Rehabilitative Ultrasound Imaging of Pelvic Floor Muscle Function

Abstract

found that 78% of women with LBP report concurrent UI. As such, there is a need for physical therapists to have access to tools that accurately evaluate the various aspects of pelvic floor muscle function (elevating and occlusion functions, as well as neuromuscular control, strength, and endurance) both in laboratory and clinical environments.Ultrasound imaging is a potential tool that has been used to evaluate the morphology 7,52 and certain components of the function 24,27,67,81,82,86 of these muscles. Specifically, ultrasound imaging has been shown to be more specific than intravaginal palpation for measurement of the lifting action of the pelvic floor muscles on the bladder neck 31 and base, 20,31 and it provides information about the supporting function of the pelvic floor muscles during various maneuvers. 20,57,85 As the use of rehabilitative ultrasound imaging for assessment of pelvic floor muscles function is a relatively new procedure, the goal of this commentary i t is well accepted that the pelvic floor muscles, specifically the levator ani, provide an important contribution to the continence mechanism.17 is to provide an understanding of current applications, the available quantitative and qualitative information, the associated limitations, and to show how rehabilitative ultrasound imaging can be incorporated as a form of biofeedback during rehabilitation. Furthermore, as the compilation and comparison of data depends on consistency of measurement techniques, this commentary highlights considerations for measurement accuracy and interpretation and provides generic guidelines for future investigation based upon international consensus. 80QuantitatiVe eVaLuation u ltrasound imaging has been used to measure the morphology 7,52 of the pelvic floor muscles. It has also been used to measure the impact of pelvic floor muscle contraction or increase in intra-abdominal pressure (straining, cough, sneeze, or leg-raising task) on the bladder from a variety of approaches (transperineal and transabdominal; Figure 1), planes (sagittal and transverse), and positions. 6,22,27,57,61,67,76,83,84,96 The transperineal approach (placement of the ultrasound transducer in a sagittal plane along the midline of the perineum) is considered advantageous to the transabdominal approach, as both the pubic symphysis and the proximal junction of the bladder neck and urethra are included within the field of view and can serve

Pelvic floor muscle displacement during voluntary and involuntary activation in continent and incontinent women: a systematic review

“…A larger lift may result from either a forceful PFM contraction or increased fascial laxity. In contrast, a small lift observed during a voluntary PFM contraction may indicate either a weak contraction or high PFM resting activity [37,57,58]. Kelly et al [24] found displacement to be positiondependent too, with more displacement of the bladder base in the standing than in the crook-lying position.…”

“…Comparing TAUS with TPUS showed 85 % agreement for assessing the direction of movement during voluntary contraction [57]. Other authors addressed potential transducer movement with TAUS leading to misinterpretation [58]. Reddy et al [40] took the probe movement into account when assessing the magnitude of BN movement by TPUS and thereby suggested correcting the value of BN motion.…”

Effects of percutaneous posterior tibial nerve stimulation on voiding dysfunctions in cerebral palsy: A case report

“…Abdomen was exposed from xiphoid to symphysis pubis. Transducer was pressed against the midline just above the symphysis pubis [10]. The bladder urine volume was measured by ultrasound before voiding and PVR volum was measured immediately after voiding [3].…”

Ultrasound Imaging as a Feedback Tool in the Rehabilitation of Trunk Muscle Dysfunction for People With Low Back Pain

“…nly preliminary work on the use of RUSI as a feedback tool has been performed in those with LBP, 6,43,45,49 and pelvic floor dysfunction. 6,4,9 However, the potential applications for this method of feedback are far-reaching.…”