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.

Bladder artifacts during bone single photon emission computed tomography (SPECT) is a common source of errors. The extent and severity of bladder artifacts have been described for filtered back projection (FBP) reconstruction. OSEM may help to address this poor record of bladder artifacts, which render up to 20% of the images unreadable. Aims and objectives To evaluate the relationship of the bladder to acetabulum ratio in guiding the choice of the number of iterations and subsets used for OSEM reconstruction, for reducing bladder artifacts found on FBP reconstruction. Materials and Methods 105 patients with various indications for bone scans were selected and planar and SPECT images were acquired. The SPECT images were reconstructed with both filtered back projection and OSEM using four different combinations of iterations and subsets. The images were given to three well experienced Nuclear Physicians who were blinded to the diagnosis and type of reconstruction used. They then labelled images from the best to the worst after which the data was analysed. The bladder to acetabulum ratio for each image was determined which was then correlated with the different iterations and subsets used. Results The study demonstrated that reconstruction using OSEM led to better lesion detectability compared to filtered back projection in 87.62% of cases. It further demonstrated that the iterations and subsets used for reconstruction of an image correlates to the bladder to acetabulum ratio. Four iterations and 8 subsets yielded the best results in 48.5% of the images whilst two iterations and 8 subsets yielded the best results in 33.8%. The number of reconstructed images which yielded the best results with 2 iterations and 8 subsets were the same as or more than those with 4 iterations and 8 subsets when the bladder/acetabulum ratio was between 0.2-0.39. A ratio below 0.2 or above 0.39 supports the usage of 4 iterations and 8 subsets over 2 iterations and 8 subsets. Conclusion Bladder to acetabulum ratio can be used to select the optimum number of iterations and subsets for reconstruction of bone SPECT for accurate characterization of lesions. This study also confirms that reconstruction with OSEM (vs FBP) leads to better lesion detectability and characterisation. / Dissertation (MSc)--University of Pretoria, 2011. / Nuclear Medicine / unrestricted

Orientadores: Simone Botelho Pereira, Cássio Luís Zanettini Riccetto / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T06:45:26Z (GMT). No. of bitstreams: 1 Alves_FabiolaKenia_M.pdf: 1692641 bytes, checksum: 229f8f470a88f89b5d3255ed8cccd5e1 (MD5) Previous issue date: 2013 / Resumo: O processo de envelhecimento é um dos principais fatores de disfunções uroginecológicas. O treinamento dos músculos do assoalho pélvico (TMAP) é o método de primeira escolha para o tratamento de incontinência urinária e também recomendado para a prevenção e tratamento de prolapsos dos órgãos pélvicos. O objetivo deste estudo foi avaliar o efeito de um programa de TMAP em grupo sobre a contratilidade muscular em mulheres na pós-menopausa, assim como sobre a presença de sintomas urinários e prolapsos de órgãos genitais. Métodos. Foi realizado um ensaio clínico, randomizado, controlado e cego com 30 mulheres na pós-menopausa (idade média de 65.93 ±8.76 anos), divididas em dois grupos: Resumo: Grupo Tratado (n=18) e Grupo Controle (n=12). A avaliação foi realizada antes e após o tratamento em ambos os grupos e consistiu de palpação vaginal (Escala Modificada de Oxford), eletromiografia de superfície dos músculos do assoalho pélvico, avaliação da presença de prolapsos dos órgãos pélvicos e avaliação de sintomas miccionais e vaginais por meio da aplicação dos questionários validados: International Consultation on Incontinence Questionnaire - Short Form (ICIQ-UI SF); International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB) e International Consultation Questionnaire on Vaginal Symptoms (ICIQ-VS). O protocolo de tratamento consistiu de 12 sessões em grupo de 8-10 participantes, duas vezes na semana, por 30 minutos, totalizando seis semanas. Foram utilizados para análise estatística os Testes ANOVA, Teste de Comparação múltipla de Tukey, Teste de Wilcoxon e Teste Perfil de Contrastes. Resultados. A contratilidade dos músculos do assoalho pélvico aumentou significativamente depois do programa de treinamento tanto na eletromiografia (p=0.003) quanto na palpação digital (p=0.001). Houve decréscimo do escore do questionário ICIQ-OAB apenas no grupo tratado (p<0.001) com diferença significativa entre os grupos através do tempo (p=0.002). Houve decréscimo do escore do questionário ICIQ-UI SF com diferença significativa entre o grupo controle e o grupo tratado depois do tratamento (p=0.03). O grau do prolapso anterior também diminuiu apenas no grupo tratado (p=0.03). Não foram encontradas diferenças significativas no grau do prolapso posterior e no questionário ICIQ-VS. Conclusão. O programa de TMAP em grupo foi eficaz para o aumento da contratilidade muscular, diminuição da gravidade do prolapso de parede anterior e dos sintomas urinários em mulheres na pós-menopausa. / Abstract: Introduction. The aging process is one of the major reasons for urogynecological dysfunctions. Pelvic floor muscle training (PFMT) is the method chosen in the first place for the treatment of urinary incontinence, also indicated for the prevention and treatment of the pelvic organs' prolapses. The aim of this study was to evaluate the effects of a group pelvic floor muscle training program on post-menopausal women's pelvic floor muscle contractility , as well as on the presence of urinary symptoms and genital organ prolapses. Methods. A clinical, randomized, controlled and assessor-blinded study was conducted with 30 post-menopausal women (mean age 65.93 ±8.76 years), divided into two groups: Treatment Group (n=18) and Control Group (n=12). The evaluation was carried out using digital palpation (Modified Oxford Grading Scale), pelvic floor surface electromyography (sEMG), the Pop-Q System to evaluate the presence of pelvic organ prolapse using validated questionnaires: International Consultation on Incontinence Questionnaire - Short Form (ICIQ-UI SF); International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB) and International Consultation Questionnaire on Vaginal Symptoms (ICIQ-VS). The treatment protocol consisted of 12 group sessions, with 8-10 participants, carried out by a physiotherapist (main investigator), twice a week, with 30 minutes of duration each, totaling six weeks. The statistical analysis was performed using ANOVA, Tukey¿s Multiple Comparison Test, McNemar¿s Test and the Contrast Profile Test. Results. The pelvic floor muscle contractility increased after the training program, assessed by sEMG (p=0.003) and by vaginal palpation (p=0.001). There was a decrease in the ICIQ-OAB scores only in the treated group's final evaluation (p<0.001) with a significant difference between the groups along the time (p=0.002). There was a decrease in the ICIQ-UI SF scores (p=0.03) between the treated and control groups after the treatment. There was a significant decrease in the anterior pelvic organ prolapse (p=0.03) in the treated group. No significant differences were found in the posterior pelvic organ prolapse and the ICIQ-VS scores. Conclusion. Group pelvic floor muscle training program is an effective way to increase the pelvic floor muscle contractility and to decrease the anterior pelvic organ prolapse as well as urinary symptoms in post-menopausal women. / Mestrado / Fisiopatologia Cirúrgica / Mestra em Ciências

À ce jour, cette thèse n’a pas été déposée auprès de l’université de soutenance. L’Université Clermont Auvergne est donc dans l’impossibilité d’en assurer le traitement, la conservation et la diffusion. / To date, this thesis has not been deposited. The Université Clermont Auvergne is therefore unable to ensure its processing, conservation and dissemination.

The main purpose of the essay is to serve as a documentation of my research practice on the movement of the tailbone and its connections to my dancing body. The essay is being written from my personal perspective which springs out of my interest in the importance of using the tailbone whilst dancing. In the first part of the text I have included personal information to the reader about where my interest in the movement of the tailbone arose. One of the methods during the research was to write a process diary as a way to combine a physical practice and writing practice. This process diary is now a big part of this essay. In the essay you as a redear can follow how the research has transformed and changed throughout working time on the project. The second part of the essay reflects on the process of researching the tailbone-ing movement practice and what the practical presentation should look like. In the last pages of the essay you find a choreographic score which is both a documentation of the practice as well as a score to perform it. Working on the essay opens up new possibilties for further research on the importance of the tailbone and the pelvic floor in the dancing body. / <p>This master work includes both a performing and a written part. </p>

Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal.

Although mechanical alterations to pelvic floor ligaments, such as the cardinal and uterosacral ligaments, are one contributing factor to the development and progression of pelvic floor disorders, very little research has examined their mechanical properties. In this study, the first biaxial elastic and viscoelastic tests were performed on uterosacral and cardinal ligament complexes harvested from adult female swine. Biaxial elastic testing revealed that the ligaments undergo large strains and are anisotropic. The direction normal to the upper vagina was typically stiffer than the transverse direction. Stress relaxation tests showed that the relaxation was the same in both directions, and that more relaxation occurred when the tissue was stretched to lower initial strains. In order to describe the experimental findings, a three-dimensional constitutive model based on the Pipkin-Rogers integral series was formulated and the parameters of such model were determined by fitting the model to the experimental data. In formulating the model, it was assumed that the tissues consist of a ground substance with two embedded families of fibers oriented in two directions and that the ligaments are incompressible. The model accounts for finite strains, anisotropy, and strain-dependent stress relaxation behavior. This study provides information about the mechanical behavior of female pelvic floor ligaments, which should be considered in the development of new treatment methods for pelvic floor disorders. / Master of Science

No / This study aimed to address whether a water exercise programme improves pain and quality of life in pregnant patients with Pelvic Girdle Pain (PGP) compared to a land-based exercise programme and the feasibility of undertaking a large-scale research programme. Twenty-three participants with diagnosed PGP, recruited at St George’s Hospital London, were randomised into two groups (water or land exercise). Each group received, four, once-weekly exercise sessions on land or water. Exercise effects on PGP were measured using the Pelvic Girdle Pain Questionnaire (PGPQ) (primary outcome), Visual Analogue Scale (VAS), Patient Specific Functional Score (PSFS) and Active Straight Leg Raise (ASLR). Quality of life was measured using the Subjective Exercise Experience Scale (SEES). Outcomes were assessed at baseline and post four weeks exercise. Results showed there was a clinically significant improvement shown in all outcome measures in the water group, compared to the land group. A statistical difference between groups was shown for ASLR (p=0.036), Positive Well-Being (p=0.000) and Fatigue levels (p=0.011). No statistical difference was shown for PGPQ (p=0.056), PSFS (p=0.530) and Psychological Distress (p=0.712) scores. Exercise in water appears to offer a clinical benefit for patients experiencing PGP compared to a land exercise, particularly with Fatigue, Positive Well-Being and ASLR scores. Statistical differences between groups are limited by small sample size and that no power calculation was used in this study. Methodology and results provide support for a larger study on this topic to provide more definitive conclusions to support the use of water-based therapy for PGP. / The full text may be available depending on permission from the publisher.

The effectiveness of exercise has been increasingly studied as exercise has been popular for the improvement of physical performance and rehabilitation of lumbar spine. A variety of exercises have been used to reduce back pain or spinal degeneration. However, there are no studies to determine effects of exercise on lumbar spine kinematics, including lumbar-pelvic coordination and instantaneous axis of rotation. The current study aimed to examine these lumbar spine kinematical changes due to exercise and therapy. We hypothesized that exercise and therapy will affect the changes of lumbar spine kinematics. Lumbar-Pelvic motions were recorded from 86 healthy subjects while performing lifting and lowering tasks of 10% and 25% of body weight. The influence of exercise was quantified from coefficients of curve-fitting for pelvic and lumbar angles. There was a significant difference (p<0.05) for the range of lumbar motion (distribution, D) between the control group and the cardiovascular exercise group after 12-week program. However, there was no significance for lumbar-pelvic coordination, C. A second study was performed to investigate the changes of instantaneous axis of rotation (IAR) at which trunk angle reached 25º. Results indicated that a superior-inferior location of IAR was significantly (p<0.05) modified by the cardiovascular exercise after 12 weeks, but there was no significant effectiveness of the physical therapy exercise. Finding of lumbar spine kinematics during lifting and lowering a weight which are the most popular manual handling activities may provide great understanding of the exercise effectiveness. Future studies are recommended to assess whether the changes of lumbar spine kinematics lead to the decrease instances of lumbar spine injuries or low back pain. / Master of Science