Lab

Motor Function Measurement Laboratory

About the lab

The Motor Function Measurement (MFM) lab is run through the University of Ottawa department of Rehabilitation Science in the Faculty of Health Sciences under the supervision of Dr. Linda McLean. She and her team are interested in investigating women’s health issues associated with the pelvic floor such as urinary incontinence, pelvic pain, and motor dysfunction associated with pregnancy and delivery. Specifically, their research focuses on the biomechanical and neurophysiological mechanisms responsible for these health issues. Measurement of musculoskeletal and neuromuscular function as well as development of predictive models of successful rehabilitation outcomes through the use of electromyography and ultrasound imaging are research areas of interest.

Featured research (12)

Background While cumulative loading of the pelvic floor during exercise appears to increase the risk of developing pelvic floor disorders, the pathophysiologic role of pelvic floor loading is poorly understood. The aim of this exploratory study was to present a method for evaluating vibrational frequency damping of the female pelvic floor and to investigate the potential utility of this approach in a preliminary evaluation. Methods Female participants were instrumented with an intravaginal accelerometer and a hip-mounted accelerometer, then ran on a treadmill at 7 km/h and 10 km/h both before and after a 30-min self-selected pace. Displacement of the pelvic floor relative to the bony pelvis was calculated using double integration of the accelerometer data. Vibrational damping coefficients were calculated using a wavelet-based approach to determine the effect of continence status, parity, running speed and time on vibrational damping. Findings Seventeen women (n = 10 reported regularly leaking urine while exercising, while n = 7 reported not leaking) completed the running protocol. No differences in vibrational damping were detected between continent and incontinent women when all frequency bands were evaluated together, however significant effects of parity, time, running speed and continence status were found within specific frequency bands. Parous women demonstrated less damping in the 25-40 Hz band compared to nulliparae, damping in the 13-16 Hz band was lower after the 30-min run, and incontinent women demonstrated lower damping in the 4.5–5.5 Hz band than continent women when running at 7 km/h. Interpretation Intra-vaginal vibrational damping may be useful in detecting biomechanical mechanisms associated with pelvic floor disorders experienced by females during exercise.
Background: The role of levator ani muscle (LAM) dysfunction in female stress urinary incontinence (SUI) is not known. Purpose: To determine whether LAM function is associated with SUI severity, and whether changes in LAM function induced through pelvic floor muscle training (PFMT) are associated with improvements in SUI in females. Methods: Females with SUI were recruited from urogynaecology and physiotherapy clinics. LAM function was evaluated using ultrasound imaging (USI) and manual palpation (PERFECT-Scheme) before and after participants underwent a 12-week PFMT program. SUI severity was assessed using the ICIQ-FLUTS-UI and a 30-minute pad test(30MPT). Results: At baseline (n=97), lower 30MPT was weakly associated with higher bladder neck position(ρs=-0.209,p=0.044) yet with lower PERFECT-Scheme outcomes(overall ρs=0.206, repeated maximum voluntary contractions (MVCs):ρs=0.203, power/motor control ρs=0.214,p<0.05) except perineal lift during coughing was associated with lower ICIQ-FLUTS-UI. All measures of SUI and LAM function were significantly improved after the PFMT intervention (p<0.05). Greater improvements in ICIQ-FLUTS-UI were associated with greater reductions in levator plate length during MVC (ρs=0.238,p=0.041) yet with less improvement in the ability to repeat MVCs(ρs=0.303,p=0.009). Greater improvements in the 30MPT were associated with more bladder neck elevation(ρs=-0.261,p=0.027) and greater reductions in levator plate length(ρs=0.292,p=0.016) during MVC. Conclusion: Improvements in bladder neck support and elevation during MVC show weak associations with improvement in SUI signs and symptoms. Implications: While associations are weak, improved bladder neck support and elevation during MVC may play a role in improving continence function among females with SUI. The PERFECT-Scheme provides limited information on LAM function relevant to SUI or PFMT outcomes.
ABSTRACT Background: As we have observed unfortunately during the recent COVID-19 pandemic, all healthcare professionals are at a high risk of both acquiring and spreading infections. This includes physiotherapists working in pelvic health. If proper guidelines for infection control measures are lacking, there may be an increased risk of infection transmission. It is known that health-related behaviours are affected by knowledge, attitudes and practices. Yet, no studies exploring these concepts have been conducted in pelvic health physiotherapy practice, where assessment and treatment approaches can involve practices that are more invasive in nature than other areas of physiotherapy practice. Objective: To explore the Knowledge, Attitudes, Practices & Clinical Settings (KAP) pertaining to infection prevention and control (IPAC) among Canadian physiotherapists working in pelvic health. Methods: This was a cross-sectional, observational study that received ethic approval (University of Ottawa, #H-10-19-4764). Using a convenient sampling approach, Canadian pelvic health physiotherapists were recruited through pelvic health physiotherapy groups on social media and a Canadian continuing education provider. Between May 6th and 22, 2020, while clinics were closed, participants completed an investigator designed on-line questionnaire pertaining to respondents’ KAP using current best-practices. The questionnaire was comprised of 78 closed & open-ended questions and options to provide comments as well general demographic information. An exploratory data & descriptive analysis was performed. For open-ended questions, thematic coding was conducted. Results: A total of 80 eligible physiotherapists completed the questionnaire. Results of this study revealed that participants achieved a mean score of 17.95/24 (74.8±10%) pertaining to IPAC on the knowledge section of the survey, a mean score of 8.87/10 (88.7±11.6) on recommended IPAC practices and a mean score of 9.09/14 (64.9±19%) on desirable attribute of clinical settings in terms of IPAC. Although physiotherapists’ 2-Attitudes: hepatitis B & influenza vaccination were perceived by a large proportion of respondents (33/70 and 41/80 respectively) as being somewhat or not important; vaccine uptake was 70/80 and 44/80 respectively. 3-Practices: non-bacteriostatic single packet lubricant is not universally used (23/80) for intravaginal/intra-anal palpation, and intra-rectal balloon catheters are used repeatedly in a given patient by most (19/30) physiotherapists who use them. 4-Clinical setting: 30% of participants (24/78) were not aware of infection control guidelines in the workplace prior to COVID-19, where some clinics (22/78) were carpeted and more than half (41/77) did not have a dedicated sink for cleaning equipment or handwashing (i.e. shared with kitchen or washroom). Conclusions: While our findings demonstrate that pelvic health physiotherapists in Canada were generally following IPAC recommendations, some problematic KAP on IPAC were observed. Further studies should look into the impact of IPAC training for pelvic health physiotherapists, and the evolution of IPAC KAP throughout the COVID-19 pandemic. Implications: This study identifies behaviours and practices that may hinder optimal IPAC in pelvic health physiotherapy practice. These findings provide guidance for the development of IPAC training and guidelines for pelvic health physiotherapy practice. Keywords: Infection Control, Pelvic Health Physiotherapy, KAP survey. Funding: This project was unfunded.
Introduction and hypothesis: This single-blind, randomised controlled trial was aimed at determining whether peri-operative physiotherapist-supervised pelvic floor muscle (PFM) training was superior to standard care (handout) in terms of improvements in stress urinary incontinence (SUI) symptoms, cure rate, and/or post-operative filling or voiding symptoms among women undergoing surgical mid-urethral sling (MUS) insertion for SUI. Methods: Women with SUI were recruited from surgical wait lists at four participating urogynecology clinics. Participants were assessed at baseline (V1) then randomised (1:1 allocation) to receive supervised PFM training or a handout. Immediately following the 12-week intervention period (V2) and at 12 weeks following surgery (V3) the groups were compared based on the Female Lower Urinary Tract Symptoms (FLUTS) questionnaire total score and urinary incontinence, filling, and voiding subscale scores as well as on a standardised 30-min pad test administered by a blinded assessor. Intention-to-treat analyses were performed. Results: A total of 52 participants were randomised to physiotherapy and 51 to the control group between December 2012 and August 2016. The groups were not different on any outcomes at V1 and all were improved at V3 compared with V1 (p < 0.001). At V3 the physiotherapy group reported significantly fewer UI symptoms (FLUTS UI subscale score) than the control group; yet, there were no group differences in FLUTS overall score or the pad test (p > 0.05). Based on a FLUTS UI subscale score <4, the cure rate at V3 was higher in the intervention group (73%) than in the control group (47%); (2.36 < OR < 3.47, p = 0.012). There were no group differences in cure rate at V3 based on a pad test (p = 0.27). No group differences were found in the filling or voiding symptoms at V3 (p > 0.05). No adverse events were reported. Conclusion: Physiotherapist-supervised PFM training improves SUI cure rates associated with surgical MUS insertion when considering symptoms of SUI, but does not improve post-operative continence function as measured by a pad test, nor does it lead to fewer post-operative voiding or filling symptoms.

Lab head

Linda Mclean
Department
  • School of Rehabilitation Sciences

Members (7)

Flávia Ignácio Antônio
  • University of Ottawa
Catriona Czyrnyj
  • University of Ottawa
Marie-Eve Berube
  • University of Ottawa
Kaylee Brooks
  • University of Ottawa
Marylène Charette
  • University of Ottawa
Olena Klahsen
  • University of Ottawa
Megan R Vandermolen
  • University of Ottawa
Duane Hickling
Duane Hickling
  • Not confirmed yet
Vincent Della Zazzera
Vincent Della Zazzera
  • Not confirmed yet
Kevin Varette
Kevin Varette
  • Not confirmed yet
Ana Brennan
Ana Brennan
  • Not confirmed yet
Layla Mitri
Layla Mitri
  • Not confirmed yet
Samantha Boucher
Samantha Boucher
  • Not confirmed yet
Eric Lanteigne
Eric Lanteigne
  • Not confirmed yet