High density Surface EMG Assessment of the Pelvic Muscle Hypertonicity Associated with Interstitial Cystitis/Bladder Pain Syndrome

高密度表面肌电图评估与间质性膀胱炎/膀胱疼痛综合征相关的盆腔肌肉张力过高

• 批准号: 9387628
• 负责人: Yingchun Zhang
• 金额: $ 24.2万
• 依托单位: UNIVERSITY OF HOUSTON
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-07-15 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9387628
• 关键词: Affect; Agreement; Characteristics; Clinical Treatment; Data; Detection; Female; Functional disorder; Goals; Increased frequency of micturition; Injection of therapeutic agent; Interstitial Cystitis; Location; Maps; Measures; Modality; Muscle; Muscle Fibers; Muscle function; Myofascial Pain Syndromes; Myofascial Trigger Point; Noise; Pain; Palpation; Patients; Pattern; Pelvic Examination; Pelvic Floor Muscle; Pelvic floor dysfunction; Pelvic floor structure; Pelvis; Perception; Peripheral; Phase; Phenotype; Physical therapy; Physiological; Protocols documentation; Relaxation; Research; Rest; Severities; Signal Transduction; Standardization; Surface; Syndrome; Techniques; Testing; Therapeutic; Training; United States; Urologist; Woman; chronic pain; chronic pelvic pain; clinical phenotype; density; digital; experience; improved; individual patient; innovation; micturition urgency; nerve supply; novel; physical therapist; signal processing; tool; trigger point

Abstract Interstitial cystitis/bladder pain syndrome (IC/BPS) is a debilitating chronic pelvic pain condition associated with urinary urgency and frequency that affects as many as 7.9 million women in the United States. The pathophysiology of IC/BPS remains incompletely understood but is thought to involve both central and peripheral disturbances in the processing of pain and viscerosensory signals. Pelvic floor dysfunctions likely contribute to the pain experienced by affected women, as myofascial pain and hypertonic pelvic floor dysfunction coexist in 85 % of patients with IC/BPS and other chronic pain syndromes. It was also found that myofascial pain was demonstrated in 78.3% of IC patients with at least one myofascial trigger point (TP). Current treatment modalities aimed at pelvic floor relaxation, including TP injection and physical therapy, have shown positive results on improving the syndromes; however, assessment of pelvic floor TP and hypertonicity is subjective, qualitative and operator-dependent. Identification of TPs through digital palpation depends on the therapist's subjective perception of what constitutes an abnormality and there has been disagreement between expert urologists and therapists regarding the presence or absence of TPs, their locations and degrees of abnormality. No agreement exists upon protocol or standardization of the pelvic exam. Objective measures of pelvic floor muscle (PFM) functions in IC/BPS patients are lacking, which would otherwise help elucidate the contribution of pelvic floor dysfunctions to the pathophysiology of IC/BPS and provide an objective phenotypic characteristic of IC/BPS. The goal of this proposal is to develop an objective and quantitative tool to standardize the characterization of pelvic floor dysfunction in IC/BPS using the most recent advances in high density (HD) surface electromyogram (EMG) techniques. This research represents the first effort to comprehensively and quantitatively assess the hypertonicity of the PFMs associated with IC/BPS, by taking advantage of the most recent advances in HD surface EMG recording and signal processing techniques. The PI has successfully captured HD surface EMG signals from the PFM of 10 young healthy female subjects using multi-channel EMG probes, see preliminary data. In this proposal, the innovation will be applied to IC/BPS patients. The patient-specific hypertonicity severity map, trigger point map and innervation zone (IZ) map of PFMs objectively determined with HD surface EMG will help understand the underlying PFM dysfunction in IC/BPS. The proposed hypertonicity severity mapping technique can also serve as a novel tool to objectively and quantitatively evaluate the hypertonicity the PFMs in patients with IC/BPS. The TPs and IZs of the PFM will be compared in order to better understand their physiological connections and further better understand the pathophysiology of IC/BPS. The TP and IZ detection techniques can also be utilized to improve current therapeutic approaches such as TP injection and myofascial physical therapy by providing objective injection or training targets.

摘要 间质性膀胱炎/膀胱疼痛综合征（IC/BPS）是一种使人衰弱的慢性盆腔疼痛疾病， 尿急和尿频影响着美国多达790万女性。的 IC/BPS的病理生理学仍不完全清楚，但被认为涉及中枢和 疼痛和内脏感觉信号处理中的外周干扰。可能是骨盆底功能障碍 有助于受影响的妇女所经历的疼痛，如肌筋膜疼痛和高张力骨盆底 85%的IC/BPS和其他慢性疼痛综合征患者同时存在功能障碍。还发现 78.3%的IC患者至少有一个肌筋膜触发点（TP）。 目前针对骨盆底松弛的治疗方式，包括TP注射和物理治疗， 在改善综合征方面显示出积极的结果;然而，骨盆底TP和 高渗是主观的、定性的和依赖于操作者的。通过手指触诊识别TP 取决于治疗师对什么构成异常的主观看法， 专家泌尿科医生和治疗师之间关于存在或不存在TP的分歧，他们 异常的位置和程度。对于骨盆的协议或标准化， 考试缺乏对IC/BPS患者盆底肌（PFM）功能的客观测量， 否则将有助于阐明骨盆底功能障碍对IC/BPS病理生理学的贡献 提供了IC/BPS的客观表型特征。该提案的目标是制定一项 客观和定量的工具，以标准化的特征，骨盆底功能障碍在IC/BPS使用 高密度（HD）表面肌电图（EMG）技术的最新进展。 这项研究代表了第一次全面和定量评估高渗性的努力， 通过利用HD表面EMG的最新进展，与IC/BPS相关的PFMs 记录和信号处理技术。PI已成功捕获HD表面EMG信号 来自使用多通道EMG探头的10名年轻健康女性受试者的PFM，参见初步数据。 在本提案中，创新将应用于IC/BPS患者。患者特异性高渗严重程度 HD表面肌电图客观测定的PFMs图、触发点图和神经支配区（IZ）图 将有助于了解IC/BPS中潜在的PFM功能障碍。拟定的高渗严重程度 标测技术也可作为一种新的客观定量评价高渗性的工具 IC/BPS患者的PFMs。将比较PFM的TP和IZs，以便更好地 了解它们的生理联系，并进一步更好地了解IC/BPS的病理生理学。 TP和IZ检测技术也可用于改善当前的治疗方法，例如 TP注射和肌筋膜物理治疗通过提供客观的注射或训练目标。