Is balance different in women with and without stress urinary incontinence?

Investigating the lumbar proprioception and core muscles recruitment pattern while getting up from a chair with weight lifting in patients with chronic functional constipation: cross-sectional study

INTRODUCTION AND HYPOTHESIS

Patients with chronic functional constipation have some problems such as weakness of pelvic floor muscles, and a lack of coordination of pelvic floor and abdominal muscles has been seen. The goal of this study was to investigate the lumbar proprioception and the core muscle recruitment pattern.

METHODS

The study type is a cross-sectional case-control study. There were 30 participants (case, n = 15, and control, n = 15). Electromyography of the core muscles was recorded while the subjects were getting up from the chair accompanied by lifting a weight, to check the pattern of muscle recruitment. Moreover, the lumbar proprioception was evaluated by an isokinetic device in both groups. The study was analyzed using independent t test and Mann-Whitney U test, and a nonparametric Friedman test was performed followed by Bonferroni pairwise comparison.

RESULTS

The comparison of muscle activity delay between the two groups showed that there was a significant difference between the two groups regarding the abdominal muscles, anal sphincter, and erector spinae (p < 0.05). However, there was no significant difference in the rectus femoris and gluteal muscles between the two groups (p > 0.05). Moreover, the proprioception of the lumbar region showed a significant difference (p < 0.05) between the two groups.

CONCLUSIONS

The results of this study demonstrated that the lumbar proprioception sense was reduced in the case group. This result can be justified, based on the problems in constipation (lack of coordination of muscles, weakness of pelvic floor muscles). The coordination of core muscles changed in patients with chronic functional constipation during a functional task.

Effects of Pure Barre Exercise on Urinary Incontinence Symptoms: A Prospective Observational Cross-Sectional Study

IMPORTANCE

Pure Barre is a form of physical exercise using low-impact, high-intensity, pulsatile isometric movements that may serve as a treatment option for urinary incontinence.

OBJECTIVE

The objective of this study was to measure the effects of the Pure Barre workout on urinary incontinence symptoms and sexual function.

STUDY DESIGN

This was a prospective observational study of new, female Pure Barre clients with urinary incontinence. Eligible participants completed 3 validated questionnaires at baseline and at follow-up after 10 Pure Barre classes within 2 months. Questionnaires included the Michigan Incontinence Symptoms Index (M-ISI), the Pelvic Floor Distress Inventory-20, and the Female Sexual Function Index-6. Matched differences in domain questionnaire scores between baseline and follow-up were analyzed.

RESULTS

All questionnaire domains significantly improved for all 25 participants after 10 Pure Barre classes. Median M-ISI severity domain scores decreased from 13 (interquartile range, 9-19) at baseline to 7 at follow-up (interquartile range, 3-10; P < 0.0001). Mean ± SD M-ISI urgency urinary incontinence domain scores decreased from 6.40 ± 3.06 to 2.96 ± 2.13 ( P < 0.0001). Mean ± SD M-ISI stress urinary incontinence scores decreased from 5.24 ± 2.71 to 2.48 ± 1.58 ( P < 0.0001). Mean ± SD Urinary Distress Inventory domain scores decreased from 42.17 ± 17.15 to 29.67 ± 13.73 ( P < 0.0001). Matched rank sum analysis indicated increasing Female Sexual Function Index-6 scores from baseline to follow-up ( P = 0.0022).

CONCLUSION

The Pure Barre workout may be an enjoyable, conservative management option that improves symptoms of urinary incontinence and sexual function.

Impact of Urinary Incontinence on Physical Function and Respiratory Muscle Strength in Incontinent Women: A Comparative Study between Urinary Incontinent and Apparently Healthy Women

Patients with stress urinary incontinence (SUI) may be afraid to increase intra-abdominal pressure to avoid incontinence. This could lead to weak expiratory muscles. The aim of this study was to investigate the association between respiratory muscle strength, physical function, and SUI in patients with SUI. A cross-sectional study was conducted in the Physical Medicine and Functional Rehabilitation Department. Thirty-one incontinent women (IG) and twenty-nine women in a control group (CG) were enrolled in this study. Anthropometric data, respiratory muscle strength (maximal inspiratory pressure; maximal expiratory pressure), SUI (Urogenital Distress Inventory-6; Incontinence Impact Questionnaire-7; Pad test), and physical function (waist circumference; timed-up-and-go test; abdominal muscle strength) were assessed. Body fat, body mass index, body weight, and waist circumference were higher in IG than CG (p < 0.01), while postural gait and abdominal muscles were lower (p < 0.001). Respiratory muscle strength displayed moderate correlations with SUI severity, especially for maximal expiratory pressure (p < 0.01). Maximal expiratory pressure was moderately associated with physical function. Deterioration in respiratory muscle strength is a characteristic of women with SUI. In this population, pelvic floor muscle training may be prescribed to improve continence. By feeling more confident about increasing intra-abdominal pressure, women with SUI would strengthen their expiratory muscles and eventually improve their physical function.

The Prevalence and Association of Stress Urinary Incontinence, Core Muscle Endurance, and Low Back Pain among Married Women in Saudi Arabia: A Case-Control Study

Purpose

There may be a strong association among stress urinary incontinence (SUI), low back pain (LBP), and core muscle endurance (CME) in married women. This study is aimed at evaluating the prevalence and clinical association between SUI, CME, and LBP among married women in Saudi Arabia.

Methods

The study was based on a case-control research design, conducted among 143 women with LBP (mean age, 32 ± 7.4 years) and 160 healthy women (mean age, 31.7 ± 6.7 years). SUI, CME, and functional disability were assessed using the international consultation on the Incontinence Questionnaire-Short Form (ICIQ-SF), prone plank test (PP), and Oswestry Disability Index for LBP-United Arab Emirates edition (ODI-UAE).

Results

The prevalence of SUI was found to be 60% in the LBP group while 20% in the control group. CME revealed a stronger negative correlation with SUI in the LBP group (r_s = −0.75) than in the control group (r_s = −0.63).

Conclusions

The prevalence of SUI was observed higher in women with LBP than healthy women. CME exhibited a stronger association with SUI than LBP among women with LBP compared to healthy women in Saudi Arabia. Therefore, the role of CME in SUI development or vice versa among married women with LBP may be subjected to further research.

The association between bladder dysfunction, balance and falls in women with multiple sclerosis: The specific contribution of fear of falling

BACKGROUND

Bladder dysfunction is the most common autonomic disturbance in people with MS (PwMS). Only a few studies have examined the relationship between bladder dysfunction and falls in PwMS. Bladder dysfunction has been deemed only a secondary outcome measure, and classified by a gross measure providing a limited perspective of this disturbing symptom. Furthermore, no study to date has focused on the relationship between bladder dysfunction and balance performance in PwMS.

RESEARCH QUESTION

Determine the relationship between bladder dysfunction with balance, falls and fear of falling in women with MS.

METHODS

The study was observational, including 44 women with MS, mean age 46.3 (SD = 5.7), all with at least a mild bladder dysfunction. Outcome measures included the Urinary Incontinence Quality of Life Scale (I-QoL), Bladder Control Scale (BLCS), Timed Up and Go Test (TUG), Four Square Step Test (FSST), Falls Efficacy Scale International (FES-I), Falls status, and posturography.

RESULTS

Participants performed the TUG in 14.1 s (S.D. = 11.1), and the FSST in 20.5 s (S.D. = 22.4). A relatively large proportion (68.2 %) of women was classified as fallers. However, no differences were found between those classified as fallers (n = 30) or non-fallers (n = 14) in terms of the I-QoL and the BLCS, controlling for age, EDSS and number of vaginal deliveries. Significant correlations scores were found between the I-QoL, BLCS and FES-I (rho ∼0.47), while controlling for age, EDSS and number of vaginal deliveries. No associations were demonstrated between the bladder dysfunction outcome scores and either the TUG and/or FSST.

SIGNIFICANCE

Women afflicted with MS and suffering from bladder dysfunction tend to fall and present with more balance difficulties compared with disability-matched PwMS. Nevertheless, once bladder dysfunction is detected, the perceived severity of the condition is not associated with balance and prevalence of falling, but rather on fear of falling.

Postural Sensorimotor Control on Anorectal Pressures and Pelvic Floor Muscle Tone and Strength: Effects of a Single 5P® LOGSURF Session. A Cross-Sectional Preliminary Study

Pelvic floor dysfunction (PFD) is a functional condition present most frequently in women. Despite pelvic floor muscle training being considered by the International Continence Society (ICS) as the first-line treatment in uncomplicated urinary incontinence, other more comprehensive postural methods as 5P^® LOGSURF have emerged. This preliminary cross-sectional study explores the effects of a single 5P^® LOGSURF session on pelvic floor muscle (PFM) tone and strength (MVC), resting anal tone, intrarectal pressure, and deep abdominal muscles activation. Thirty women were included (11 without PFD and 19 with PFD). Primary outcome measures were PFM tone, PFM MVC and resting anal tone and secondary measures outcomes were intrarectal pressure and deep abdominal activation. All outcome measures were collected before, throughout and after a single 30′ 5P^® LOGSURF session. The findings from this study suggest that PFM tone (PFD group: p = 0.09, d = 0.72; non-PFD group: p = 0.003, d = 0.49) and PFM MVC (PFD group: p = 0.016; non-PFD group: p = 0.005) decreased in both groups after a single 5P^® LOGSURF session, with a medium effect size for women with PFD. Contrarily, deep abdominal muscle MVC increased (PFD group: p < 0.001; non-PFD group: p = 0.03). Intrarectal pressure and resting anal tone decreased in both groups throughout the session. These results suggest that 5P^® LOGSURF method may be interesting if is performed by women with mild symptoms of PFD or healthy women to achieve a decrease in PFM tone in women who manifested pain to intracavitary techniques or practices. Further research with higher sample sizes and long-term are necessary for generalizing.

Linking Pelvic Floor Muscle Function Terminology to the International Classification of Functioning, Disability and Health

OBJECTIVE

A previous systematic review on pelvic floor muscle function (PFMF) identified a miscellaneity of terms. The lack of consensual terminology might have come from the complexity of neuromusculoskeletal function itself. This study sought to link the previously identified PFMF terms to the International Classification of Functioning, Disability and Health (ICF) terminology.

METHODS

In this secondary analysis study, 10 linkage rules were applied to link 196 previously identified PFMF terms to the ICF. Two researchers performed the linking process independently. Disagreements were solved by open dialogue with a third researcher. Percentage agreement was computed for main outcome.

RESULTS

A total of 184 (93.9%) PFMF terms were subsumed into the following 6 ICF terms: tone, involuntary movement reaction, control, coordination, strength, and endurance. The most frequently investigated PFMF was strength (25.5%), followed by involuntary movement reaction (22.9%), endurance (17.2%), control (14.1%), coordination (9.9%), and tone (4.2%). Only 6.2% PFMF could not be linked to ICF terminology. A wide variation of instruments/methods was used to measure PFMF. Vaginal palpation was the only method employed to measure all 6 PFMF. Percentage agreement between raters was 100%.

CONCLUSIONS

Linking PFMF terminology to the ICF was feasible and valid. It allowed the identification of the most investigated PFMF and their measuring methods. ICF terminology to describe PFMF should be used since it may improve communication, data gathering, and the advance in scientific knowledge.

IMPACT

Standardized terminology anchored in a theoretical framework is crucial to data gathering, communication, and dissemination of evidence-based practice. PFMF terminology based on ICF can be used to improve data pooling and communication.

Effect of a strong desire to void on walking speed in individuals with multiple sclerosis and urinary disorders

BACKGROUND

Lower urinary tract symptoms, especially overactive bladder, are frequent and disabling in individuals with multiple sclerosis (IwMS). An association with gait disorders is common, which could aggravate continence difficulties and affect quality of life. The association between the need to void and walking has never been studied in this population.

OBJECTIVE

The primary aim of this study was to assess the effect of a strong desire to void (SDV) on walking speed in IwMS and lower urinary tract symptoms. The secondary aim was to identify clinical or urodynamic factors associated with walking speed impairment at SDV in this population.

METHODS

We included IwMS with urinary disorders and Expanded Disability Status Scale score<7 in this observational study. Individuals underwent 3 10-m walk tests (10MWT) and one Timed Up and Go (TUG) test at SDV and at post-void (PV).

RESULTS

Among the 72 IwMS included (mean [SD] age 50.6 [11.6] years; 46 [64%] females), the mean (SD) speed for 10MWT was 1.00 (0.31) m.s^-1 at SDV and 1.07 (0.30) m.s^-1 at PV (P<0.0001). Time for TUG was also increased when individuals felt SDV: mean 11.53 (4.6) sec at SDV versus 10.77 (3.8) sec at PV (P=0.004). No predictors of greater impairment of walking speed at SDV were identified.

CONCLUSION

This study suggests a clinical impact of bladder sensation on walking speed in IwMS and urinary disorders. None of the individual characteristics could predict greater decrease in gait velocity at SDV.

Controle postural estático e risco de quedas em mulheres idosas com e sem incontinência urinária

RESUMO A incontinência urinária (IU) está associada à ocorrência de quedas em idosos e pode ter relação com déficits no controle postural. O objetivo deste trabalho é comparar o controle postural estático, na condição de olhos abertos e fechados, e o risco de quedas entre idosas com IU e idosas sem IU. A amostra foi dividida em dois grupos: idosas com IU (n=21, idade=65,33±4,57 anos) e idosas sem IU (n=19, idade=66,37±5,26 anos). As características da perda urinária do grupo com IU foram avaliadas por meio do International Consultation on Incontinence Questionnaire: Short Form (ICIQ-SF). O controle postural estático dos grupos foi mensurado pelo deslocamento do centro de pressão (COP) por meio de uma plataforma de força; e o risco de quedas foi avaliado pelo teste timed up and go. Para a análise estatística, foi utilizado o teste U de Mann-Whitney e o teste qui-quadrado. A maioria das participantes com IU perdiam urina em pequena quantidade e todas perdiam em baixa frequência. Não foi observada diferença entre os grupos em relação às variáveis do COP (p>0,05) e o risco de quedas (p=0,082). Entretanto, na análise intragrupos, houve diferença na velocidade do COP de ambos os grupos na comparação olhos abertos versus olhos fechados (p<0,05). Não houve diferença no controle postural estático e no risco de quedas entre idosas com e sem IU.

Characteristics of Lower Limb Muscle Strength, Balance, Mobility, and Function in Older Women with Urge and Mixed Urinary Incontinence: An Observational Pilot Study

Purpose: After the age of 65, urinary incontinence (UI) occurs in one of every two women. A positive correlation between falls and urgency UI (UUI) or mixed UI (MUI) has also been identified. However, lower extremity impairments in older women with UUI or MUI have not been thoroughly investigated. The primary goal of this study was to compare lower limb strength, balance, mobility, and function in older women with and without UUI or MUI. The secondary goal was to evaluate the association between these measurements and UI severity. Method: A total of 40 older women with and without UUI or MUI completed standardized tests for lower limb strength (knee flexor or extensor dynamometry, 30-second sit-to-stand test), balance (single-leg stance test, Four Square Step Test, Activities-specific Balance Confidence questionnaire), mobility (10-metre walk test, 6-minute walk test), and function (Human Activity Profile questionnaire, 12-Item Short Form Health Survey). Results: Significant differences in balance and mobility were observed between the two groups. Women with UI had shorter single-leg stance times, lower balance confidence scores, and slower gait speeds. Conclusions: The results from this pilot study suggest that high-functioning older women with UUI or MUI have balance and mobility impairments. More studies are needed to confirm these results. By reporting power calculations for sample size, this pilot study provides a useful basis on which to design and conduct larger studies.

Proprioception in stress urinary incontinence: A narrative review

Background: Urinary incontinence (UI) is more common than any other chronic disease. Stress urinary incontinence (SUI), among the various forms of urinary incontinence, is the most prevalent (50%) type of this condition. Female urinary continence is maintained through an integrated function of pelvic floor muscles (PFMs), fascial structures, nerves, supporting ligaments, and the vagina. In women with SUI, the postural activity of the PFMs is delayed and the balance ability is decreased. Many women, by learning the correct timing of a pelvic floor contraction during a cough, are able to eliminate consequent SUI. Timing is an important function of motor coordination and could be affected by proprioception. This study was conducted to review and outline the literature on proprioception as a contributory factor in SUI.

Methods: PubMed, Scopus, and Google Scholar databases were systematically searched from 1998 to 2017 for articles on the topic of pathophysiology, motor control alterations, and proprioception role in women with SUI.

Results: A total of 6 articles addressed the importance of proprioception in motor control and its alterations in women with SUI. There were also publications on postural control, balance, and timing alterations in women with SUI in the literature. However, there was no research on measuring proprioception in the pelvic floor in this group.

Conclusion: Both the strength of the PFMs and the contraction timing and proprioception are important factors in maintaining continence. Thus, conducting research on PFMs proprioception in women with SUI, as a cause of incontinence, is encouraged.

Terminology of Pelvic Floor Muscle Function in Women With and Without Urinary Incontinence: A Systematic Review

BACKGROUND

Pelvic floor muscle function (PFMF) is a target of the physical therapist intervention for women with urinary incontinence (UI). However, possible variations in PFMF terminology might hamper communication among researchers and health care professionals in Women's Health.

OBJECTIVE

The objective of this study was to investigate the terminology of PFMF regarding clear terms, conceptual definitions, and operational definitions.

DATA SOURCES

Data sources include PUBMED, CINAHL, LILACS, and SCIELO.

STUDY SELECTION

Observational studies investigating any PFMF in women with or without UI, published in English, Spanish, or Portuguese from 2005 through 2017, were considered.

DATA EXTRACTION

The risk of bias was assessed by a questionnaire on the quality of observational studies. Data on terminology were extracted as terms, conceptual definitions, and operational definitions of PFMF and were synthesized according to key words, key ideas, and key operationalization, respectively. Consistencies and variations were identified for the most frequently investigated PFMF.

DATA SYNTHESIS

Sixty-four studies were included, and a low risk of bias was identified. All studies presented terms and operational definitions of PFMF, but only 29.7% presented conceptual definitions of those terms. One hundred ninety-six different terms referred to PFMF. According to similarities in terminology, 161 PFMF terms could be grouped under 26 terms; the other 35 were left ungrouped. Therefore, a total of 61 different PFMF terms were identified in the literature.

LIMITATIONS

A limitation in the study was that only observational studies were included.

CONCLUSIONS

A large variation in PFMF terminology was identified, precluding data gathering and meta-analysis. The lack of use of standardized terminology delays the progress of scientific knowledge and evidence-based practice dissemination. Efforts toward creating a collaborative, consensual terminology based on a sound framework are necessary.

A comparison of a step-initiation task in women with and without urinary incontinence. A case-control study

AIMS

The aim of the study was to objectively determine differences in postural response by women with and without urinary incontinence during a step-initiation task depending on the degree of bladder filling.

METHODS

The study comprised 22 women with stress urinary incontinence and 20 women without urinary incontinence. All women participated in four trials: unperturbed and perturbed (obstacle crossing) transition between platforms, step-up and step-down trials. Velocities of center of pressure displacement, double-support period, time from exit from steady standing until the lead foot resting on the other platform and time from raising the foot from the first platform until gaining quiet standing on the other platform were measured and compared.

RESULTS

No significant differences were noted between the performance of a step-initiation task by incontinent women with full/empty bladder whereas continent women performed differently during unperturbed transition with full/empty bladder. The step-up trial revealed significant intergroup differences. The antero-posterior mean velocity of center of pressure during the empty bladder test was significantly higher in women with stress urinary incontinence (effect size = 1.02). During the same bladder condition the women with stress urinary incontinence performed significantly more slowly in unperturbed (effect size = 1.09) and perturbed (effect size = 0.84) transition compared to control group.

CONCLUSIONS

Our results indicate that women with incontinence performed the step initiation task slowly on the empty bladder tests compare to continent women.

Functional assessment of the pelvic floor muscles by electromyography: is there a normalization in data analysis? A systematic review

ABSTRACT This study aims to evaluate the method of analysis of electromyographic data considering the functional assessment of pelvic floor muscles (PFM). We have included in our search strategy the following databases: Medline, PubMed, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, PEDro, and IBECS, considering articles published in the last ten years (2004-2014). The identified articles were independently examined by two evaluators, according to these inclusion criteria: (1) population: female adults; (2) PFM assessment by electromyography (EMG) with vaginal/anal probe; and (3) description of how electromyographic data analysis is performed. The Newcastle-Ottawa Scale (NOS) was used to assess the risk of bias. We identified 508 articles, of which 23 were included in the review. The data showed differences between the collection protocols, and a significant number of studies did not normalize the electromyographic data. Physiotherapists are among the clinicians who most frequently use EMG to evaluate the function and dysfunction of the neuromuscular system. Although some previous studies have provided an overview to guide the evaluator in the assessment, few succeeding studies followed their recommendations.

Dynamic lumbopelvic stabilization for treatment of stress urinary incontinence in women: Controlled and randomized clinical trial

OBJECTIVES

To compare the results of the dynamic lumbopelvic stabilization (DLS) exercises with exercises for the pelvic floor muscles (PFM) in women with stress urinary incontinence.

METHODS

Randomized controlled clinical trial comparing 17 women submitted to the DLS with 16 women submitted to the exercises for the PFM. The evaluated outcomes were incontinence severity, quality of life (QoL), and impression of improvement in three moments. Significance was set at 5%.

RESULTS

For socio-demographic and clinical variables, only climacteric was more prevalent in the DLS group (82% vs. 44%, P = 0.02). Soon after the intervention, there was no difference between the groups in relation to the outcomes evaluated. In the evaluation after 90 days, the DLS group presented better values for the severity of the losses (4.1 ± 2.6 vs. 5.7 ± 2.4, P = 0.006, d = 0.64), daytime frequency (4.6 ± 0.4 vs. 6.2 ± 0.6, P < 0.001, d = 2.67), and nighttime frequency (0.4 ± 0.3 vs. 1.4 ± 0.5, P < 0.001, d = 2.50), QoL and impression of improvement (P < 0.001).

CONCLUSIONS

After treatment, the DLS plus PFM exercise patients had results similar to those performing PFM exercises alone. However, the DLS plus PFM exercises were superior in the outcomes of incontinence severity, QoL, and impression of improvement in the post-90-day evaluation, showing longer lasting effect.

Static postural stability in women with stress urinary incontinence: Effects of vision and bladder filling

AIMS

This case-control study was designed to compare static postural stability between women with stress urinary incontinence and continent women and it was hypothesized that women with incontinence aged around 50 years also have balance disorders.

METHODS

Eighteen women with incontinence and twelve women without incontinence aged 50-55 years participated in two 60-s trials of each of four different testing conditions: eyes open/full bladder, eyes open/empty bladder, eyes closed/full bladder, eyes closed/empty bladder. The center of foot pressure (COP): sway range, root mean square, velocity (in the antero-posterior and medio-lateral directions), and COP area were recorded. The stabilograms were decomposed into rambling and trembling components.

RESULTS

The groups of women with and without incontinence differed during the full bladder condition in antero-posterior COP sway range, COP area, and rambling trajectory (range in the antero-posterior and medio-lateral directions, root mean square in the antero-posterior and medio-lateral directions and velocity in the antero-posterior direction).

CONCLUSION

The women with incontinence had more difficulty controlling their postural balance than continent women while standing with a full bladder. Therefore, developing therapeutic management focused on strengthening the women's core muscles and improving their postural balance seems advisable.

Children with nocturnal enuresis have posture and balance disorders

INTRODUCTION

Integration of the neuromuscular system is required for maintaining balance and adequate voiding function. Children with enuresis have delayed maturation of the motor cortex, with changes in the sensory and motor systems. Along with various alterations, including the genetic, hormonal, behavioral, and sleep disturbances, and neuromotor and sensory deficits associated with nocturnal enuresis (NE) in children and adults, a consistent alteration in the posture of children with NE has been observed in the current practice. Because posture and the balance control system are strongly connected, this study aimed to investigate posture and balance in children and teenagers with NE.

MATERIAL AND METHODS

A total of 111 children with enuresis were recruited to the enuretic group (EG) and 60 asymptomatic children made up the control group (CG). The participants were divided into two age subgroups: (A) 7-11 years old, N = 77 for EG/A, N = 38 for CG/A; and (B) 12-16 years old, N = 34 for EG/B, N = 22 for CG/B. Balance was assessed using an electronic force plate (100 Hz) to calculate the area of the center of pressure (COP) displacement. The COP is the point that results from the action of vertical forces projected onto the force plate. Sensory integration was analyzed using a 60-s trial with the subject standing under four conditions: (1) eyes open, stable surface; (2) eyes closed, stable surface; (3) eyes open, unstable surface; (4) eyes closed, unstable surface. Posture was assessed by placing reflective anatomical landmarks on the anterior superior iliac spine, the posterior superior iliac spine, the greater trochanter, and lateral malleolus. A photograph was taken while the subject stood quietly. The angles were obtained from landmark connections using software to assess the following posture variables: pelvic ante/retroversion and pelvic ante/retropulsion.

RESULTS

The EG showed a greater area of COP displacement compared with the CG under all four sensory conditions and both subgroups, except for EG/B in condition 3. Regarding posture, EG showed higher pelvic anteversion angles than CG.

CONCLUSIONS

Enuretic children showed forward inclination of the pelvis and had worse balance compared with control children.

Evaluation of bioelectrical activity of pelvic floor muscles and synergistic muscles depending on orientation of pelvis in menopausal women with symptoms of stress urinary incontinence: a preliminary observational study

OBJECTIVES

Evaluation of resting and functional bioelectrical activity of the pelvic floor muscles (PFM) and the synergistic muscles, depending on the orientation of the pelvis, in anterior (P1) and posterior (P2) pelvic tilt.

DESIGN

Preliminary, prospective observational study.

SETTING

Department and Clinic of Urology, University Hospital in Wroclaw, Poland.

PARTICIPANTS

Thirty-two menopausal and postmenopausal women with stress urinary incontinence were recruited. Based on inclusion and exclusion criteria, sixteen women aged 55 to 70 years were enrolled in the study.

PRIMARY OUTCOME MEASURES

Evaluation of resting and functional bioelectrical activity of the pelvic floor muscles by electromyography (sEMG) and vaginal probe.

SECONDARY OUTCOME MEASURES

Evaluation of activity of the synergistic muscles by sEMG and surface electrodes.

RESULTS

No significant differences between orientations P1 and P2 were found in functional and resting sEMG activity of the PFM. During resting and functional PFM activity, higher electrical activity in P2 than in P1 has been recorded in some of the synergistic muscles.

CONCLUSIONS

This preliminary study does not provide initial evidence that pelvic tilt influences PFM activation. Although different activity of synergistic muscles occurs in various orientations of the pelvic tilt, it does not have to affect the sEMG activity of the PFM.

[Prevalence and risk factors of urinary incontinence in women who visit the doctor with low back pain: multicentre study]

Objetivos

Estimar la prevalencia y los factores de riesgo de incontinencia urinaria (IU) en mujeres con dolor lumbopélvico (DLP) y describir sus características sociodemográficas y clínicas.

Diseño

Estudio observacional transversal.

Emplazamiento

Dos centros de Atención Primaria del Sur de Córdoba y un centro privado en Madrid.

Participantes

Trescientas sesenta y cuatro mujeres de 20-65 años (de 466 contactadas, 33 fueron excluidas y 69 rechazaron participar) que consultaron por dolor de espalda localizado entre la doceava costilla y el pliegue glúteo.

Intervenciones

Entrevista mediante cuestionario.

Mediciones principales

Cuestionarios (Índice de discapacidad de Oswestry y cuestionarios de IU [International Consultation on Incontinence Questionnaire SF e Cuestionario de Impacto de la Incontinencia-7]), prueba funcional (test ASLR) y comorbilidad de interés para la IU. Análisis estadístico descriptivo y multivariante.

Resultados

Se encontró IU en 155 mujeres (43%; IC del 95%, 37%-48%), en su mayoría de esfuerzo (83%) y mínimo impacto (60%). Frente a las continentes, las mujeres incontinentes presentaron diferencias significativas en la edad, el índice de masa corporal (IMC), el estado civil, el nivel de instrucción y la convivencia, el consumo de fármacos/día, el número de partos vaginales y totales, las intervenciones quirúrgicas abdominopélvicas, el asma, el estreñimiento, la hipertensión, la diabetes, el porcentaje de incapacidad y el test funcional ASLR. En el análisis multivariante, las variables que más influyen en la probabilidad de ser incontinente fueron el asma, la hipertensión, el estreñimiento, el número de partos totales, el IMC y el porcentaje de incapacidad.

Conclusiones

La prevalencia de IU en mujeres con DLP es mayor que la encontrada en mujeres de similar edad sin DLP. El asma, el estreñimiento y la paridad son los factores más influyentes en la aparición de IU.

Effect of airway control by glottal structures on postural stability

Maintenance of upright posture involves complex neuromotor processes that include control of thoracic and abdominal pressures. Control of airflow by glottal structures is a primary determinant of thoracic pressure and may have a role in control of postural stability. This study aimed to investigate the effect of modulation of airway control on upright postural stability during postural perturbations. Standing balance was gently perturbed in the sagittal plane during 7 breathing/voicing tasks that ranged from completely closed (breath-hold), to partially opened (voicing) or completely open (sigh) glottal conditions in 11 healthy adults. Dependent measures were peak amplitude of displacement of the thorax and center of pressure (CoP). When the glottis was completely open during sigh, thoracic displacement in response to the perturbation was greater than in all other conditions, regardless of direction of perturbation (post hoc, all P < 0.002). The absolute amplitude of CoP displacement was greater with backward perturbation (main effect, Direction P = 0.001) and was greater at both extremes of glottal modulation (glottis closed and completely open) than when the glottis was partially opened during counting out loud (post hoc, all P < 0.04). These results show that airway modulation affects postural control during upright perturbations. The thorax was more stable when the glottis was engaged than when it was required to remain open, whereas control of CoP displacement appeared more optimal during the natural dynamic mid-range airway modulation of voicing. These data suggest that glottal control influences balance, and that glottal control strategies may be an important consideration for patients with breathing and/or balance disorders.

'The core': understanding it, and retraining its dysfunction

"Core stability training" is popular in both the therapeutic and fitness industries but what is actually meant and understood by this concept? And does everyone need the same training approach? This paper examines the landscape of 'the core' and its control from both a clinical and research perspective. It attempts a comprehensive review of its healthy functional role and how this is commonly changed in people with spinal and pelvic girdle pain syndromes. The common clinically observable and palpable patterns of functional and structural change associated with 'problems with the core' have been relatively little described. This paper endeavors to do so, introducing a variant paradigm aimed at promoting the understanding and management of these altered patterns of 'core control'. Clinically, two basic subgroups emerge. In light of these, the predictable difficulties that each group finds in establishing the important fundamental elements of spino-pelvic 'core control' and how to best retrain these, are highlighted. The integrated model presented is applicable for practitioners re-educating movement in physiotherapy, rehabilitation, Pilates, Yoga or injury prevention within the fitness industry in general.

The effects of repetitive haemarthrosis on postural balance in children with haemophilia

Sensory information from visual, vestibular and proprioceptive systems is necessary to control posture and balance. Impairment in proprioception due to repetitive joints bleeding may lead to a deficit in postural balance which, in turn, leads to high joint stress and risk of bleeding recurrence. Despite the increase in attention in this field during the past few years, the data concerning to how bleeds can affect postural control in children with haemophilia (CWH) remain scarce. This study aimed to evaluate the postural balance in CWH. Twenty CWH Haemophilia Group (HG) and 20 age-matched children Control Group (CG) were recruited to this study. A force plate was used to record centre of pressure (COP) displacement under four different postural conditions during quiet standing: eyes open on firm surface, eyes open on foam surface, eyes closed on firm surface and eyes closed on a foam surface. Variables of COP as sway area and mean velocity and in anterior-posterior (y) medio-lateral (x) direction were processed and for each variable sensory, quotients were calculated and compared between groups. No differences were found in visual and vestibular quotients variables between groups. A higher value was found in sway area variable on proprioception quotient in the HG when compared with CG (P = 0.042). CWH with repetitive joint bleed on lower limbs showed differences in postural balance when compared with non-haemophiliac children. The identification of early balance impairments in CWH can help us understand better the effects of bleeds inside joints on postural control and plan a more effective preventive and rehabilitative treatment.

Effects of PFM rehabilitation on PFM function and morphology in older women

AIMS

The purpose of this study was to examine the effect of a pelvic floor muscle (PFM) rehabilitation program on incontinence symptoms, PFM function, and morphology in older women with SUI.

METHODS

Women 60 years old and older with at least weekly episodes of SUI were recruited. Participants were evaluated before and after a 12-week group PFM rehabilitation intervention. The evaluations included 3-day bladder diaries, symptom, and quality of life questionnaires, PFM function testing with dynamometry (force) and electromyography (activation) during seven tasks: rest, PFM maximum voluntary contraction (MVC), straining, rapid-repeated PFM contractions, a 60 sec sustained PFM contraction, a single cough and three repeated coughs, and sagittal MRI recorded at rest, during PFM MVCs and during straining to assess PFM morphology.

RESULTS

Seventeen women (68.9 ± 5.5 years) participated. Following the intervention the frequency of urine leakage decreased and disease-specific quality of life improved significantly. PFM function improved significantly: the participants were able to perform more rapid-repeated PFM contractions; they activated their PFMs sooner when coughing and they were better able to maintain a PFM contraction between repeated coughs. Pelvic organ support improved significantly: the anorectal angle was decreased and the urethrovescial junction was higher at rest, during contraction and while straining.

CONCLUSIONS

This study indicated that improvements in urine leakage were produced along with improvements in PFM co-ordination (demonstrated by the increased number of rapid PFM contractions and the earlier PFM activation when coughing), motor-control, pelvic organ support.

Eletromiografia de superfície para avaliação dos músculos do assoalho pélvico feminino: revisão de literatura

A eletromiografia de superfície tem grande importância clínica e de pesquisa para o fisioterapeuta. Apesar de captar a atividade elétrica promovida pelo recrutamento das unidades motoras, há boa correlação entre o número de unidades ativadas e a força muscular. É um dos métodos de maior especificidade na avaliação do assoalho pélvico, embora não haja consenso em relação à sua aplicação. Essa revisão de literatura foi desenvolvida com o objetivo de agrupar as informações sobre o uso da eletromiografia de superfície na avaliação do assoalho pélvico. Foram pesquisados artigos nas bases de dados Medline, PubMed, Lilacs, SciELO e Biblioteca Cochrane, e selecionados os que avaliassem o assoalho pélvico feminino por meio de eletromiografia de superfície. Apesar de sua metodologia ainda carecer de padronização, é um instrumento que deve ser considerado nas pesquisas científicas em nosso meio, pois parece apresentar boa reprodutibilidade e confiabilidade. Pacientes com disfunções do assoalho pélvico possuem alterações no tempo de ativação dos músculos do assoalho pélvico (MAP) e músculos abdominais. Quanto à gestação e puerpério, ainda faltam evidências sobre possíveis alterações da ativação elétrica dos MAP nesses períodos.

The positive effect of mirror visual feedback on arm control in children with spastic hemiparetic cerebral palsy is dependent on which arm is viewed

Mirror visual feedback has previously been found to reduce disproportionate interlimb variability and neuromuscular activity in the arm muscles in children with Spastic Hemiparetic Cerebral Palsy (SHCP). The aim of the current study was to determine whether these positive effects are generated by the mirror per se (i.e. the illusory perception of two symmetrically moving limbs, irrespective of which arm generates the mirror visual feedback) or by the visual illusion that the impaired arm has been substituted and appears to move with less jerk and in synchrony with the less-impaired arm (i.e. by mirror visual feedback of the less-impaired arm only). Therefore, we compared the effect of mirror visual feedback from the impaired and the less-impaired upper limb on the bimanual coupling and neuromuscular activity during a bimanual coordination task. Children with SHCP were asked to perform a bimanual symmetrical circular movement in three different visual feedback conditions (i.e. viewing the two arms, viewing only one arm, and viewing one arm and its mirror image), combined with two head orientation conditions (i.e. looking from the impaired and looking from the less-impaired body side). It was found that mirror visual feedback resulted in a reduction in the eccentric activity of the Biceps Brachii Brevis in the impaired limb compared to the condition with actual visual feedback from the two arms. More specifically, this effect was exclusive to mirror visual feedback from the less-impaired arm and absent when mirror visual feedback from the impaired arm was provided. Across conditions, the less-impaired arm was the leading limb, and the nature of this coupling was independent from visual condition or head orientation. Also, mirror visual feedback did not affect the intensity of the mean neuromuscular activity or the muscle activity of the Triceps Brachii Longus. It was concluded that the positive effects of mirror visual feedback in children with SHCP are not just the result of the perception of two symmetrically moving limbs. Instead, in order to induce a decrease in eccentric neuromuscular activity in the impaired limb, mirror visual feedback from the ‘unaffected’ less-impaired limb is required.

Global Postural Re-education: an alternative approach for stress urinary incontinence?

OBJECTIVE

The aim of this study was to evaluate the impact of Global Postural Re-education (GPR) on stress urinary incontinence symptoms and to compare it to Pelvic Floor Muscle Training (PFMT).

STUDY DESIGN

Fifty-two women with stress urinary incontinence were distributed into two groups: Group 1 (G1) was submitted to weekly sessions of GPR for three months and Group 2 (G2) performed Pelvic Floor Muscle Training four times a week for three months. Patients were evaluated through the King's Health Questionnaire, a three-day voiding diary including daily pad use and a Functional Evaluation of the Pelvic Floor (FEPF), before treatment (T0), at the end of treatment (T1) and six months after treatment (T2).

RESULTS

The number of leaking episodes dropped significantly in both groups at the end of treatment and at six months follow-up, with a significantly greater decrease in G1. Daily pad use dropped significantly in both groups. At the end of treatment, 72% of the patients in G1 and 41% of the patients in G2 needed no pads and at six-month follow-up, 84% and 50%, respectively. FEPF improved significantly in both groups, with no significant difference between the groups (P=0.628). The King's Health Questionnaire demonstrated significant improvement in both groups and in all domains. The GPR group presented higher adherence to treatment, with no dropouts.

CONCLUSIONS

GPR could represent an alternative method to treat stress urinary incontinence in women, should the results be long lasting.

Correlation between the Severity of Female Urinary Incontinence and Concomitant Morbidities: A Multi-Center Cross-Sectional Clinical Study

Purpose

The aim of this study was to identify the relationship between urinary incontinence (UI) and low back pain (LBP) discomfort and disability, static balance, and demographic factors.

Methods

A total of 348 women aged 20-80 years were included in this cross-sectional study. The general characteristics of the subjects and the main outcome (UI condition, LBP discomfort, LBP disability, and static balance ability) were assessed by using clinical questionnaires and assessment tools.

Results

Of all the subjects, 22.8% had experienced UI. Women with UI showed a significantly higher relationship of LBP and disability, and static balance ability (P<0.01). We found a significant correlation between UI, age, LBP and disability, and static balance ability (P<0.01).

Conclusions

These findings suggest that UI correlates negatively with LBP discomfort, LBP disability, and static balance ability. Further studies should focus on the identification of the precise mechanisms underlying UI and its related physical symptoms and on the development of therapeutic strategies to manage this condition.

Mirror visual feedback induces lower neuromuscular activity in children with spastic hemiparetic cerebral palsy

The study examined the effects of mirror feedback information on neuromuscular activation during bimanual coordination in eight children with spastic hemiparetic cerebral palsy (SHCP) and a matched control group. The 'mirror box' creates a visual illusion, which gives rise to a visual perception of a zero lag, symmetric movement between the two arms. The study incorporated two additional visual feedback conditions by placing a glass or opaque screen between the arms. During bilateral symmetric circular arm movements mirror visual feedback induced lower neuromuscular intensities in the shoulder muscles of the less impaired arm of children with SHCP compared to the other visual conditions. In addition, the mirror lead to shorter relative durations of eccentric and concentric activity in the elbow muscles of the more impaired arm, whereas no effects of visual feedback were found in a matched control group. These results suggest that replacing veridical visual information of the more impaired arm with a mirror reflection of the less impaired arm improves the motor control of children with SHCP during interlimb coupling. The effects of the availability of visual feedback in individuals with hemiparesis are discussed with reference to: (1) increase ipsilateral motor cortex excitability and (2) congruence between afferent (visual) feedback and the internal copy of the motor commands.

Prevalence of urinary incontinence in women with osteoporosis

OBJECTIVE

To investigate the prevalence and frequency of urinary incontinence in women presenting to a specialist osteoporosis clinic.

METHODS

Participants included 412 female patients aged 22 to 94 years (mean 62 years) presenting to a hospital-based specialist multidisciplinary osteoporosis clinic over one year. The presence or absence of urinary incontinence, urgency without leakage, type of symptoms (stress, urge, mixed) and frequency of urinary incontinence were recorded.

RESULTS

Sixty-seven percent of patients (277/412) reported some symptoms of urinary incontinence, 23% reported no symptoms and 10% reported urgency without any leakage. Of those who reported some urinary incontinence, 51% reported symptoms of stress incontinence, urgency, and urge incontinence. Almost 40% of all patients (163/412) and 59% of those with any urinary incontinence (163/277) reported leakage at least once per week.

CONCLUSION

The prevalence of at least weekly urinary incontinence in this population is much higher than that reported in studies of other older adult female populations. There is also a high prevalence of incontinence accompanied by urgency in women with osteoporosis. Based on these results and because urinary incontinence can limit a woman's ability to be physically active and increase the risk of falls and fractures, screening for incontinence should be a routine part of osteoporosis management. Clinicians seeing patients for osteoporosis should consider the presence of incontinence when prescribing exercise for bone health and fall prevention.

Vibratory perception and female stress urinary incontinence

PURPOSE

We investigated the value of measuring the vibratory perception threshold with a biothesiometer to clinically evaluate women with stress urinary incontinence.

MATERIALS AND METHODS

The study consisted of 3 groups, including group 1--66 women with stress urinary incontinence, group 2--44 age matched women without stress urinary incontinence and group 3--60 younger women without stress urinary incontinence. A total of 50 patients with stress urinary incontinence underwent videourodynamics. Using a biothesiometer the vibratory perception threshold was measured over the middle finger, middle toe and clitoris in all study subjects. A higher threshold indicated lower sensitivity to vibratory stimulation. Motions leading to stress urinary incontinence were also determined.

RESULTS

The stress urinary incontinence and age matched control groups were older than the younger control group and had greater parity. The incontinence group had a higher vibratory perception threshold than the younger control group but there was no difference between women with incontinence and age matched women without incontinence. Women in whom incontinence was induced by walking upstairs or downstairs had a higher finger and toe vibratory perception threshold than those without incontinence. The threshold in the groups with and without intrinsic sphincter deficiency did not differ significantly.

CONCLUSIONS

Vibratory perception is not related to stress urinary incontinence in females. Finger and toe vibratory perception is less sensitive in patients with stress urinary incontinence while walking upstairs or downstairs.

The reliability of surface EMG recorded from the pelvic floor muscles

The neuromuscular function of the pelvic floor muscles (PFMs) is frequently evaluated using surface electrodes embedded on vaginal probes. The purpose of this study was to determine the between-trial and between-day reliability of EMG data recorded from the PFM using two different vaginal probes while subjects performed PFM maximum voluntary contractions and a coughing task. The Femiscan and the Periform vaginal probes were used to acquire EMG data while the subjects performed the tasks. Peak RMS amplitudes were computed for each instrument, task, and side of the pelvic floor using a sliding window technique. The between-trial reliability was evaluated using intraclass correlation coefficients (ICCs) and coefficients of variation (CV). Between-trial reliability was determined using ICCs, Pearson's correlation coefficients, computing the mean absolute difference between days, and calculating the standard error the measurement (SEM) for each instrument and task. EMG amplitude differences were detected between the left and right PFM (p<0.05), therefore all of the analyses were performed separately for each side. Overall, between-trial reliability was fair to high for the Femiscan (ICC((3,1))=0.58-0.98, CV=8.5-20.7%) and good to high for the Periform (ICC((3,1))=0.80-0.98, CV=9.6-19.5%), however between-day reliability was generally poor for both vaginal probes (ICC((3,1))=0.08-0.84). The results suggest that although it is acceptable to use PFM surface EMG as a biofeedback tool for training purposes, it is not recommended for use to make between-subject comparisons or to use as an outcome measure between-days when evaluating PFM function.

Motor control patterns during an active straight leg raise in chronic pelvic girdle pain subjects

STUDY DESIGN

Repeated measures.

OBJECTIVE

To investigate motor control (MC) patterns in chronic pelvic girdle pain (PGP) subjects during an active straight leg raise (ASLR).

SUMMARY OF BACKGROUND DATA

The ASLR is a test used to assess load transference through the pelvis. Altered MC patterns have been reported in subjects with chronic PGP during this test. These patterns may impede efficient load transfer, while having the potential to impinge on respiratory function and/or to adversely affect the control of continence.

METHODS

Twelve female subjects with chronic PGP were examined. Electromyography of the anterior abdominal wall, right chest wall and the scalene, intraabdominal pressure, intrathoracic pressure, respiratory rate, pelvic floor kinematics, and downward leg pressure of the nonlifted leg were compared between an ASLR lifting the leg on the affected side of the body versus the nonaffected side.

RESULTS

Performing an ASLR lifting the leg on the affected side of the body resulted in a predominant MC pattern of bracing through the abdominal wall and the chest wall. This was associated with increased baseline shift in intraabdominal pressure and depression of the pelvic floor when compared with an ASLR lifting the leg on the nonaffected side.

CONCLUSION

This MC pattern, identified during an ASLR on the affected side of the body, has the potential to be a primary mechanism driving ongoing pain and disability in chronic PGP subjects.