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Zvulun N1, Kafri M2, Dunsky A3, Beer-Gabel M4
1Sheba Medical Center, Tel Hashomer, Pelvic Floor Rehabilitation Unit, Ramat Gan, Israel, 2University of Haifa, Department of Physical Therapy, Haifa, Israel, 3Wingate Institute, Netanya, Israel, 4Sheba Medical Center, Tel-Hashomer, Neurogastroenetrology and Pelvic Floor Unit, Ramat Gan, Israel
Background: Motor imagery (MI) is a cognitive process characterized by imagining a movement without obvious muscular activity or creating muscular tension. The principal aim is to improve learning and enhance skill performance. MI is applied in sports, music and rehabilitation of neurological disorders.
Stress urinary incontinence (SUI), defined as involuntary urinary leakage during rise of intra-abdominal pressure, is common among postmenopausal women and may compromise quality of life.
Physiotherapy focusing on muscle strengthening and regaining adequate kinematic patterns is the first-line treatment in women with SUI. The positive effect reported for MI in other motor disciplines suggests that this approach may be useful for training women with SUI.
Purpose: To compare the effects of MI of contraction of pelvic floor muscles and that of MI of an activity unrelated to the pelvic floor in women with SUI on:
1. Quality of muscle contraction, and
2. Quality of MI
Methods: 30 postmenopausal women (mean age=60.9±7.2), fulfilling the diagnostic criteria of SUI were recruited. Participants attended one session that included questionnaires and various study-related measurements. Participants were randomized into two groups. The experimental group (MI-PF) performed MI of pelvic floor contraction and the control group (MI-STS) performed MI of sit-to-stand transfer. The intervention was delivered lying down. Participants listened to an audiotaped script of the relevant task according to their group assignment and were asked to follow the script in their imagery. MI scenarios included eight imagined pelvic floor contractions or four imagined sit-to-stand transfers. The assessment of primary outcome measures took place at baseline, end of intervention and 30 minutes post-intervention. Outcome measures were recorded during three consecutive maximal pelvic floor muscle contractions, and included mean EMG amplitude and latency, rating muscle strength by manual muscle testing, and observation-based rating of accessory muscle involvement. Additionally, the difficulty/ease of generating the imagery was rated at the beginning and end of the intervention. Data analysis was performed using repeated measures mixed model analysis of variance.
Results: There was significant time and group interaction for pelvic floor manual muscle testing score (p=0.045), such that in the PF-MI group the score increased between baseline and follow-up (p=0.025), with no significant change in the STS-MI group. In addition, in the PF-MI group there was increase in the mean EMG amplitude between baseline and post measurements (p=0.028).
Regarding accessory muscle involvement, a significant decrease in activity of diaphragm and gluteus maximus was found in the PF-MI group only (p=0.001, p=0.003 respectively).
There was a significant increase in the quality of the kinesthetic MI (i.e. imaging of feeling the contraction was more easily generated) but not in the quality of visual MI in the PF-MI group only (p=0.022).
Conclusion(s): Use of MI of pelvic floor muscle contraction appears to improve pelvic floor muscle contraction strength and decrease accessory muscle activity in the immediate term.
Implications: Further research is needed to confirm the efficacy of an intervention program, and more specifically longer one, based on a combination of MI with pelvic floor muscle contraction in women with SUI.
Keywords: Motor imagery, Pelvic floor muscles, Stress urinary incontinence
Funding acknowledgements: This study was partially funded by the Israeli Physiotherapy Society.
Stress urinary incontinence (SUI), defined as involuntary urinary leakage during rise of intra-abdominal pressure, is common among postmenopausal women and may compromise quality of life.
Physiotherapy focusing on muscle strengthening and regaining adequate kinematic patterns is the first-line treatment in women with SUI. The positive effect reported for MI in other motor disciplines suggests that this approach may be useful for training women with SUI.
Purpose: To compare the effects of MI of contraction of pelvic floor muscles and that of MI of an activity unrelated to the pelvic floor in women with SUI on:
1. Quality of muscle contraction, and
2. Quality of MI
Methods: 30 postmenopausal women (mean age=60.9±7.2), fulfilling the diagnostic criteria of SUI were recruited. Participants attended one session that included questionnaires and various study-related measurements. Participants were randomized into two groups. The experimental group (MI-PF) performed MI of pelvic floor contraction and the control group (MI-STS) performed MI of sit-to-stand transfer. The intervention was delivered lying down. Participants listened to an audiotaped script of the relevant task according to their group assignment and were asked to follow the script in their imagery. MI scenarios included eight imagined pelvic floor contractions or four imagined sit-to-stand transfers. The assessment of primary outcome measures took place at baseline, end of intervention and 30 minutes post-intervention. Outcome measures were recorded during three consecutive maximal pelvic floor muscle contractions, and included mean EMG amplitude and latency, rating muscle strength by manual muscle testing, and observation-based rating of accessory muscle involvement. Additionally, the difficulty/ease of generating the imagery was rated at the beginning and end of the intervention. Data analysis was performed using repeated measures mixed model analysis of variance.
Results: There was significant time and group interaction for pelvic floor manual muscle testing score (p=0.045), such that in the PF-MI group the score increased between baseline and follow-up (p=0.025), with no significant change in the STS-MI group. In addition, in the PF-MI group there was increase in the mean EMG amplitude between baseline and post measurements (p=0.028).
Regarding accessory muscle involvement, a significant decrease in activity of diaphragm and gluteus maximus was found in the PF-MI group only (p=0.001, p=0.003 respectively).
There was a significant increase in the quality of the kinesthetic MI (i.e. imaging of feeling the contraction was more easily generated) but not in the quality of visual MI in the PF-MI group only (p=0.022).
Conclusion(s): Use of MI of pelvic floor muscle contraction appears to improve pelvic floor muscle contraction strength and decrease accessory muscle activity in the immediate term.
Implications: Further research is needed to confirm the efficacy of an intervention program, and more specifically longer one, based on a combination of MI with pelvic floor muscle contraction in women with SUI.
Keywords: Motor imagery, Pelvic floor muscles, Stress urinary incontinence
Funding acknowledgements: This study was partially funded by the Israeli Physiotherapy Society.
Topic: Women's & men's pelvic health
Ethics approval required: Yes
Institution: Sheba Medical Center, Ramat Gan.
Ethics committee: the Helsinki Committee of Sheba Medical Center, Ramat Gan.
Ethics number: 3062-16-SMC
All authors, affiliations and abstracts have been published as submitted.
