinamento: TAP Cinesioterapia (TAP CAP) e TAP Realidade Virtual (TAP RV); bem como identificar a presença de coativação entre os músculos. Pacientes e Métodos: Participaram desta pesquisa 47 mulheres jovens, nulíparas, continentes com idade média de 25,79 (±3,85) anos, divididas de forma randomizada em dois grupos: (G1) TAP_CAP (n=22) e (G2) TAP_RV (n=25). Os protocolos foram supervisionados por fisioterapeuta treinado, com duração de 30 minutos por sessão, três vezes por semana, totalizando 10 sessões. As mulheres foram avaliadas antes e após a realização dos protocolos, por meio de palpação digital (PD) dos MAP e eletromiografia (EMG) simultânea dos MAP e Tra/OI. Resultados: Os grupos apresentaram-se homogêneos quanto às condições sociodemográficas. Na avaliação por Palpação Digital observou-se aumento significativo na contratilidade dos MAP tanto no TAP_CAP (p=0,001) como no TAP_RV (p=0,0001), sem diferença entre os grupos (p=0,1). Em contrapartida, quando avaliado por EMG, não foi verificado diferença significativa na análise pré e pós- treinamento (p=0,05) em nenhum dos grupos. Ao solicitar a contração voluntária máxima do músculo Transverso do abdômen/ obliquo interno, para observação da coativação, observou-se resultado significativo (p=0,001) no grupo TAP RV após o treinamento. Entretanto, não foram encontrados resultados significativos no grupo TAP_CAP. Conclusão: O treinamento abdominopélvico por meio de realidade virtual proporcionou melhora da coativação dos músculos do assoalho pélvico em resposta à contração do Tra / Abstract: Introduction: Recent literature has investigated the abdominopelvic training effect (APT) effect as means of to prevent and treat pelvic floor dysfunction. In this context, globally muscle training exercises are being explored in clinical research. In the present study, two abdominopelvic protocols were used: by kinesiotherapy and by virtual reality, aiming to investigate the interaction of abdominopelvic enclosure muscles, and consequently, the behavior of the pelvic floor muscles (PFM) and transversus abdominis/internal obliquos (Tra/IO) muscle, in some peculiarly situations like maximum voluntary contraction (MVC) and coactivation. Aims: To investigate the pelvic floor and abdominal muscle¿s electrical activity using two training protocols: APT by kinesiotherapy (APT K) and APT by virtual reality (APT VR); as well as to indentify the presence of coactivation between these muscles. Patients and Methods: 47 young, nulliparous and continent women (mean age 25.79±3.85 years) participated in this study. They were randomly divided into two groups: (G1) APT_K (n=22) and (G2) APT_VR (n=25). The protocols were supervised by a physiotherapist, lasting 30 minutes per session, three times per week, during 10 sessions. The women were assessed before and after the completion of the protocols by digital palpation (DP) and electromyography (EMG) of simultaneous MAP and Tra/IO. Results: The groups were homogeneous in demographic conditions. There was a significant increase in PFM contractility in both APT_K (p = 0.001) and APT_VR (p=0.0001) groups when assessed by digital palpation, with no difference in the comparison between groups (p=0.1). In contrast, when measured by EMG, PFM electromyography activity did not showed a significant difference in pre and post training analysis (p=0.05). When requesting the Transverse / internal oblique maximum voluntary contraction, for observation of coactivation, a significant result (p=0.001) was observed in APT_VR group after training. However, no significant results were found in APT_K group. Conclusion: The abdominopelvic training by virtual reality showed an improvement in the coactivation of pelvic floor muscle contraction in response to Tra / Mestrado / Fisiopatologia Cirúrgica / Mestra em Ciências

INTRODUÇÃO: A fibromialgia (FM) foi definida pelo American College of Rheumatology (ACR) em 1990 como a presença de dor crônica e difusa de origem musculoesquelética nos quatro quadrantes e esqueleto axial associada à presença de pelo menos 11 de 18 tender points. Em 2010 uma revisão dos critérios diagnósticos apontou para outros sintomas, como o sono não reparador, dor de cabeça e depressão. A prevalência dos distúrbios do assoalho pélvico é alta e causa impacto negativo na qualidade de vida das mulheres, entretanto existem poucos estudos com esse enfoque em fibromiálgicas. OBJETIVO: Avaliar a força do assoalho pélvico, perda urinária e desempenho sexual em mulheres com fibromialgia e verificar se existe associação entre a FM e a incontinência urinária (IU). MÉTODO: Foram avaliadas 128 mulheres com idade entre 19 e 65 anos distribuídas em dois grupos, sendo um com diagnóstico médico de fibromialgia (GFM) e outro sem fibromialgia (GS). A avaliação foi realizada em um único encontro e com o mesmo avaliador, na qual foram obtidos dados pessoais e ginecológicos, características da incontinência urinária, avaliação do assoalho pélvico segundo o Esquema PERFECT e perineometria, aplicação do King Health Questionnaire (KHQ) para mulheres incontinentes e do questionário Quociente Sexual - Versão Feminina (QS-F). RESULTADOS: As mulheres GFM apresentaram menor grau de força muscular no esquema PERFECT (p < 0,001) e na perineometria (p=0,04). A IU foi frequente nas fibromiálgicas (p < 0,001). As mulheres do GFM tiveram pior desempenho no KHQ nos domínios Saúde Geral (p < 0,001) e sono/ energia (p < 0,003) e quanto ao escore total do QS-F (p<0,001). CONCLUSÃO: A incontinência urinária é frequente nas mulheres com fibromialgia, e está relacionada com o grau de força dos músculos do assoalho pélvico, afetando negativamente sua qualidade de vida, principalmente no que diz respeito a saúde geral e sono/ energia, afetando ainda seu desempenho sexual. / INTRODUCTION: In 1990, fibromyalgia (FM) was defined by the American College of Rheumatology as chronic and widespread pain of musculoskeletal origin in the four quadrants and axial skeleton associated with the presence of 11 of the 18 tender points. The fibromyalgia studies were focused on pain, but a 2010 review of the diagnostic criteria pointed to other symptoms such as non-repairing sleep, headache and depression. The prevalence of pelvic floor disorders is high and has a negative impact on women\'s quality of life, however there are few studies with this focus on women with fibromyalgia. OBJECTIVE: To assess the strength of the pelvic floor, urinary loss and sexual performance in women with fibromyalgia and to verify if there is an association between FM and urinary incontinence (UI). METHOD: A total of 128 women aged 19 to 65 years old were distributed in two groups, one group of 62 that were diagnosed with fibromyalgia (GFM) and one group of 64 that were not (GS). Data were collected in a single meeting with the same evaluator and included personal data, clinical data, and information about urinary tract symptoms, pelvic floor assessment was according to the PERFECT Scheme and perineometry. The King\'s Health Questionnaire was given to women who reported urinary leakage and Sexual Quotient - Female Version questionnaire (QS-F) for sexually active women. RESULTS: GFM women presented lower muscle strength in the PERFECT scheme (p < 0.001) and in perineometry (p=0.04). UI was frequent in GFM (p < 0.001). GFM women had poorer KHQ performance in the General Health (p < 0.001) and Sleep/Energy domains (p < 0.003) and QS-F final score (p < 0.001). CONCLUSION: UI is frequent in women with fibromyalgia and is related to pelvic floor muscle strenght, negatively affecting their quality of life, especially regarding general health and sleep/ energy, also affecting their sexual performance

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2018-07-20T20:10:21Z No. of bitstreams: 1 Erica Feio Carneiro Nunes.pdf: 1021018 bytes, checksum: 040c57768f7aed071b8aa73bd056ade6 (MD5) / Made available in DSpace on 2018-07-20T20:10:21Z (GMT). No. of bitstreams: 1 Erica Feio Carneiro Nunes.pdf: 1021018 bytes, checksum: 040c57768f7aed071b8aa73bd056ade6 (MD5) Previous issue date: 2018-03-06 / Contextualization: Weakening of pelvic floor muscles (PMFs) has been considered a major cause of stress urinary incontinence (SUI). In this way, the physiotherapeutic treatment, classically, turned to the strengthening of these muscles. In this study it was hypothesized that, in addition to PMFs weakness, this dysfunction may also be related to a change in the pattern of reflex response of these muscles. Objective: The study objectives were to compare the contraction response time and strength of cough-induced PMFs among continents and SUI women, and to conduct a literature review on the use of biofeedback for pelvic floor muscle training in women with this dysfunction. Methods: Study II: A systematic review was conducted with a search of the databases Science Direct, Embase, MEDLINE, Pedro, SciELO, CINAHL and LILACS for randomized clinical trials that had biofeedback (BF) as a therapeutic tool for SUI. Study II: This was a cross-sectional study that evaluated the cough PMFs of 20 healthy women and 20 women with SUI. The clinical evaluation consisted of the application of questionnaires that assessed the severity of urinary incontinence and quality of life. Signal capture was performed with a 4-channel acquisition system (EMG System do Brasil Ltda®) to capture the signals obtained through vaginal dynamometry, electromyography (EMG) of the right external obliquus muscle and accelerometry. Statistical analysis was performed using the Shapiro-Wilk, independent t test or Mann-Whitney test according to the data distribution and the covariance analysis (ANCOVA) with post hoc Bonferrone test. The statistical significance considered for all tests was p <0.05. Results: Study I: the training of the PMFs with BF was not better than the control group (without training and orientation, vaginal electrical stimulation). However, these contradictory results and poor quality of the studies are probably not clinically significant. Study II: the contraction response of the PMFs was significantly different between the groups for the activation time of the PMFs (F = 19.51, P <0.0001, p2= 0.61), external oblique muscle activation time (F = 11.41, P <0.002, p2= 0.23) and time of the cough pulse (F = 4.21, P <0.04, p2= 0.10). Conclusion: The systematic review provides evidence that the training of BF-PMFs does not offer superior therapeutic benefits to other types of interventions in the treatment of female SUI. The cross-sectional study showed that women with SUI have delayed cough-induced contraction of PMFs. / Contextualização: O enfraquecimento dos músculos do assoalho pélvico (MAPs) tem sido considerada uma das principais causas da incontinência urinária por esforço (IUE). Dessa maneira, o tratamento fisioterapêutico, classicamente, se voltou para o fortalecimento desses músculos. Nesse estudo foi hipotetizado que, além da fraqueza dos MAP, essa disfunção também pode estar relacionada à uma alteração no padrão de resposta reflexa desses músculos. Objetivo: Os objetivos deste estudo foram comparar o tempo de resposta da contração e a força dos MAPs induzidos pela tosse entre mulheres continentes e com IUE e, realizar uma revisão de literatura sobre o uso do biofeedback para treinamento muscular do assoalho pélvico em mulheres com essa disfunção. Métodos: Estudo I: Foi realizada uma revisão sistemática com uma busca nas bases de dados Science Direct, Embase, MEDLINE, Pedro, SciELO, CINAHL e LILACS por ensaios clinicos randomizados que tivessem o biofeedback (BF) como instrumento terapeutico para a IUE. Estudo II: Esse foi um estudo transversal que avaliou os MAPs durante a tosse de 20 mulheres saudáveis e 20 mulheres com IUE. A avaliação clínica consistiu na aplicação dos questionários que avaliaram a gravidade da incontinência urinária e a qualidade de vida. A captação dos sinais foi realizada com um sistema de aquisição com 4 canais (EMG System do Brasil Ltda®) para captar os sinais obtidos por meio da dinamometria vaginal, da eletromiografia (EMG) do músculo obliquo externo direito e da acelerometria. Para análise estatística foram utilizados os testes de Shapiro-Wilk, t independente ou Mann-Whitney test de acordo com a distribuição dos dados e a análise de covariância (ANCOVA) com test post hoc de Bonferrone. A significância estatística considerada para todos os testes foi de p<0,05. Resultados: Estudo I: o treinamento dos MAPs com BF não foi melhor do que o grupo controle (sem treinamento e orientação, estimulação elétrica vaginal). No entanto, estes resultados contraditórios e a má qualidade dos estudos provavelmente não são clinicamente significativos. Estudo II: A resposta de contração dos MAPs foi significativamente diferente entre os grupos para o tempo de ativação dos MAPs (F=19.51, P <0.0001,p2=0.61), Tempo de ativação do músculo obliquo externo (F=11.41, P < 0.002, p2=0.23) e tempo do pulso da tosse (F=4.21, P < 0.04, p2=0.10). Conclusão: A revisão sistemática fornece evidências de que a treinamento dos MAPs com BF não oferece benefícios terapêuticos superiores a outros tipos de intervenções no tratamento da IUE feminina. O estudo tranversal mostrou que mulheres com IUE apresentam atraso na resposta da contração dos MAPs induzidos pela tosse.

Bakgrund: Förlossningsskador kan ge fysiska och psykiska besvär. Skadorna är olika omfattande och eftervården är viktig för att rehabilitera kvinnan. Fysioterapeuters kompetens lämpar sig för undersökning och behandling av förlossningsskador. Dock är professionen inte en självklar del av eftervården och det finns kunskapsluckor om fysioterapeuters upplevelser och erfarenheter av att arbeta med förlossningsskador. Syfte: Syftet med den här studien var att beskriva fysioterapeuters upplevelser och erfarenheter inom den svenska sjukvården av att arbeta med kvinnor som har förlossningsskador. Metod: Studien var en semi-strukturerad kvalitativ intervjustudie som inkluderade fem deltagare som arbetar med förlossningsskador. Deltagarna rekryterades via Fysioterapeuternas hemsida på kompetenskartan för kvinnors hälsa och Facebookgruppen "Fysioterapeuter inom kvinnors hälsa”. Ändamålsenligt bekvämlighetsurval tillämpades. Databearbetning av intervjumaterialet gjordes genom en kvalitativ innehållsanalys. Resultat: Analysprocessen resulterade i fyra kategorier: Fysioterapeutens roll i patientmötet, Känslomässigt arbete, Framgångsfaktorer inom vården av förlossningsskador och Utmaningar inom vården av förlossningsskador med elva tillhörande subkategorier. Konklusion: Fysioterapeuterna har en betydande roll och kompetens som kan göra skillnad för patienter med förlossningsskador. De drivs av ett stort engagemang och vill se vidare utveckling av området samt stärka fysioterapeutens roll inom vården av förlossningsskador. Det behövs vidare forskning för att fylla kunskapsluckan av fysioterapeuters arbete med förlossningsskador. / Background: Pelvic floor dysfunction (PFD) after giving birth causes physical and mental discomfort. The injuries vary and the healthcare afterward is important for the mother´s rehabilitation. The competence of physiotherapists is suitable for the examination and treatment of PFD after giving birth. However, the profession is not established in this area. There are knowledge gaps about the physiotherapist's views and experiences of working with PFD after giving birth. Purpose: The purpose of this study was to describe the physiotherapist's views and experiences of working in Swedish healthcare with women with PFD after giving birth. Method: The study was a semi-structured qualitative interview study that included five participants who work with PFD after giving birth. The participants were recruited via the competence map for women's health on Fysioterapeuternas' website and via the Facebook group “Fysioterapeuter inom kvinnors hälsa”. Samples of convenience was applied. Data processing of the interview material was done through a qualitative content analysis. Results: The analysis process resulted in four categories: The physiotherapist's role when meeting patients, Emotional work, Successful factors in the healthcare of PFD after giving birth and Challenges in the healthcare of PFD after giving birth divided into eleven subcategories.  Conclusion: Physiotherapists have a significant role and the competence to make a difference for patients with PFD after giving birth. They are driven by commitment and want to see a further development of women’s health as well as strengthen the physiotherapist's role in maternity care. Further research is needed to fill the knowledge gap of physiotherapists' work with PFD after giving birth.