EMG registration of the pelvic floor and pelvic floor muscle activity patterns during, abdominal, hip adductor, and gluteal muscle contractions in healthy women

Commercially available bi-polar EMG probes are not valid to use as a comparison
between different sessions within patients and comparison between patients.
Besides this, the electrodes of these probes cover multiple muscles and giving
a summation of EMG signals, making the resulting differential signal invalid
and unfitted for any comparison.
The MAPLe is the only commercially available probe which is used in a unipolar
configuration. This makes the MAPLe valid for comparison between other muscles
and between individuals. Furthermore, the location of the electrodes is
validated in MRI and 2D and 3D ultrasound. The results show that the single
electrodes are located nearest to the individual muscles of the pelvic floor
(5). Also, the MAPLe has small electrode surfaces, making it less sensitive for
cross-talk. Besides this, the size of the probe (15mm in circumference) is
chosen to be as minimally invasive as possible to prevent a reaction of the PFM
to the presence of the probe. Also, the MAPLe has a standard location for
orientation and depth, assuring an optimal placement and replacement of the
probe. On the contrary, the electrodes of MAPLe are located nearest to the
individual muscles of the pelvic floor and capable of differentiating between
these muscles. Research shows that it is proven to be reliable and valid. This
makes it possible to make a comparison of EMG activity of individual muscles
within and between patients.

Relationships among the PFM and abdominal muscles are thought to exist in order
to allow women to maintain for example urinary continence in situations of
elevated urethral pressure (6-8). Co-activation of the abdominal muscles
appears to contribute to the generation of a strong PFM
Sapsford et al. found that the PFM were activated during abdominal muscle
contractions and that the converse was also true, that is, the abdominal
muscles were activated during PFM contractions (7). Similarly, Neumann and
Gill reported that it was not possible for continent women to fully contract
their PFM without also contracting their transversus abdominis and the
internal oblique muscles (8). Bo et al. , in studying three physiotherapists
who were well trained in isolating PFM contractions, determined that these
individuals were not able to perform a maximal PFM contraction without a rise
in EMG activity in the lower portion of rectus abdominus (6).
Together, these studies indicate that there is co-activation between the PFM
and abdominal muscles. However, literature addressing the crosstalk problem is
scarce and oftentimes flawed (9).

To describe the EMG activity of the pelvic floor muscles (PFM) with a bi-polar
EMG probe and the MAPLe and effect on the registered EMG activity with the
probes in relation to the contractions of the muscles surrounding the pelvic
floor.
To describe the validity and reliability of the fixation rings on the MAPLE for
EMG measurements in sitting and standing position

Ten healthy pelvic floor physiotherapists without no known history of
incontinence, neurological disease, or urinary tract infection and able to
perform a correct pelvic floor muscle contraction using the MAPLe in daily
practice will be approached by mailthe SOMT if they want voluntarily
participate in this research.
The ability to voluntary contract the PFM will be evaluated by vaginal
palpation.
A commercially available bi-polar EMG probe (Periform, Neen) and the Multiple
Array Probe Leiden (MAPLe, Novuqare Pelvic Health) will be used for EMG
registrations. EMG activity will be recorded continuously with the participants
lying in a supine position and the knees bend and supported, in sitting and in
standing position.
Crosstalk from the EMG activity will be evaluated in supine, sitting and
standing position:
1. pelvic floor alone : Rest, Maximum Voluntary Contraction (MVC) and endurance
2. hip adductor contraction with resistance, during rest, MVC and endurance of
the pelvic floor
3. gluteal muscle contraction, , during rest, MVC and endurance of the pelvic
floor
4. contraction of the M.Transversus abdominus, , during rest, MVC and endurance
of the pelvic floor
5. backward tilting of the pelvis, , during rest, MVC and endurance of the
pelvic floor
6. Lifting the head, during rest, MVC and endurance of the pelvic floor

The procedure will be performed with probe placed vaginally and observation of
inward movement of the perineum during contraction.
An integrated EMG with estimation of the area covered by the interference EMG
curve was chosen as an overall measure for the total increase in muscle
activity.
Coughing and Valsalva are omitted because of the displacement of the probe
during these manoeuvres. Coughing and Valsalva are expected to be
heterogeneous, with low reliability, in clinical test situations. Potential
crosstalk from other muscles involved in coughing could limit the
interpretation of our results (10).

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