Masters Degrees (Physiotherapy)

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Browsing Masters Degrees (Physiotherapy) by Author "Avni, Corina Marie Coralie"

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    Pelvic floor muscle function during gait
    (Stellenbosch : Stellenbosch University, 2017-03) Avni, Corina Marie Coralie; Hanekom, Susan D.; Jones, Ruth C.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Physiotherapy.
    ENGLISH SUMMARY : Introduction: The pelvic floor muscles (PFMs) contribute to visceral control, including bladder bowel and sexual function. There is strong evidence in support of PFM retraining as first line conservative management of pelvic floor disorders. Investigations into PFM activity and function have often been conducted in lying, for subject comfort and investigator convenience. Recent technological advances have allowed for investigations into PFM function in weightbearing and during physical activity. Aims: To establish current practise in measuring the PFMs during gait and weightbearing, and to describe PFM electromyographic (EMG) activity during gait with respect to the various weightbearing phases (primary study). Methods: We searched 6 databases in August 2014, updated October 2016; and included all human trials that measured the PFMs during gait and weightbearing. Eligible trials were screened by a pair of reviewers. Data was charted to a custom spreadsheet. Based on the results, we designed a descriptive observational primary study including healthy nulliparous female adult volunteers to describe PFM EMG activity during gait. We defined a Base Level of PFM EMG activity in standing – baseline at rest, three maximum voluntary contractions (MVC) (averaged), one submaximal contraction. The maximum uV achieved during the maximum voluntary contractions was normalised as 100%MVC for each subject, with PFM EMG during gait presented as %MVC. Subjects walked freely and easily, 6 times the data capture area. We compared five variables of PFM EMG during gait to describe the impact of weightbearing on PFM activity. Weightbearing phases were derived from motion analysis variables, and indicated time as a % of the gait cycle. PFM EMG was captured with the Periform electrode (Neen, UK), and synchronised wirelessly (Noraxon) with three-dimensional motion analysis (VICON). Results: We identified forty-four studies; all reported on data captured in standing. Four main measurement modalities emerged with many studies reporting on more than one modality – electromyography (55%), pressure (41%), ultrasound (27%) and manual assessment (18%). Most common approach was vaginally, with application via probe. Five studies reported on PFM data gathered during gait or phase thereof. Three studies used surface EMG – two investigated vaginal EMG during running, and one tested the reactions of the striated urethral and external anal sphincters during single-leg stepping in men. Wireless vaginal pressure during walking, running and specified activities was investigated in two studies. Twelve studies investigated PFM function during a variety of weightbearing activities, using EMG and pressure modalities. There is data of PFM function in weightbearing from 1699 subjects; predominantly adult n=1593 (children n=106) and female n=1563 (male n=136). The primary study presented data from eight subjects (age 33,5 ± 8,52 years; BMI 23,98 ± 5,06 kg/m2). Means and SDs of voluntary PFM EMG during Base Level in standing showed a baseline of 20.25±9.33%MVC; an average of three maximal voluntary contractions of 66.5±6.19%MVC; and a submaximal contraction of 37.875±12.39%MVC. During gait, PFM EMG included double support onto left of 42.375±8.71%MVC; single support on left of 41±16.18%MVC; double support onto right of 39.375±15.20%MVC; and single support on right of 41.75±17.42%MVC. Characteristics emerged during gait; with differences seen in range, amplitude, wave pattern and timing. Subjects showed wide variation, ranging from 20-100%MVC. There was greater inter than intra subject variability. Conclusion: Measurements of the PFMs during gait are in their infancy. Involuntary PFM activity exists during walking, and PFM EMG is sensitive enough to identify differences between individual subjects, and between individual limbs within subjects. The development of an electrode capable of differentiating between involuntary activity from various PFMs during gait would improve understanding into the complexity of pelvic function when physically active. PFM measurements made in standing differ from lying. The PFMs are more active, albeit involuntarily, in standing than when non-weightbearing. A disturbance in or disruption to this normal background involuntary PFM activity can cause pelvic dysfunction.