Top

Published in:

01-10-2020 | Stress Incontinence | Original Article

Electromyography of pelvic floor muscles with true differential versus faux differential electrode configuration

Authors: Claudia Ballmer, Patric Eichelberger, Monika Leitner, Helene Moser, Helena Luginbuehl, Annette Kuhn, Lorenz Radlinger

Published in: International Urogynecology Journal | Issue 10/2020

Abstract

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, FVC_4peak 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.

Bø K, Sherburn M. Evaluation of female pelvic-floor muscle function and strength. Phys Ther. 2005;85:269.CrossRef

Auchincloss C, McLean L. The reliability of surface EMG recorded from the pelvic floor muscles. J Neurosci Methods. 2009;182:85–96. https://doi.org/10.1016/j.jneumeth.2009.05.027.CrossRefPubMed

Enck P, Vodušek DB. Electromyography of pelvic floor muscles. J Electromyogr Kinesiol. 2006;16:568–77. https://doi.org/10.1016/j.jelekin.2006.08.007.CrossRefPubMed

Grape H, Dedering Å, Jonasson A. Retest reliability of surface electromyography on the pelvic floor muscles. Neurourol Urodyn. 2009;28:395–9. https://doi.org/10.1002/nau.20648.CrossRefPubMed

Koenig I, Luginbuehl H, Radlinger L. Reliability of pelvic floor muscle electromyography tested on healthy women and women with pelvic floor muscle dysfunction. Ann Phys Rehabil Med. 2017;60:382–6. https://doi.org/10.1016/j.rehab.2017.04.002.CrossRefPubMed

Luginbuehl H, Baeyens JP, Kuhn A, Christen R, Oberli B, Eichelberger P, et al. Pelvic floor muscle reflex activity during coughing—an exploratory and reliability study. Ann Phys Rehabil Med. 2016;59:302–7. https://doi.org/10.1016/j.rehab.2016.04.005.CrossRefPubMed

Dumoulin C, Hay-Smith EJ, Mac Habee-Seguin G (2014) Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. (5):CD005654. https://doi.org/10.1002/14651858.CD005654.pub3.

Keshwani N, McLean L. State of the art review: intravaginal probes for recording electromyography from the pelvic floor muscles. Neurourol Urodyn. 2015;34:104–12. https://doi.org/10.1002/nau.22529.CrossRefPubMed

Flury N, Koenig I, Radlinger L. Crosstalk considerations in studies evaluating pelvic floor muscles using surface electromyography in women: a scoping review. Arch Gynecol Obstet. 2017;295:799–809. https://doi.org/10.1007/s00404-017-4300-5.CrossRefPubMed

10.

Hermens HJ, Freriks B, Disselhorst-Klug C, Rau G. Development of recommendations for SEMG sensors and sensor placement procedures. J Electromyogr Kinesiol. 2000;10:361–74. https://doi.org/10.1016/S1050-6411(00)00027-4.CrossRefPubMed

11.

Shafik A. A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation: mass contraction of the pelvic floor muscles. Int Urogynecol J Pelvic Floor Dysfunct. 1998;9:28–32.CrossRef

12.

Thor KB, de Groat WC. Neural control of the female urethral and anal rhabdosphincters and pelvic floor muscles. Am J Physiol Regul Integr Comp Physiol. 2010;299:R416–38. https://doi.org/10.1152/ajpregu.00111.2010.CrossRefPubMedPubMedCentral

13.

Madill SJ, Harvey MA, McLean L. Women with stress urinary incontinence demonstrate motor control differences during coughing. J Electromyogr Kinesiol. 2010;20:804–12. https://doi.org/10.1016/j.jelekin.2009.10.006.CrossRefPubMed

14.

Madill SJ, Harvey MA, McLean L. Women with SUI demonstrate motor control differences during voluntary pelvic floor muscle contractions. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20:447–59. https://doi.org/10.1007/s00192-008-0800-y.CrossRefPubMed

15.

Leitner M, Moser H, Eichelberger P, Kuhn A, Radlinger L. Evaluation of pelvic floor muscle activity during running in continent and incontinent women: an exploratory study. Neurourol Urodyn. 2017;36:1570–6. https://doi.org/10.1002/nau.23151.CrossRefPubMed

16.

Moser H, Leitner M, Eichelberger P, Kuhn A, Baeyens JP, Radlinger L. Pelvic floor muscle activity during jumps in continent and incontinent women: an exploratory study. Arch Gynecol Obstet. 2018;297:1455–63. https://doi.org/10.1007/s00404-018-4734-4.CrossRefPubMed

17.

Bump RC, Mattiasson A, Bø K, Brubaker LP, DeLancey JO, Klarskov P, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175:10–7.CrossRef

18.

Avery K, Donovan J, Peters TJ, Shaw C, Gotoh M, Abrams P. ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn. 2004;23:322–30. https://doi.org/10.1002/nau.20041.CrossRefPubMed

19.

Laycock J, Jerwood D. Pelvic floor muscle assessment: the PERFECT scheme. Physiotherapy. 2001;87:631–42.CrossRef

20.

Chmielewska D, Stania M, Sobota G, Kwaśna K, Błaszczak E, Taradaj J, et al. Impact of different body positions on bioelectrical activity of the pelvic floor muscles in nulliparous continent women. Biomed Res Int. 2015;2015:905897. https://doi.org/10.1155/2015/905897.CrossRefPubMedPubMedCentral

21.

Hodges P, Bui BH. A comparison of computer-based methods for the determination of onset of muscle contraction using electromyography. Electroencephalogr Clin Neurophysiol. 1996;101:511-519. https://doi.org/10.1016/S0921-884X(96)95190-5.CrossRefPubMed

22.

Pataky TC, Vanrenterghem J, Robinson MA. Zero- vs. one-dimensional, parametric vs. non-parametric, and confidence interval vs. hypothesis testing procedures in one-dimensional biomechanical trajectory analysis. J Biomech. 2015;48:1277–85. https://doi.org/10.1016/j.jbiomech.2015.02.051.CrossRefPubMed

23.

Wren TA, Do KP, Rethlefsen SA, Healy B. Cross-correlation as a method for comparing dynamic electromyography signals during gait. J Biomech. 2006;39:2714–8. https://doi.org/10.1016/j.jbiomech.2005.09.006.CrossRefPubMed

24.

Robinson MA, Vanrenterghem J, Pataky TC. Statistical parametric mapping (SPM) for alpha-based statistical analyses of multi-muscle EMG time-series. J Electromyogr Kinesiol. 2015;25:14–9. https://doi.org/10.1016/j.jelekin.2014.10.018.CrossRefPubMed

25.

Bortz J, Schuster C. Statistik für Human- und Sozialwissenschaftler. 2010. Heidelberg: Springer.CrossRef

26.

Voorham-van der Zalm PJ, Voorham JC, van den Bos TW, Ouwerkerk TJ, Putter H, Wasser MN, et al. Reliability and differentiation of pelvic floor muscle electromyography measurements in healthy volunteers using a new device: the multiple Array probe Leiden (MAPLe). Neurourol Urodyn. 2013;32:341–8. https://doi.org/10.1002/nau.22311.CrossRefPubMed

27.

Enck P, Hinninghofen H, Wietek B, Becker HD. Functional asymmetry of pelvic floor innervation and its role in the pathogenesis of fecal incontinence. Digestion. 2004;69:102–11. https://doi.org/10.1159/000077876.CrossRefPubMed

28.

Burden A, Bartlett R. Normalisation of EMG amplitude: an evaluation and comparison of old and new methods. Med Eng Phys. 1999;21:247–57. https://doi.org/10.1016/S1350-4533(99)00054-5.CrossRefPubMed

29.

Espuña-Pons M, Dilla T, Castro D, Carbonell C, Casariego J, Puig-Clota M. Analysis of the value of the ICIQ-UI SF questionnaire and stress test in the differential diagnosis of the type of urinary incontinence. Neurourol Urodyn. 2007;26:836–41. https://doi.org/10.1002/nau.20379.CrossRefPubMed

30.

Morin M, Dumoulin C, Bourbonnais D, Gravel D, Lemieux MC. Pelvic floor maximal strength using vaginal digital assessment compared to dynamometric measurements. Neurourol Urodyn. 2004;23:336–41. https://doi.org/10.1002/nau.20021.CrossRefPubMed

Title: Electromyography of pelvic floor muscles with true differential versus faux differential electrode configuration
Authors: Claudia Ballmer
Patric Eichelberger
Monika Leitner
Helene Moser
Helena Luginbuehl
Annette Kuhn
Lorenz Radlinger
Publication date: 01-10-2020
Publisher: Springer International Publishing
Keywords: Stress Incontinence
Urinary Incontinence
Urinary Incontinence
Published in: International Urogynecology Journal / Issue 10/2020
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-020-04225-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Electromyography of pelvic floor muscles with true differential versus faux differential electrode configuration

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 10/2020

The impact of prior prolapse repairs on surgical outcomes with minimally invasive sacral colpopexy

Outcomes of native tissue transvaginal apical approaches in women with advanced pelvic organ prolapse and stress urinary incontinence

Does concurrent posterior repair for an asymptomatic rectocele reduce the risk of surgical failure in patients undergoing sacrocolpopexy?

Pain after permanent versus delayed absorbable monofilament suture for vaginal graft attachment during minimally invasive total hysterectomy and sacrocolpopexy

Cosmetic gynecology—a systematic review and call for standardized outcome measures

Total colpocleisis technique in huge neglected ulcerated uterovaginal prolapse