Pelvic floor muscle function during gait

Avni, Corina Marie Coralie (2017-03)

Thesis (MScPhysio)--Stellenbosch University, 2017.

Thesis

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.

AFRIKAANSE OPSOMMING : Inleiding: Die bekkenvloerspiere (BVS) dra by tot ingewande beheer, asook blaas, kolon en seksuele funksie. Daar is sterk bewys ter ondersteuning van BBS heropleiding as eerste linie konserwatiewe bestuur van bekkenbodem wanorde. Tot onlangs was navorsing van BBS aktiwiteit en funksie in ‘n leende posisie onderneem vir die gerief van beide proefpersoon en navorser. BVS funksie kan tydens gewigdra en fisiese aktiwiteite ondersoek word te danke aan tegnologiese vooruitgang. Doelwitte: Om huidige praktyk te bevestig in die bepaling van die BBS tydens loopgang en gewigdra. Beskrywing van elektromiografiese (EMG) BBS aktiwiteit tydens loopgang met betrekking tot die verskillende gewigdraende fases (primere studie).Metodes: Ses databasisse is deursoek in Augustus 2014 en opgedateer in Oktober 2016. Dit sluit alle menslike proewe in waar die BVS gemeet word tydens loopgang en gewigdra. Toepaslike studies is deur middel van n siftingsproses deur twee beoordelaars identifiseer. Data is op 'n aangemete sigblad saamgebring. Op grond van die resultate, is 'n beskrywende waarnemings- primere studie ontwerp. Dit sluit gesonde nullipareuse vroulike volwasse vrywilligers in en BVS EMG aktiwiteit word beskryf tydens loopgang. ‘n Basisvlak vir bekkenvloerspier EMG aktiwiteit is in staan gedefinieer - basislyn in rus, drie maksimum willekeurige kontraksies (MWK) (gemiddeld) en een submaximal kontraksie. Die piek uV wat tydens elke maksimum willekeurige kontraksies behaal is, is genormaliseer as 100% MWK vir elke deelnemer. Bekkenvloerspier EMG was as %MWK voorgestel tydens die loopgang. Deelnemers het ses keer op hulle gemak oor die data insamelings gebied geloop. Vyf BVS EMG veranderlikes tydens loopgang is vergelyk om die impak van gewigdra op BVS aktiwiteit beskryf. Gewigdra fases is afgelei van beweging analise veranderlikes, en het tydsverloop as 'n persentasie van die loopgang siklus aangedui. Bekkenvloerspier EMG is gemeet met die Periform elektrode (Neen, Verenigde Koninkryk), en dmv draadloos gesinchroniseer (Noraxon) met ‘n drie-dimensionele beweging analiseerder (Vicon). Resultate: Vier-en-veertig studies wat rapporteer oor data kolleksie tydens staan is geidentifiseer. Vier hoof meting modaliteite het na vore gekom - Elektromiografie (55%), druk (41%), ultraklank (27%) en manuele evaluasie (18%). Die mees algemene benadering was vaginaal met ‘n meet instrument. Vyf studies rapporteer oor BVS data wat ingesamel is gedurende loop of ‘n fase daarvan. Drie studies maak gebruik van oppervlak EMG. Twee van hierdie studies ondersoek vaginale EMG waardes tydens hardloop, en een studie die reaksies van die gestreepte uretrale en eksterne anale sfinkters tydens enkel-been trap in mans. Draadlose vaginale druk is tydens loop, hardloop en spesifieke aktiwiteite in twee studies ondersoek. BVS funksie is met behulp van EMG en druk modalitieite in twaalf studies ondersoek, tydens 'n verskeidenheid van gewigdra aktiwiteite. Data oor BVS funksie tydens gewigdra is beskikbaar van 1699 deelnemers. Die deelnemers was oorwegend volwassenes N = 1593 (kinders n = 106) en vroulike N = 1563 (manlike N = 136). Die primere studie het agt deelnemers (ouderdom 33,5 ± 8,52 jaar, BMI 23,98 ± 5,06 kg / m2). Gemiddeldes en standaard deviasie van willekeurige BVS EMG tydens die basisvlak in die staan posisie het 'n basislyn van 20,25 ± 9,33% MVC; 'n gemiddeld van drie maksimale willekeurige kontraksies van 66,5 ± 6,19% MVC; en 'n submaximal kontraksie van 37,875 ± 12,39% MVC. Bekkenvloerspier EMG resultate sluit in: dubbel ondersteuning aan die linker kant van 42,375 ± 8,71% MVC; enkele ondersteuning aan die linkerkant van 41 ± 16,18% MVC; dubbel ondersteuning aan die regter kant van 39,375 ± 15,20% MVC; en enkele ondersteuning aan die regter kant van 41,75 ± 17,42% MVC. Daar was verskille gesien in die reeks, amplitude, golfpatroon en tydsberekening tydens loop. Deelnemers het groot variasie getoon wat wissel tussen 20-100% MWK. Daar was 'n groter inter as intra onderwerp variasie. Gevolgtrekking: Meting van die BBS tydens gang is in kinderskoene. Onwillekeurige BBS aktiwiteit bestaan gedurende loop. BBS EMG is sensitief genoeg om verskille tussen individuele proefpersone te identifiseer asook verskille tussen individuele ledemate. 'n Versteuring in of ontwrigting van normale onwillekeurige BBS aktiwiteit kan bydra tot pelviese disfunksie. Die ontwikkeling van 'n elektrode in staat om onwillekeurige aktiwiteit te onderskie in BBS tydens gang sal begrip van die kompleksiteit van pelviese funksie tydens fisiese aktiwiteit verbeter.

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