A Bearinger, SPT; B Cobb, SPT; L Shank, SPT; M Gevontmakher, SPT

Transcription

1 What goes up must come down? An analysis of the Periform Plus intravaginal sensor with indicator using simultaneous Ultrasound imaging and Surface Electromyography in healthy continent women. A Bearinger, SPT; B Cobb, SPT; L Shank, SPT; M Gevontmakher, SPT Faculty Advisors: Dr. Ruth Maher, PT, DPT, WCS, BCB-PMD,CEAS. Dr. Jeanne Welch, PT, DPT, NCS

2 Background Information The International Continence Society (ICS) has described 7 different types of urinary incontinence. Stress urinary incontinence (SUI) is the most prevalent type and affects 1 in 3 women. Symptoms include urinary leakage upon exertion such as coughing, sneezing, laughing or exercise. Despite its prevalence it is not a normal part of aging.

3 Background Information The Coughing Bladder The Laughing Bladder

4 Background Information Over $12 billion is spent annually in the U.S. for SUI; this does not account for the social or emotional cost of living with SUI. SUI a silent epidemic and few health care providers inquire as to its presence. The causes are multifaceted pelvic floor weakness, in addition to poor coordination and timing of contractions have been identified as a contributing factor.

5 Background Information Few health care professionals are trained with regard to PFM function, assessment or examination. Literature shows that over 80% will benefit from PFM exercises if performed correctly. Difficult to perform or confirm a correct PFM contraction as the muscles do not move a joint and are not clearly visible or palpable. The most common method of instruction is by verbal description of how to perform the correct contraction. Less than 40% of women can perform PFM contractions correctly when given verbal instructions.

6 Background Information Devreese et al. (2007) determined that incontinent patients performed a PFM contraction that most closely resembled a continent PFM contraction pattern in standing as compared to supine, supine with knees bent, and sitting upright. Several other studies have shown a positional/postural effect on PFM contractions. Recent study showed the the presence of vaginal probes did not affect PFM activation

7 Background Information Many women use adjunctive methods to enhance PFM recruitment and strength Vaginal cones/weights Electrical stimulation Biofeedback which takes many forms

8 Purpose of our study Determine if the direction and amount of displacement of the external indicator of the Periform Plus sensor confirms if an appropriate PFM contraction is occurring. AND Determine if displacement of the indicator is associated with direction and displacement noted on ultrasound imaging (US) and the magnitude of pelvic floor muscle (PFM) activity assessed via semg.

9 The Periform/Educator Suggested Training positions Educator Periform with semg

10 Study Design, materials & methods Observational pilot study with 5 college aged women who could perform an appropriate PFM contraction in supine and standing. An appropriate PFM was defined as a contraction which resulted in cranial displacement/encroachment of the bladder assessed with transabdominal US imaging.

11 Study Design, materials & methods Each participant completed a bladder filling protocol to allow for delineation of structures during US imaging. Periform sensors were used for acquisition of semg data and an external indicator was affixed to each sensor.

12 Study Design, materials & methods To protect participant modesty each wore an adult diaper(nappy) with a cutout to provide space for the indicator to move.

13 Study Design, materials & methods 4 randomly ordered positions were assessed: 1. Standing barefoot on flat floor 2. Supine with feet flat against a wall 3. Supine with feet relaxed 4. Crooklying supine knees flexed to 90 Each participant performed 5 PFM contractions of 5 secs duration with 5 sec rest between repetitions. Two minutes rest was given between each position.

14 Study Design, materials & methods All US imaging was acquired transabdominally using a MyLabGold 25 US unit and a curvilinear transducer (Esaote, Indianopolis, IN). semg (RMS) activity was acquired using MyTrac Infiniti and processed using BioGraph Infiniti software (Thought Technology, Montreal, CA).

15 Study Design, materials & methods Displacement of the Periform indicator was assessed in centimeters using the a customized measuring device. Bubble levels were fixed to the unit to ensure the position of the unit was standardized during assessment.

16 Assessing displacement of Periform indicator with simultaneous US imaging and semg

17 Methods

18 Standing

19 Supine

20 Supine 90

21 Supine feet against Wall

22 Bladder Displacement during PFM Contractions Supine Supine Standing Supine feel at wall

23 Results Position Mean Periform Indicator displacement (cm) Direction of Ultrasound Displacement Mean Maximal EMG (µv) Supine 2.34 ± % => 40% ** ± Supine feet flat at wall 2.30 ± % => 20% ** ± Hooklying Standing 2.47 ± ± % 100% ± ± all displacement was down cranial displacement on US imaging caudal displacement on US imaging ** Those with caudal displacement exhibited the highest semg values

24 Conclusion Few studies if any have evaluated vaginal biofeedback devices using simultaneous US imaging and semg. This pilot study showed that the direction of the indicator on the Periform Plus did not always correlate with the direction of displacement on US imaging during PFM contractions. Increases in IAP was noticeable indicating the participants used different strategies in different positions to perform a PFM.

25 Conclusion Caution should be exercised when relying on semg to confirm a PFM contraction. The findings of our study concur with those of Thompson et al. (2006) who showed that increased abdomino-pelvic semg activity occurred during a Valsalva/caudal displacement.

26 Implications for clinical practice Caution should be exercised when solely relying on the directional displacement of the indicator. Strategy of performing a PFM was affected by participant position. Clinicians should monitor abdominal muscle recruitment and not just PFM recruitment and should teach patients simple strategies to do the same.

27 Questions

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