Neuromuscular and biomechanical mechanisms associated with PFM function in humans

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The long term objective of my research program is to understand the normal function of the pelvic floor muscles (PFMs) in terms of their contributions to continence function, sexual function, pelvic organ support, and postural control in both women and men. Despite their obvious and important roles in each of these systems, the normative function of the PFMs is poorly understood. In part, this knowledge gap is related to the limited availability of tools and techniques because the physiological and mechanical properties of the PFMs cannot be studied using traditional electromyographic, kinematic and kinetic approaches. Further, the PFMs are involved in multiple functions, and, at times, have competing demands for contraction and relaxation.*******To date, my research has followed three distinct, but complementary pathways to the achieve my long-term objective. These are: (1) the development of novel measurement tools and techniques to study PFM function, (2) understanding the neuromuscular control of the PFMs in the context of their need to support multiple systems, and (3) understanding the biomechanical properties of the PFMs and how these relate to their role within different human systems . Over the past five years, we have made significant gains in all of these areas, and my proposed research program will build on these achievements under the same general pathways:*******(1) Novel tools and techniques: (i) we will complete in-vivo testing of a new intravaginal dynamometer designed to measure PFM contractile force and passive stiffness properties, (ii) we will automate our sagittal plane ultrasound image analysis to study urethral kinematics and kinetics during dynamic tasks, (iii) We will develop and evaluate shear wave elastography methods to measure PFM tissue stiffness in-vivo. We will evaluate how these properties relate to active and passive tissue properties measured using our vaginal dynamometer.****(2) PFM neuromuscular control: We will use dual and higher order task paradigms to investigate the ways in which the PFMs and their synergists respond to concurrent challenges. We will investigate how the human systems prioritize PFM activation and the effect of age on PFM function in this context. Finally, we will investigate proprioceptive sensation from the PFMs and investigate the relationship between proprioceptive outcomes and capacity for PFM activation.****(3) PFM biomechanics: We will build a normative dataset to investigate the biomechanical properties of the PFMs in vivo and will study how these properties change with age.****This work will culminate in a clear understanding of the motor control and biomechanics of PFM function in women, with the view to understanding how the PFMs simultaneously support continence and motor functions. This work will pave the way to follow-on steps including the study of sex differences in pelvic floor structure and function and the role of the PFMs in sexual function.***