Application of a new method in the study of pelvic floor muscle passive properties in continent women.

The aim of this study was to present a new methodology for evaluating the pelvic floor muscle (PFM) passive properties. The properties were assessed in 13 continent women using an intra-vaginal dynamometric speculum and EMG (to ensure the subjects were relaxed) in four different conditions: (1) forces recorded at minimal aperture (initial passive resistance); (2) passive resistance at maximal aperture; (3) forces and passive elastic stiffness (PES) evaluated during five lengthening and shortening cycles; and (4) percentage loss of resistance after 1min of sustained stretch. The PFMs and surrounding tissues were stretched, at constant speed, by increasing the vaginal antero-posterior diameter; different apertures were considered. Hysteresis was also calculated. The procedure was deemed acceptable by all participants. The median passive forces recorded ranged from 0.54N (interquartile range 1.52) for minimal aperture to 8.45N (interquartile range 7.10) for maximal aperture while the corresponding median PES values were 0.17N/mm (interquartile range 0.28) and 0.67N/mm (interquartile range 0.60). Median hysteresis was 17.24N *mm (interquartile range 35.60) and the median percentage of force losses was 11.17% (interquartile range 13.33). This original approach to evaluating the PFM passive properties is very promising for providing better insight into the patho-physiology of stress urinary incontinence and pinpointing conservative treatment mechanisms.

An instrumented cylinder measuring pinch force and orientation.

BACKGROUND: The function of a cylinder allowing simultaneous measurements of the opposition axis of the index finger and thumb of the hand and the magnitude of pinch force is described. METHODS: The apparatus is made of two half-cylinders that are bonded together through a 6-axis force/torque sensor and allows the measurement of 3D orthogonal forces and moments of force. The amplitude of the pinch force exerted on the cylinder by the fingers is defined as the resultant of the forces in the different axes. A software program was developed to measure the barycentre of the forces on the instrumented cylinder, allowing calculation of the angle of the opposition axis between the fingers and the location of the resulting pinch force on the cylinder, assuming that the pinch or grip forces are co-linear through the center of the cylinder. In order to assess the validity and reliability of the measurements, the cylinder was mounted on a milling table and seven calibrated weights (from 100 to 500 g) were successively applied perpendicularly to a 9*9 matrix of sites separated by 1 cm. With the exception of the extreme lateral parts of the cylinder, the dispersion of the calculated vertical position of the resulting force was always within 1 mm of the application point, suggesting a high reliability of these measurements. In addition, the errors in the angles of the applied force were calculated and found to be less than 2 degree with no clear patterns of variation across the different locations of the cylinder. RESULTS: The usefulness of the cylinder is demonstrated by evaluating the pinch force and the opposition axis in six healthy subjects lifting the cylinder from the table using three different orientations of their right hand. The magnitude of the grip force was not significantly different across orientations (45, 22 and -22 degrees relative to the midline of the subject) suggesting that force grip is controlled. CONCLUSION: From these results, it has been concluded that the cylinder is a valid, reliable and precise instrument that may prove useful for evaluating opposition axis and grip force in healthy and pathological populations.

Threshold position control of arm movement with anticipatory increase in grip force.

The grip force holding an object between fingers usually increases before or simultaneously with arm movement thus preventing the object from sliding. We experimentally analyzed and simulated this anticipatory behavior based on the following notions. (1) To move the arm to a new position, the nervous system shifts the threshold position at which arm muscles begin to be recruited. Deviated from their activation thresholds, arm muscles generate activity and forces that tend to minimize this deviation by bringing the arm to a new position. (2) To produce a grip force, with or without arm motion, the nervous system changes the threshold configuration of the hand. This process defines a threshold (referent) aperture (R(a)) of appropriate fingers. The actual aperture (Q(a)) is constrained by the size of the object held between the fingers whereas, in referent position R(a), the fingers virtually penetrate the object. Deviated by the object from their thresholds of activation, hand muscles generate activity and grip forces in proportion to the gap between the Q(a) and R(a). Thus, grip force emerges since the object prevents the fingers from reaching the referent position. (3) From previous experiences, the system knows that objects tend to slide off the fingers when arm movements are made and, to prevent sliding, it starts narrowing the referent aperture simultaneously with or somewhat before the onset of changes in the referent arm position. (4) The interaction between the fingers and the object is accomplished via the elastic pads on the tips of fingers. The pads are compressed not only due to the grip force but also due to the tangential inertial force ("load") acting from the object on the pads along the arm trajectory. Compressed by the load force, the pads move back and forth in the gap between the finger bones and object, thus inevitably changing the normal component of the grip force, in synchrony with and in proportion to the load force. Based on these notions, we simulated experimental elbow movements and grip forces when subjects rapidly changed the elbow angle while holding an object between the index finger and the thumb. It is concluded that the anticipatory increase in the grip force with or without correlation with the tangential load during arm motion can be explained in neurophysiological and biomechanical terms without relying on programming of grip force based on an internal model.

Threshold control of motor actions prevents destabilizing effects of proprioceptive delays.

It is usually assumed that proprioceptive feedback comes to motoneurons too late to contribute to the initial activity of agonist muscles during fast arm movements, leading to the suggestion that this feedback is only efficient in slow movements and postural control. The argument does not take into account that the changes in the motoneuronal membrane potentials and the associated changes in the state of spinal neurons preceding the initial activity of muscles deeply affect, in a forward way, the state of reflex systems by shifting their thresholds, as suggested in the lambda model for motor control. As a result, the initial muscle activity emerges with full contribution of these systems so that the effects of reflex delays become negligible. We tested the hypothesis that threshold control of muscle activation may be instrumental in preventing destabilizing effects of proprioceptive delays in spinal and trans-cortical pathways to motoneurons. The analysis was made by recording fast elbow movements (peak velocity approximately 300-500 degrees/s) and simulating them in a dynamic model that incorporates the notion of threshold control of intrinsic and reflex muscle properties. The model was robust in reproducing experimental movement patterns (R (2)>0.95). It generated stable output despite substantial proprioceptive (up to 100 ms) and electromechanical (40 ms) delays. Stability was thus ensured for delays not only in segmental (about 25-50 ms) but also in trans-cortical loops (50-70 ms). Our study illustrates that a natural physiological process--threshold control--may manifest feed-forward properties hitherto attributed to hypothetical internal neural models.