The purpose of this study was to investigate the reliability of three different electromyography (EMG) detection systems commonly used to acquire EMG data from the pelvic floor muscles (PFM) at rest, during maximum voluntary contractions (MVCs) and during a coughing task. Twelve nulliparous women between the ages of 24 and 40 participated in the study. EMG data were recorded from each side of the pelvic floor using surface (Femiscan™ and Periform™ vaginal probes), and fine-wire electrodes while subjects performed three repetitions of each task in supine and in standing. RMS amplitudes of baseline and peak PFM activity were computed from the data acquired during the MVC and the coughing tasks. The peak RMS amplitudes from the cough data were also normalized to each subject’s MVC and report as a percent of their maximum voluntary electrical activation (% MVE). Signal to noise ratio (SNR) was calculated for each task. Comparisons were made between the RMS amplitudes and SNR recorded from each side of the PFM. Between-trial and between-day reliability was determined using a variety of measures including intraclass correlation coefficients (ICC), coefficients of variation (CV) and mean absolute difference (MAD). The reliability of the different devices was compared using the MAD normalized to average signal amplitude (nMAD). The results indicated that the EMG data recorded from the right and left sides of the PFM were different, therefore the EMG data acquired from each side of the pelvic floor were analyzed separately. Between-trial reliability assessed by ICC was good for all the devices (left and right average ICC(3,1) = 0.80 – 0.96); the CVs supported these findings (average CV = 12.4 – 17.1%) Between-day reliability was poor and inconsistent across all devices as tasks. When the cough data were normalized however, the between-day RMS amplitudes were very consistent (79.5 – 90.2% MVE). Each device recorded consistent activation amplitudes within a given day. Between-day reliability results indicate that EMG data recorded on separate days with these instruments should not be compared unless data can be normalized. Clinicians and researchers are cautioned to normalize their data if day-to-day comparisons in EMG amplitude are to be made using data recorded with these devices. / Thesis (Master, Rehabilitation Science) -- Queen's University, 2007-12-14 17:31:34.552

Background: Age-related changes in pelvic floor muscle (PFM) biomechanics may contribute to urinary incontinence in older women; however, empirical evidence is scant. Purpose: This study aimed to understand the age-related changes in the biomechanical properties of the PFMs in women with no major risk factors for urinary incontinence. Methods: Thirty-three nulliparous women (20-64 years) were recruited to study active force, rate of force development, endurance, resistance to passive stretch and stiffness properties of the PFMs using an automated dynamometer. Separate regression analyses were performed to investigate the relationship between age and each outcome measure. Results: No significant relationships were observed between age and any of the outcome measures. Conclusion: The findings from this study do not support the presence of any age-related changes in PFM mechanics among women aged 20-64. Recruiting women over the age of 65 may be essential to detect age-related changes in PFM biomechanics in nulliparous women.

Dynamic transperineal ultrasound (TPUS) video allows for kinematic analysis of urogenital morphology and mobility, however, measures are often limited to peak displacements of anatomical landmarks and are vulnerable to error incurred by probe rotation during imaging. This thesis aimed to (1) develop an algorithm to calculate kinematic curves of urogenital landmark motion from TPUS video and to (2) investigate the error incurred in these kinematic measures due to in-plane ultrasound probe rotation. UROKIN, a semi-automated software, was developed and, as a proof of concept, was used to identify differences in urogenital kinematics during pelvic floor muscle maximum voluntary contractions between women with and without stress urinary incontinence. A mathematical model revealed that the error incurred by TPUS probe rotation in the x- (anterior-posterior) and y- (cranial-caudal) directions, was a factor of: r, the radius of rotation; Ɵ, the in-plane angular probe rotation; and α, the angular deviation between the anatomical planes and the coordinate system in which error was calculated. As an absolute measure, the error incurred by in-plane probe rotation is reduced to a factor of only r and Ɵ. Moving forward, UROKIN must be adapted to include findings from (1), and must be tested for validity and reliability.

The thesis deals with primary dysmenorrhea (PD) in relation to the locomotor system. The aim of the the sis was to compare the frequency of selected joint blocks and the incidence of constitutional hypermobility in PD patients in comparison with the control group. The patient group included 9 women with PD symptoms and the control group consisted of 10 women without these symptoms. The incidence of atlanto - occipital joint block within the patient group was significantly higher than within the control group (p < 0,05). The total number of stuck ribs was also considerably higher in PD patients (p < 0,01). Pain on palpation on the top of the coccygeum apex was significantly higher within the patient group (p < 0,001). Patients with PD did not show significantly different results in Beighton score test for constitutional hypermobility assessment when compared with the control group. Another aim of the thesis was to judge the effect of physical therapy on PD symptoms. For three months, the group of 9 patients had been encouraged to do regular exercises with the impact on postural stability and diagnosed functional disorders of the locomotor system by means of physical therapy. As was shown after the therapy, the reduction of the total number of stuck ribs was statistically significant (p < 0,001). Furthermore,...

Introdução: Incontinência Urinária (IU) é comum na população feminina afetando um terço das mulheres adultas, podendo comprometer sua função sexual (FS). Ainda há controvérsia sobre o impacto da IU sobre a FS. A associação da FS e da funcionalidade da MAP é uma questão relevante que necessita aprofundamento. Objetivo: Comparar a FS de mulheres com Incontinência Urinária de Esforço (IUE) e Incontinência Urinária Mista (IUM), e correlacionar a funcionalidade da musculatura do assoalho pélvico (MAP) à FS destas mulheres. Método: Observacional e transversal, n=61 mulheres, de 30 a 70 anos que tiveram relação sexual nos últimos 12 meses. As participantes foram classificadas em dois grupos: IUE (n=22) E IUM (n=39). A avaliação foi constituída por ficha de anamnese, biofeedback pressórico, escala PERFECT, e questionário PISQ-12. A análise estatística foi realizada através do teste Shapiro-Wilk para verificar a normalidade dos dados. Para comparação dos dados foi utilizado o teste T de amostras independentes e o teste U de Mann-Whitney. Para correlação foi utilizado o teste de Correlação de Spearman. O nível de significância adotado foi de 5%. Resultados: Diferença significativa na paridade e duração da queixa entre os grupos; na comparação do escore total do PISQ-12 e no domínio físico; nos itens P e F da escala PERFECT. Não houve correlação significativa entre a CVM Média e o Escore Total PISQ-12. Conclusão: Não foi demonstrado correlação entre a função da MAP e a FS nos grupos. Porém, houve diferença significativa entre a FS nos grupos. / Introduction: Urinary Incontinence (UI) is common among the female population. It affects one third of adult women and can compromise their sexual function (SF). There are still controversy about the impacts of UI on the SF. The association of the SF and the functionality of the pelvic floor muscles (PMF) is a relevant issue that needs to be better comprehended. Goal: Comparing the SF of women with Stress Urinary Incontinence (SUI) and Mixed Urinary Incontinence (MUI), and correlating these women’s PMF functionality to their SF. Method: Observational and cross-sectional, n=61 women aged 30 to 70 yo, who had had sexual relations in the last 12 months. The participants were divided into two groups: SUI (n=22) and MUI (n=39). The assessment consisted of the anamnesis record, pressure biofeedback, PERFECT scale and the PISQ-12 questionnaire. Statistical analysis was carried out using the Shapiro-Wilk test to verify the normality of the data. The independent t-test and the Mann-Whitney U test were used for data comparison. Spearman’s rank correlation was used to correlate data. The adopted level of significance was 5%. Results: Significant difference between the groups regarding the parity and duration of complaints; the PISQ-12 total score and the physical domain; the items Power-Pressure and Fast of the PERFECT scale. There was no significant correlation between the Maximum Voluntary Contraction (MVC) and the PISQ-12 total score. Conclusion: The tests did not find a correlation between the PFM functions and the SF in the groups. However, there was a significant difference in the SF between groups.

Tyrimo objektas. Moterų dubens dugno raumenų jėga ir jų treniravimo galimybės. Tyrimo problema. Dubens dugno raumenys vaidina svarbų vaidmenį šlapimo sulaikymui ir dubens organų palaikymui (Bo & Sherburn, 2005). Su amžiumi atrofuojasi (silpnėja ir nyksta) gleivinė, silpnėja dubens dugno raumenys, mažėja jungiamojo audinio, jis tampa ne toks elastingas, susilpnėja šlapimo pūslės sfinkteris (raumenų žiedas), pasikeičia šlapimo pūslės ir makšties anatomija (Thakar & Stanton, 2000). Kai sutrinka raumenų, laikančių uždarytą šlapimo pūslę, funkcija, gali atsirasti šlapimo nelaikymas. Ligoniai susiduria su daugybe socialinių ir psichologinių problemų, apribojamas žmogaus fizinis ir socialinis aktyvumas (Peeker et al., 2003). Tyrimo tikslas. Įvertinti dubens dugno raumenų treniravimo efektyvumą moterų šlapimo nelaikymo prevencijai. Tyrimo uždaviniai. 1. Įvertinti tiriamųjų dubens dugno raumenų jėgą prieš ir po kineziterapijos; 2. Įvertinti tiriamųjų dubens dugno raumenų pajėgumą amžiaus aspektu; 3. Nustatyti priklausomybę tarp dubens dugno raumenų pajėgumo, gimdymų skaičiaus ir gimdymo būdo; 4. Nustatyti ryšį tarp dubens dugno raumenų pajėgumo ir pilvo raumenų statinės ištvermės. Tyrimo metodika. Anketinės apklausos metu buvo išsiaiškintas tiriamųjų amžius, ūgis, svoris, gimdymų skaičius ir gimdymo būdas. Objektyvus dubens dugno raumenų jėgos testavimas buvo atliekamas penkiasdešimčiai moterų, naudojant dubens dugno raumenų treniruoklį bei dubens dugno raumenų funkcijos matavimo... [toliau žr. visą tekstą] / Object of research: Strength of women pelvic floor muscles and the possibilities of their training. Problem of research: Pelvic floor muscles play an important role in the urinary continence and support of pelvic organs (Bo & Sherburn, 2005). With age the mucous atrophies (weakens and wanes), the pelvic floor muscles weaken, connecting tissue diminishes, it becomes less elastic, sphincter (ring of muscles) of the bladder weakens, the anatomy of bladder and vagina changes (Thakar & Stanton, 2000). When the function of muscles that maintain the bladder closed disconcerts, the incontinence may manifest. Patients confront many social and psychological problems, physical and social activity of the person become limited (Peeker et al., 2003). Aim of research: Assess the effectiveness of pelvic floor muscle exercises to the prevention of incontinence of women. Goals of research: 1. Evaluate the strength of participants pelvic floor muscles before and after the physiotherapy; 2. Evaluate the strength of participants pelvic floor muscles with respect to the age; 3. Determine the relationship among the strength of pelvic floor muscles, number and ways of deliveries; 4. Determine the relationship between the strength of pelvic floor muscles and static endurance of abdominal muscles. Methods of research: With the help of questionnaire there were determined the age, height, weight, number of deliveries and ways of deliveries of participants. Pelvic floor muscle strength of fifty women was... [to full text]

Advanced prostate cancer (PCa) patients are offered androgen deprivation therapy (ADT) to control their cancer’s growth. ADT impairs sexual function and the sleep patterns of ADT patients. Since ADT deprives patients of estrogen, and supplemental estrogen reduces such problems in menopausal women, I studied whether administering estrogen reduces these problems for castrated male rats as a model for PCa patients on ADT. First, I tested how early versus late estradiol treatment after castration influenced rats’ sexual behaviour. Estradiol increases mounting behaviour to comparable levels regardless of when the treatment was started after castration, suggesting that estrogen’s ability to restore male sexual interest is insensitive to a delay since castration. Secondly, to understand the biological basis of these behavioural effects, I examined brain and muscle tissues from the same animals. Specifically, I compared changes in 1) estrogen receptors (ERs) and c-Fos protein (a neuronal activation marker) levels in brain areas controlling sex behavior; 2) ERs levels in pelvic floor muscles, important for erection; and 3) ERs levels in the hippocampus and prefrontal cortex. Prolonged castration increases ER? levels in the preoptic area (POA), a key brain area that regulates mating behaviour, and estradiol treatment reduced these effects. In the POA, mating-induced c-Fos expression was not affected by estradiol regardless of when the treatment began post-castration. Estrogen may upregulate ERs in pelvic floor muscles, and downregulate ERs in the hippocampus and prefrontal cortex, depending on administration time after castration. These findings suggest that mating activates POA neurons, and this activation induces mounting only in the presence of estrogen. Additionally, the duration after castration influences ER autoregulation in the pelvic floor muscles, hippocampus, and prefrontal cortex in response to estradiol. Lastly, I studied how estrogen modulates the sleep-wake behaviour of orchiectomized rats. Estradiol promotes baseline wakefulness during the dark period and prevents castration-induced impairment in sleep recovery after sleep deprivation. These findings suggest that estradiol may positively influence the sleep-wake behaviour of castrated males. Collectively, I demonstrate that estrogen administered to castrated rats improves sexual and sleep functions. It may similarly improve the quality of life of PCa patients on ADT.

Previous studies have suggested that protective responses in the pelvic floor muscles (PFMs), described in terms of hypertonicity and over-reactivity, are associated with and may worsen the symptoms of provoked vestibulodynia (PVD, i.e., chronic vulvar pain). A recent study reported that, upon manual palpation of the PFM, hypertonicity was consistently found in the superficial but not the deep PFM layers. The goals of this study were to compare superficial and deep PFM resting tone, protective response magnitude and onset timing to moderate perceived vulvar pain between women with and without PVD. Eleven women with PVD and eleven control women Tcompleted a gynecological examination and standardized PFM electromyography (EMG) testing. Three trials of sTurface EMG activity of the PFM were recorded while a pressure-pain stimulus (PPS) was applied to the vulvar vestibule. Increasing pressure was applied to achieve a perceived pain intensity rating of 6/10 using an 11-point numerical rating scale presented visually. The women with PVD had higher resting EMG activity in their superficial PFMs (p=0.04) as compared to the control group, while no difference was found at the level of the deep PFMs (p=0.12). Participants in both groups demonstrated contractile responses to the PPS in both the superficial and the deep PFM, and these responses were significantly higher (p=0.0001) in the superficial (50.06 vs 38.69 % maximal voluntary electrical activation [MVE]) as compared to the deep (24.88 vs 22.52 %MVE) PFM layers. Women with PVD had significantly higher PFM responses at the superficial layer as compared to the control women (p<0.0005). The onset of the superficial and deep EMG PFM responses followed the PPS application in both groups. No differences were found between the deep and superficial PFM onset latency to the timing of the PPS application.The results of this study suggest that women with PVD have superficial PFMs that are more responsive to vulvar pain than those in non-affected women. The findings also suggest that superficial PFM over-reactivity, rather than deep PFM over-reactivity, is part of the PFM dysfunction reported in women with PVD. / Thesis (Master, Rehabilitation Science) -- Queen's University, 2008-09-26 15:46:22.84

Introduction: The primary purpose of this research was to determine whether women with stress urinary incontinence (SUI) demonstrate pelvic floor muscle (PFM) strength or endurance deficits and/or changes in the motor control patterns used during maximum voluntary PFM contractions (PFM MVCs) and coughing. A secondary purpose was to determine the effect of age on these parameters. Methods: After first validating the use of vaginal pressure to study the functional output of the PFMs, three studies were carried out to address these objectives. In two studies vaginal pressure and PFM and abdominal muscle electromyography (EMG) data were recorded simultaneously during PFM MVCs and maximum effort coughs in continent women, women with mild SUI and women with moderate to severe SUI in both supine and standing. In the final study, the effect of continence status and age on PFM strength and endurance was measured with vaginal pressure. Results: Changes in vaginal pressure induced by PFM MVCs and coughing were found to reflect changes in urethral pressure. The women with SUI and the continent women were found to be equally able to produce peak PFM EMG and vaginal pressure amplitudes during PFM MVCs and coughs. Compared to the continent women, the women with SUI delayed activating their abdominal muscles during the PFM MVCs. During coughing, vaginal pressure and PFM EMG peaked simultaneously in the continent women, while in the women with SUI vaginal pressure peaked after PFM EMG. During both the PFM MVCs and the coughs, the EMG activity in all of the muscles tested was higher at the onset of vaginal pressure generation in the women with SUI compared to the continent women. No difference was found in PFM endurance between the women with and without SUI. The ability to generate peak vaginal pressure during coughing decreased with age. Conclusions: PFM weakness does not appear to play a significant role in SUI. Rather, the results of this research suggest that a combination of motor control deficits and delays in pressure transmission are associated with SUI in women. / Thesis (Ph.D, Rehabilitation Science) -- Queen's University, 2009-09-21 09:37:12.923

Purpose: Intravaginal probes used for recording electromyography (EMG) from the pelvic floor muscles (PFMs) likely record activity from nearby muscles (crosstalk), and move during functional tasks, causing motion artifact data contamination, threatening the validity of results obtained. This study investigated the test-retest reliability and validity of surface EMG recordings from the PFMs using a novel, theoretically superior electrode in comparison to a commercially available intravaginal probe, the FemiscanTM. Methods: Healthy subjects (n=20) performed tasks with each vaginal electrode in situ: i) PFM maximal voluntary contractions (MVC), ii) coughs, iii) unilateral hip adductor/external rotator contractions at 25%MVC, 50%MVC, and MVC while keeping the PFMs relaxed or maximally contracted, and iv) transversus abdominis contractions (TrA; recorded using fine-wires) at 25%MVC, 50%MVC, MVC. Analyses: i) Intraclass correlation coefficients (ICC), ii) t-tests of proportions (α=0.05), iii) repeated measures ANOVAs and Tukey’s post-hoc testing (α=0.05) and iv) cross-correlation functions between peaks of transversus abdominis and PFM activity were used to determine the between-trial and between-day reliability of each vaginal electrode, a difference in prevalence of motion artifact contamination between electrodes, and the presence of crosstalk from the hip and TrA, respectively. Results: Between-trial reliability of both vaginal electrodes was excellent (ICC(3,1)=0.943-0.974). Between-day reliability was less consistent (ICC(3,1)=0.788-0.924 and 0.648-0.715 for the FemiscanTM and novel electrode, respectively). No significant difference in the proportion of files contaminated with motion artifact using each electrode existed. At submaximal intensities of hip muscle contractions, the FemiscanTM recorded significantly higher EMG amplitudes compared to what it recorded when the hip was relaxed, whereas the novel electrode did not, indicating that the FemiscanTM recorded crosstalk from the hip musculature. Low cross-correlation coefficients (<0.90) and large time delays (≥ 0.5 milliseconds) between peaks of PFM and TrA activity indicated that neither vaginal electrode recorded crosstalk from the TrA. Conclusion: The novel electrode is a promising tool to record EMG from the PFMs, as it records less crosstalk from the hip musculature than current technology while maintaining a high degree of reliability when comparing results collected within the same session; however, this electrode should not be used to compare one’s muscle activity between days. / Thesis (Master, Rehabilitation Science) -- Queen's University, 2011-02-07 14:46:30.811