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INTRODUCTION AND HYPOTHESIS: In pelvic floor muscle (PFM) electromyography (EMG) two different bipolar configurations are applied: "true differential" configuration (TD) measures neuromuscular activity with two ipsilateral electrodes, whereas "faux differential" configuration (FD) has two electrodes placed on each side of the PFMs. The aim of the study was to determine possible differences and the relationship between both configurations. METHODS: A secondary data analysis of 28 continent (CON) and 22 stress urinary incontinent (SUI) women was performed. Surface EMG was measured using a vaginal probe during maximal voluntary (MVC) and fast voluntary (FVC) contractions. TD and FD were explored with amplitude- and time-related EMG parameters, cross-correlation coefficients (R(0)) and statistical parametric mapping (SPM). RESULTS: Of a total of 62 comparisons of EMG parameters of MVC and FVC, only one comparison showed significant differences between the two configurations (CON group, FVC4peak TD versus FD, p = 0.015). R(0) were high in both groups for all MVC and FVC variables (R(0) ≥ 0.989). SPM detected 3 out of 28 comparisons with short (0.124-0.404 s) significant supra-threshold clusters (p < 0.025). CONCLUSIONS: The findings suggest that TD and FD might measure neuromuscular activity almost the same. Very high cross-correlation coefficients and a very limited number of significant results from EMG parameters, as well as SPM, suggest that in the measured sample the choice of TD or FD might remain practically irrelevant. To gain further insight into the scientific and clinical relevance of choosing either of the electrode configurations, the comparisons should be re-evaluated on a sample with more severe incontinence symptoms.
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Diafragma da Pelve , Incontinência Urinária por Estresse , Eletrodos , Eletromiografia , Feminino , Humanos , Contração MuscularRESUMO
AIMS: Stress urinary incontinence (SUI) has also been attributed to a lower speed of contraction of the pelvic floor muscles (PFM). Therefore, PFM assessment and training implement fast voluntary contractions (FVC). The purpose of the study was to explore FVC regarding feasibility, on-/offset and rate of activity determination, as well as differences between continent (CON) and stress urinary incontinent (SUI) women. METHODS: Fifty women were included and examined by means of PFM EMG during rest, maximum voluntary contractions (MVC), and five FVC. MVC-peak activity was used to normalize EMG-data. On-/offset of muscle activity was determined as mean of rectified rest activity plus 1 standard deviation. Linear regression was calculated for rate of activity from onset to peak, peak to offset, and within 200 ms after both onset and peak. Peak activity and time variables related to onset, peak, and offset were calculated. RESULTS: On-/offsets were evaluable for 234/222 of 250 FVC by a computer-based algorithm, 16/28 on-/offsets had to be determined manually. There was no significant difference between groups (CON/SUI) regarding FVC peak (92.1/99.3 %MVC), time to peak (514.2/525.6 ms), and increase of activity (182.8/182.1 %MVC/s). The SUI group showed a significantly slower activity decrease (-120.7/-74.4 %MVC/s). CONCLUSIONS: FVC analyses were shown to be feasible. The significant difference observed between the groups did not refer to activity increase but instead to a prolonged relaxation phase in the SUI group. This prompts to reconsider the interpretation of FVC in PFM testing and training.
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Contração Muscular/fisiologia , Diafragma da Pelve/fisiopatologia , Incontinência Urinária por Estresse/fisiopatologia , Adulto , Eletromiografia , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: The prevalence of stress urinary incontinence during high-impact activities is high. Enhanced comprehension of pelvic floor muscle (PFM) displacement and activity is clinically relevant for the development of specific approaches in rehabilitation. The aim of the study is to investigate and to compare PFM displacement between the continent and incontinent women during jumps. METHODS: A cross-sectional, exploratory design was applied to investigate PFM displacement during drop jumps (DJ) and countermovement jumps (CMJ). PFM displacement was assessed in craniocaudal translation and forward-backward rotation with an electromagnetic tracking system. RESULTS: Twenty-eight continent and 22 incontinent women were included. During the first landing of DJ, a primary caudal, during the second landing of DJ/CMJ a primary cranial translation and during all jump a primary backward rotation was observed. No significant difference between the groups was found. DISCUSSION: PFM displacement during running demonstrated caudal translation/forward rotation before and cranial translation/backward rotation after heel strike. During the second landing of DJ/CMJ a cranial translation/backward rotation and during the first landing of DJ a caudal translation/backward rotation has been observed after ground contact. This may be due to the longer lasting bodyweight force in the first landing of DJ. No eccentric-concentric stretch-shortening cycle could be seen. CONCLUSION: This study indicates that during jumps two opposite reactions of involuntary PFM displacement happen, but no stretch-shortening cycle with an eccentric-concentric contraction could be found. Jumping stimuli inducing involuntary PFM displacement should be used for future investigations to consider a beneficial effect concerning continence.
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Diafragma da Pelve/lesões , Incontinência Urinária de Urgência/patologia , Adolescente , Adulto , Fenômenos Biomecânicos , Estudos Transversais , Exercício Físico , Feminino , Humanos , Pessoa de Meia-Idade , Contração Muscular/fisiologia , Diafragma da Pelve/diagnóstico por imagem , Rotação , Adulto JovemRESUMO
AIMS: Impact activity like running is associated with an increase in intra-abdominal pressure which needs to be sufficiently countered by pelvic floor muscle (PFM) activity to secure continence. The aim of this study was to investigate and compare PFM kinematics in continent and incontinent women during running. METHOS: Three-dimensional position and orientation was measured with the electromagnetic tracking device trakSTAR™. One sensor was attached to the vaginal probe and a second one was secured to the subjects' skin at the height of the second sacral vertebrae. Cranial-caudal and forward-backward displacement of the vaginal probe was measured during 10 sec running on a treadmill at the speeds 7, 11, and 15 km/h. Displacement data from 100 ms before to 300 ms after heel-strike were analyzed. RESULTS: Nineteen incontinent and twenty-seven continent women were included in this study. Before the foot touched the ground caudal translation and forward rotation of the vaginal probe was detected, whereas after heel-strike a cranial translation and backward rotation was measured. Cranial-caudal translation as well as backward-forward-rotation did not differ significantly between continent and incontinent subjects for the three speeds. Analysis of maximum displacements showed significantly increasing displacement with increasing speeds. CONCLUSIONS: Kinematic measurements during impact activity of running demonstrated caudal translation before and cranial translation after heel-strike. The hypothesis of caudal translation through impact activity was not confirmed. Patterns seem similar between continent and incontinent subjects. Associations between the direction of displacement and muscle action of PFMs remain assumptions.
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Diafragma da Pelve/fisiologia , Corrida/fisiologia , Incontinência Urinária por Estresse/fisiopatologia , Adulto , Fenômenos Biomecânicos , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Diafragma da Pelve/fisiopatologia , VaginaRESUMO
INTRODUCTION AND HYPOTHESIS: Investigating the activity of the pelvic floor muscles (PFMs) in women during impact activities such as jumping, running or coughing may elucidate different aspects of PFM activation and therefore clarify the pathophysiology of stress urinary incontinence (SUI). A systematic review (PROSPERO 2016:CRD42016035624) was conducted to summarize current evidence on PFM activity during impact activities in both continent and incontinent women. METHODS: PubMed, EMBASE, Cochrane, and SPORTDiscus databases were systematically searched for studies published up to December 2016. The PICO approach (patient, intervention, comparison, outcome) was used to construct the search queries. Original studies were included that investigated PFM activity during impact activities if they included terms related to muscle activity and measurement methods, test positions, activities performed and continence status. Two reviewers screened titles and abstracts independently to ascertain if the included studies fulfilled the inclusion criteria, and extracted data on outcome parameters. RESULTS: The search revealed 28 studies that fulfilled the inclusion criteria, of which 26 were cross-sectional studies. They used different electromyography measurement methods, test activities, test positions, and comparisons with other structures. Ten studies compared continent and incontinent women. The timing of PFM activity in relation to the activity of other trunk muscles seems to be a crucial factor in maintaining continence. Women with SUI have delayed PFM activity. CONCLUSIONS: The findings of this systematic review suggest that impact activities causing involuntary and reflex PFM activity should be the subject of further study. This may help guide clinical studies to improve our understanding of how the PFMs react during impact activities and to determine best practices that can be included in rehabilitation programmes.
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Músculo Esquelético/fisiologia , Diafragma da Pelve/fisiopatologia , Incontinência Urinária por Estresse/fisiopatologia , Adulto , Idoso , Tosse/fisiopatologia , Eletromiografia , Exercício Físico/fisiologia , Feminino , Humanos , Pessoa de Meia-Idade , Contração Muscular/fisiologia , Reflexo/fisiologia , Corrida/fisiologiaRESUMO
PURPOSE: Stress urinary incontinence (SUI) symptoms can be provoked during impact loads such as vertical jumps. To investigate and compare pelvic floor muscle (PFM) activity in women with SUI and continent women (CON) during drop jumps (DJ) and counter movement jumps (CMJ) could clarify the activity of the PFMs during impact loads. METHODS: A tripolar vaginal probe was used to record surface electromyographic (EMG) activity of the PFMs during DJ and CMJ. Time intervals of 30 ms were used to parameterize data from 30 ms before (pre-activity) to 150 ms after (reflex activity) ground contact on a force plate during the landing and take-off phase. EMG signals were normalized to the mean of the peak values of two maximal voluntary contractions (MVC) and expressed in percentage (% MVC). RESULTS: For all time intervals during the landing and take-off phase, no statistically significant differences could be found between women with SUI and CON. EMG values exceeded 100% MVC for all time intervals during all landing and take-off phases. Maximal PFM activation was measured during the first landing of DJ and was 404.1% MVC for SUI and 370.2% MVC for CON. CONCLUSIONS: Vertical jumps seem to stimulate pre-activity before and reflex activity after ground contact during the landing phase and activate PFMs up to 400% MVC. Jumping stimuli inducing involuntary PFM contraction could show a beneficial factor to be integrated in a PFM rehabilitation program.
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Exercício Físico/fisiologia , Contração Muscular/fisiologia , Diafragma da Pelve/fisiopatologia , Incontinência Urinária por Estresse/fisiopatologia , Adulto , Estudos Transversais , Eletromiografia/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Diafragma da Pelve/fisiologia , Vagina/fisiologiaRESUMO
AIMS: Impact activities like running are known to elicit symptoms of stress urinary incontinence (SUI). The aim of this study was to investigate and compare pelvic floor muscle activity in continent and SUI women during running at three different speeds and thereby elucidate contraction characteristics of the pelvic floor during impact. METHODS: Surface electromyographic (EMG) activity from the pelvic floor muscles during running on a treadmill was recorded with a tripolar vaginal probe. EMG was measured during 10 s at the speeds 7, 11, and 15 km/h. Data from 30 ms before to 150 ms after heel-strike were parameterised to time intervals of 30 ms. The reference value set as 100% for EMG normalisation was calculated as the mean of the peak values of two maximum voluntary contractions. RESULTS: No statistically significant differences between continent and incontinent subjects could be found for the EMG values for all time intervals. Mean EMG pre-activity and reflex activity increased significantly with speed (P < 0.05). Mean EMG activity during running was significantly above PFM onset activation. Values in women with SUI exceeded 100 %MVC for all time intervals at the highest speed of 15 km/h. CONCLUSIONS: Running appears to trigger pre-activation before and reflex-activation after heel-strike and should therefore not only be regarded with caution due to its SUI related effects. Running training stimuli may serve as a beneficial complement to a PFM training rationale, leading to reflex activity of the pelvic floor muscles, when used in sense of power training methodology.
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Contração Muscular/fisiologia , Músculo Esquelético/fisiopatologia , Diafragma da Pelve/fisiopatologia , Corrida/fisiologia , Incontinência Urinária por Estresse/fisiopatologia , Adulto , Estudos Transversais , Eletromiografia/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Reflexo , Vagina/fisiologiaRESUMO
In surgery, cognitive stress symptoms, including problems in concentrating, deciding, memorising, and reflecting are risks to patient safety. Recent evidence points to social stressors as antecedents of cognitive stress symptoms in surgery personnel. The current study tests whether cognitive stress symptoms are positively associated with emotional abuse, emotional- and task-related demands and resources in surgery work. Forty-eight surgery nurses from two hospitals filled out the Copenhagen Psychosocial Questionnaire in its German version. Task-related and emotional demands were positively related to cognitive stress symptoms. In a stepwise, multiple, linear regression of cognitive stress symptoms on task-related and emotional demands, emotional abuse and emotional demands were unique predictors (p < .05). Efforts to increase patient safety should address emotional abuse, emotional demands, and, therefore, communication and cooperation team climate in surgery personnel.
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Cognição , Emoções , Enfermeiras e Enfermeiros/psicologia , Estresse Ocupacional/psicologia , Segurança do Paciente , Enfermagem Perioperatória , Carga de Trabalho/psicologia , Adulto , Estudos Transversais , Feminino , Alemanha , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Estresse Psicológico/psicologia , Inquéritos e Questionários , SuíçaRESUMO
INTRODUCTION: Investigations of the dynamic function of female pelvic floor muscles (PFM) help us to understand the pathophysiology of stress urinary incontinence (SUI). Displacement measurements of PFM give insight into muscle activation and thus help to improve rehabilitation strategies. This systematic review (PROSPERO 2013: CRD42013006409) was performed to summarise the current evidence for PFM displacement during voluntary and involuntary activation in continent and incontinent women. METHODS: MEDLINE, EMBASE, Cochrane and SPORTDiscus databases were searched using selected terminology reflecting the PICO approach. Screening of Google Scholar and congress abstracts added to further information. Original articles investigating PFM displacement were included if they reported on at least one of the aims of the review, e.g., method, test position, test activity, direction and quantification of displacement, as well as the comparison between continent and incontinent women. Titles and abstracts were screened by two reviewers. The papers included were reviewed by two individuals to ascertain whether they fulfilled the inclusion criteria and data were extracted on outcome parameters. RESULTS: Forty-two predominantly observational studies fulfilled the inclusion criteria. A variety of measurement methods and calculations of displacement was presented. The sample was heterogeneous concerning age, parity and continence status. Test positions and test activities varied among the studies. CONCLUSIONS: The findings summarise the present knowledge of PFM displacement, but still lack deeper comprehension of the SUI pathomechanism of involuntary, reflexive activation during functional activities. We therefore propose that future investigations focus on PFM dynamics during fast and stressful impact tasks.
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Diafragma da Pelve/fisiopatologia , Incontinência Urinária por Estresse/fisiopatologia , Feminino , HumanosRESUMO
BACKGROUND: Cannabis is the illegal drug most frequently used by Minors in Austria. Due to the gradual decriminalization and legalization that has taken place in many European countries in recent years, the ÖGKJP would like to take a balanced and scientifically based stand on the complex issue of cannabis use and abuse among young people. METHODS: The authors searched the medline for current studies using searches tailored to each specific subtopic. Furthermore, recognized compendiums were quoted. RESULTS: While occasional recreational use of cannabis in adults with completed brain maturation and no risk profile for mental disorders is likely to be relatively harmless, early initiation of use with regular use and the increasingly available, highly potent cannabis varieties can lead to explicit and sometimes irreversible neurocognitive brain dysfunction. CONCLUSION: Legalisation of cannabis consumption for minors needs to be objected to due to the risks of the expected damage in the area of brain development. At the same time, however, it is important to establish sensible legal regulations in order to be able to adequately counteract the fact that over 30% of all European young people occasionally consume cannabis. We are also clearly recommending to not criminalize cannabis users and provide necessary support to vulnerable and addicted cannabis users.
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Cannabis , Drogas Ilícitas , Adulto , Humanos , Adolescente , Criança , Áustria , Psiquiatria do Adolescente , PsicoterapiaRESUMO
Objectives: To describe change in trunk flexor endurance and intra-abdominal pressure (IAP) associated with trunk flexor assessment and explore factors associated with change in trunk flexor endurance during the first postpartum year.Design: Ancillary analysis of an ongoing prospective cohort study.Methods: Participants (N = 282) were primiparous women delivered vaginally. They completed trunk flexor endurance testing while assessing IAP, body habitus measures (body mass index, waist circumference, and body composition), and questionnaires 5-10 weeks and 11-15 months postpartum. We investigated change in trunk flexor endurance by quartile of improvement and factors associated with improvement (Q4 vs. Q1-Q3) using multivariable models, adjusted for baseline endurance.Results: Mean age was 28 ± 5 years. The median (IQR) trunk flexor hold time increased from early to late postpartum (129/IQR = 68, 217 vs 148/IQR = 80, 265 seconds, p = .01) and mean (SD) IAP decreased (55/SD = 13 vs 48/SD = 14 cmH20, p < .0001). The most improved group (Q4) increased endurance time by 176 seconds (95% CI = 103, 254), were less likely to be Hispanic, more likely to be older, more educated, and have lower measures of body habitus than women in Q1-Q3. Conclusion: Trunk flexor endurance increased and IAP decreased over one year postpartum. Lower body habitus and higher age early postpartum predicted greatest improvement in trunk flexor endurance at 1 year.
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Período Pós-Parto , Tronco , Adulto , Feminino , Humanos , Estudos Longitudinais , Resistência Física , Estudos Prospectivos , Circunferência da Cintura , Adulto JovemRESUMO
BACKGROUND: High-impact activities are often related to urine leakage in women, so deeper insight into continence mechanisms of pelvic floor muscles (PFMs) while running is needed. Therefore, simultaneous information about the intensity of PFM muscle activity and fibre recruitment behavior at each time point of the gait cycle can help in understanding PFM activity patterns. OBJECTIVE: We aimed to analyse spectral changes of the pre- and post-initial contact phase during running at 3 different speeds and to compare women with stress urinary continence (SUI) to those without SUI by using a wavelet approach. METHODS: PFM electromyography (EMG) was recorded during 7, 11 and 15km/h treadmill running and analysed with Morse wavelets. The relative distribution of power was extracted during 6 time intervals of 30ms, from 30ms before to 150ms after initial contact. RESULTS: We included 28 women without SUI (mean [SD] age 38.9 [10.3] years) and 21 with SUI (mean age 46.1 [9.9] years). The groups did not differ in power spectra for each time interval. However, we found significantly less EMG intensity in the lower frequency bands but more intensity in the higher frequency bands in the pre-initial contact phase than at post-initial contact. CONCLUSION: Morse wavelets could be used to extract differences between pre- and post-initial contact activation behavior of PFMs during different running speeds as well as spectral changes toward high or low frequencies. This information sheds light on specific differences in involuntary reflexive activation patterns while running. Muscular preparation and adaptation a few milliseconds before initial contact could be helpful.
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Músculo Esquelético/fisiopatologia , Diafragma da Pelve/fisiopatologia , Corrida/fisiologia , Incontinência Urinária por Estresse/fisiopatologia , Adulto , Estudos Transversais , Eletromiografia , Teste de Esforço , Feminino , Humanos , Pessoa de Meia-Idade , Recrutamento Neurofisiológico , Análise de OndaletasRESUMO
The purpose of the study was to determine the reliability of vertical ground reaction force (VGRF) parameters during stair ascent and descent in the elderly. Forty-two elderly subjects (80.1 SD 6.4 years) were asked to perform three stair ascents and descents at their self-selected normal speed. VGRF were measured during two consecutive steps on an instrumented staircase. Force-time curves where then parameterized into force, force-time and time variables, according to a previously suggested protocol. In addition, force and force-time variables were normalized to body weight. Intraclass correlation coefficients (ICC) type (2, 1) and coefficients of variation (CV) were calculated. Force variables showed moderate to good reliability for the normalized values with ICCs ranging from 0.537 to 0.836 and CVs between 2.52% and 6.51%. Variability of Fmax1 and Fmin appeared to be higher in stair descent with CVs of >5.20% as compared to stair ascent (<3.75%). Time variables showed good reliability in stair ascent but were clearly lower in stair descent (ICCs between 0.108 and 0.684 and CVs between 10.70% and 14.45%). Significant differences were found for the ICCs between the absolute and normalized values as well as for the ICCs of the time dependent and CVs of all variables between stair ascent and descent.It has been concluded that VGRF parameters can be used as a reliable measurement tool for the quantification of stair climbing in the elderly. The present data can be further used as reference values in future investigations.