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Pediatric Surgery International Aug 2005Repair of a large diaphragmatic defect in congenital diaphragmatic hernia (CDH) and eventration of the diaphragm (DE) is difficult, especially when this is an unexpected...
Repair of a large diaphragmatic defect in congenital diaphragmatic hernia (CDH) and eventration of the diaphragm (DE) is difficult, especially when this is an unexpected finding at surgery. A patch of synthetic material may not be available at short notice, especially in developing countries. We describe the repair of nine such defects by using an abdominal muscle flap comprising the transversus abdominis and internal oblique muscles based on the intercostal and subcostal vessels. Although reports of similar flap repairs have been published in the literature [1-5], these employed a subcostal incision for abdominal entry, which we believe jeopardizes the flap's vascularity. Thus, we prefer to use an upper abdominal midline incision for abdominal entry in all cases of CDH and DE.
Topics: Abdominal Muscles; Adult; Female; Hernia, Diaphragmatic; Hernias, Diaphragmatic, Congenital; Humans; Infant, Newborn; Male; Surgical Flaps; Treatment Outcome
PubMed: 16010546
DOI: 10.1007/s00383-005-1438-1 -
Journal of Applied Physiology:... Mar 1982Although there is electromyographic evidence for abdominal muscle activity during quiet breathing in standing subjects, several studies have shown, or assumed, that...
Although there is electromyographic evidence for abdominal muscle activity during quiet breathing in standing subjects, several studies have shown, or assumed, that subjects normally breathe on their relaxation characteristics. This latter observation would by itself suggest that abdominal muscles do not contract during quiet breathing. To test this assumption we observed abdominal and rib cage displacements with magnetometers in 17 uninformed subjects. During quiet breathing most subjects showed evidence of tonic or phasic abdominal muscle contraction while standing and sitting but not supine. Subjects studied during hyperpnea immediately following exercise-showed evidence of greater abdominal muscle contraction than at rest. We conclude that most subjects standing at rest normally contract their abdominal muscles.
Topics: Abdominal Muscles; Electromyography; Female; Humans; Hyperventilation; Male; Muscle Contraction; Muscle Relaxation; Physical Exertion; Posture; Respiration; Ribs
PubMed: 6461623
DOI: 10.1152/jappl.1982.52.3.700 -
Aviation, Space, and Environmental... Feb 1985Methods to increase G tolerance of pilots flying high-performance aircraft are of vital importance. Straining maneuvers to increase G tolerance involve abdominal...
Methods to increase G tolerance of pilots flying high-performance aircraft are of vital importance. Straining maneuvers to increase G tolerance involve abdominal muscles, and high intra-abdominal pressures (IAP) are recorded during G exposure. This study was carried out to examine the effects of an 11-week abdominal muscle training program on maximal IAP, G tolerance and muscle strength/endurance in 10 fighter pilots. G tolerance was measured in a human centrifuge using simulated aerial combat maneuvers (ACM). The pilots had a higher maximal IAP before training than a control group. G tolerance, maximal IAP, and maximal peak torque of knee extensors were not changed by the training. In contrast, leg muscle endurance increased (p less than 0.01) and ratings of local perceived exertion decreased (p less than 0.01). Static endurance of the knee extensors was positively correlated (p less than 0.05) with G tolerance. It is concluded that the present abdominal training program, employed in experienced fighter pilots, is not sufficient to increase IAP or G tolerance.
Topics: Abdomen; Abdominal Muscles; Adult; Gravitation; Humans; Isometric Contraction; Muscle Contraction; Physical Education and Training; Physical Endurance; Pressure
PubMed: 3157367
DOI: No ID Found -
Respiration Physiology Sep 1993Abdominal muscle activation produced by expiratory threshold loading (ETL) helps prevent an increase in FRC thus, optimizing diaphragm length and defending VT. However,...
Abdominal muscle activation produced by expiratory threshold loading (ETL) helps prevent an increase in FRC thus, optimizing diaphragm length and defending VT. However, anesthesia may affect abdominal muscle activation, and the pattern of recruitment and level of activation of individual abdominal muscles may well be dependent on body position. Therefore, individual abdominal muscle response to ETL was assessed in awake dogs, lying in the lateral decubitus position. Eight, tracheotomized dogs were chronically instrumented with sonomicrometer transducers and bipolar, fine wire EMG electrodes, in each of the four abdominal muscles. ETL produced increases in active, expiratory shortening of the transversus abdominis (TA), internal oblique (IO) and external oblique (EO). In addition, tonic activity, assessed from a decrease in baseline length, increased in the IO. There was a significant increase in FRC during ETL but it was less than would be expected without tonic and phasic abdominal muscle activation. Although FRC increased, VT and breathing frequency were maintained. As was found previously in supine, anesthetized dogs, the internal abdominal muscle layer (TA and IO) was recruited preferentially; substantiating its greater role in the defence of lung volume.
Topics: Abdominal Muscles; Animals; Differential Threshold; Dogs; Electromyography; Female; Lung Volume Measurements; Positive-Pressure Respiration; Respiration; Work of Breathing
PubMed: 8235128
DOI: 10.1016/0034-5687(93)90075-l -
Medicine and Science in Sports and... Oct 2001The purpose of this study was twofold: 1) to determine whether elite male golfers with chronic low back pain (CLBP) exhibit different abdominal muscle activity patterns... (Comparative Study)
Comparative Study
PURPOSE
The purpose of this study was twofold: 1) to determine whether elite male golfers with chronic low back pain (CLBP) exhibit different abdominal muscle activity patterns during the golf swing than asymptomatic control (AC) golfers and 2) to determine whether elite male golfers with CLBP experience greater fatigue in the abdominal muscles than AC golfers after a typical practice session.
METHODS
Surface EMG data were collected bilaterally from the rectus abdominis (RA), external oblique (EO), and internal oblique (IO) muscles. Muscle activity during the golf swing was measured using the root mean square (RMS) of the EMG signal in various phases of the golf swing. Fatigue was assessed using the median frequency (MF) and RMS of the EMG signal during a 10-s submaximal isometric contraction. Low back pain was quantified with the McGill Pain Questionnaire before and after the practice session.
RESULTS
No differences in the RMS of abdominal muscle activity were noted during the golf swing between AC and CLBP subjects. However, EO (lead) onset times were significantly delayed with respect to the start of the backswing in CLBP subjects. Low back pain in CLBP golfers increased significantly after the practice session. Abdominal muscle fatigue, as measured with MF or RMS, was not evident after the practice session for either AC or CLBP subjects.
CONCLUSION
Abdominal muscle activity and muscle fatigue characteristics were quite similar between AC and CLBP subjects after repetitive golf swings. Despite this, it was clear that repetitive golf swings were aggravating some part of the musculoskeletal system in CLBP subjects, which resulted in increased pain in the low back area.
Topics: Abdominal Muscles; Adult; Electromyography; Golf; Humans; Low Back Pain; Male; Movement; Muscle Contraction; Muscle Fatigue; Severity of Illness Index; Video Recording
PubMed: 11581547
DOI: 10.1097/00005768-200110000-00006 -
Journal of Neuroengineering and... Feb 2016Targeted activation of the transversus abdominis (TrA) muscle through the abdominal drawing-in maneuver (ADIM) is a frequently prescribed exercise for the prevention and...
BACKGROUND
Targeted activation of the transversus abdominis (TrA) muscle through the abdominal drawing-in maneuver (ADIM) is a frequently prescribed exercise for the prevention and rehabilitation of low back pain. However, there is still debate over the role the ADIM plays in maintaining a stable spine during movement. Thus, a single cohort pre/post-intervention protocol was used to examine whether 5 min of ADIM training prior to a dynamic movement task alters dynamic spine stability and control.
METHODS
Thirteen healthy participants performed a repetitive spine flexion task twice, once before and once after they received biofeedback training on how to correctly perform the ADIM in standing. Abdominal and back muscle activation (indwelling and surface electromyography, EMG) and 3D kinematic data were recorded during all trials. EMG activation (percent maximum) and local dynamic stability of spine movement [maximum finite-time Lyapunov exponent (λmax)] were compared before and after the training using Friedman's rank test and repeated-measures ANOVA, respectively. To assess the moderating effects of absolute changes in EMG (∆EMG) of each muscle after training on changes in stability, the ∆EMG (peak and mean) were added to the ANOVA as separate covariates (ANCOVA).
RESULTS
Following ADIM training, there were greater peak and mean levels of activation in all tested abdominal muscles, including TrA, (p < 0.05), but not in the back muscles. The ANOVA showed no significant change in λmax following training (p = 0.633). However, after considering the moderating effects of the ∆EMG seen in each muscle with training, it was found that only changes in TrA EMG significantly influenced stability. The ANCOVA revealed a significant main effect of training on stability as well as a significant interaction effect between training and ∆EMG recorded from TrA (p < 0.05); those with larger increases in TrA activation demonstrated larger improvements in stability.
CONCLUSION
As a group, 5 min of ADIM training did not change spine stability during dynamic movement. However, those who were most successful in improving TrA activation with a 5-min ADIM training session showed the greatest improvements in local dynamic spine stability after training. As such, dynamic spine stability in some individuals may benefit from ADIM training.
Topics: Abdominal Muscles; Adult; Back Muscles; Biofeedback, Psychology; Biomechanical Phenomena; Cohort Studies; Electromyography; Female; Humans; Male; Muscle Contraction; Physical Education and Training; Spine
PubMed: 26922079
DOI: 10.1186/s12984-016-0126-9 -
European Spine Journal : Official... Apr 2008Spine stabilization exercises, in which patients are taught to perform isolated contractions of the transverses abdominus (TrA) during "abdominal hollowing", are a...
Spine stabilization exercises, in which patients are taught to perform isolated contractions of the transverses abdominus (TrA) during "abdominal hollowing", are a popular physiotherapeutic treatment for low back pain (LBP). Successful performance is typically judged by the relative increase in TrA thickness compared with that of the internal (OI) and external (OE) oblique muscles, measured using ultrasound. The day-to-day measurement error (imprecision) associated with these indices of preferential activation has not been assessed but is important to know since it influences the interpretation of changes after treatment. On 2 separate days, 14 controls and 14 patients with chronic LBP (cLBP) performed abdominal hollowing exercises in hook-lying, while M-mode ultrasound images superimposed with tissue Doppler imaging (TDI) data were recorded from the abdominal muscles (N = 5 on each side). The fascial lines bordering the TrA, OI and OE were digitized, and muscle thicknesses were calculated. The between-day error (intra-observer) was expressed as the standard error of measurement, SEM; SEM as a percentage of the mean gave the coefficient of variation (CV). There were no significant between-day differences for the mean values of resting or maximal thickness for any muscle, in either group (P > 0.05). The median SEM and CV of all thickness variables was 0.71 mm and 10.9%, respectively for the controls and 0.80 mm or 11.3%, respectively for the cLBP patients. For the contraction ratios (muscle thickness contracted/thickness at rest), the CVs were 3-11% (controls) and 5-12% (patients). The CVs were unacceptably high (30-50%, both groups) for the TrA preferential activation ratio (TrA proportion of the total lateral abdominal muscle thickness when contracted minus at rest). In both the controls and patients, the precision of measurement of absolute muscle thickness and relative change in thickness during abdominal hollowing was acceptable, and commensurate with that typical of biological measurements. The TrA preferential activation ratio is too imprecise to be of clinical use. Knowledge of the SEM for these indices is essential for interpreting the clinical relevance of any changes observed following physiotherapy.
Topics: Abdominal Muscles; Adult; Bias; Case-Control Studies; Chronic Disease; Female; Humans; Low Back Pain; Male; Muscle Contraction; Observer Variation; Physical Therapy Modalities; Reproducibility of Results; Ultrasonography
PubMed: 18196294
DOI: 10.1007/s00586-008-0589-x -
The Journal of Orthopaedic and Sports... Aug 2007Test-retest intrarater reliability study.
STUDY DESIGN
Test-retest intrarater reliability study.
OBJECTIVE
To examine reliability of abdominal musculature measurements across a broad range of conditions for a physical therapist newly trained in assessment using rehabilitative ultrasound imaging (RUSI).
BACKGROUND
RUSI has previously been used to assess abdominal muscle function during a drawing-in maneuver of the anterior abdominal wall, and measurements conducted by an experienced assessor have been validated by comparison with magnetic resonance imaging. Few studies have examined the reliability of less experienced operators, and only in isolated measurement conditions.
METHODS AND MEASURES
Nineteen subjects (11 female, 8 male) without a history of low back pain performed the abdominal drawing-in maneuver in a supine hook-lying position. RUSI was used bilaterally to assess the thickness of the internal oblique (IO) and transversus abdominis (TrA) muscles at rest and on contraction, as well as changes in the length of the TrA muscle (indicated by slide of the anterior abdominal fascia). The reliability of a novice rater who received 8 hours of training was examined (a) across 3 measurements of the same ultrasound image, (b) across 3 separate ultrasound images (averaged for days and sides of abdomen), and (c) across 2 days (averaged for images and sides).
RESULTS
Reliability of assessing muscle thickness was very high across 3 measurements of the sale image (intrarater correlation coefficients [ICC3.1] were all greater than 0.97), fair to high across 3 images (ICC(3,4) = 0.62-0.82), and fair to high across 2 days (ICC(3,6) = 0.63-0.85). Reliability of measuring the slide of the anterior abdominal fascia was very high across measurements from the same image (ICC(3,1) = 0.98) but very low across images (ICC(3,4) = 0.44) and across 2 days (ICC(3,6) = 0.36).
CONCLUSIONS
High reliability of a novice rater was demonstrated for some measurement conditions. Measures of reliability for recapturing the image and repetition across days ranged from low to high. Inconsistencies in the pattern of results suggest that for a novice assessor using RUSI, training should be performed and reliability assessed for each abdominal muscle and measurement condition intended to be used for research and clinical practice.
Topics: Abdominal Muscles; Abdominal Wall; Female; Humans; Low Back Pain; Male; Muscle Contraction; Queensland; Ultrasonography
PubMed: 17877284
DOI: 10.2519/jospt.2007.2416 -
British Journal of Plastic Surgery Oct 2000Abdominal weakness is a known potential complication of breast reconstruction with a pedicled or free TRAM flap. It has been presumed that the DIEP flap, which involves... (Comparative Study)
Comparative Study
Abdominal weakness is a known potential complication of breast reconstruction with a pedicled or free TRAM flap. It has been presumed that the DIEP flap, which involves no muscle resection, does not compromise abdominal muscle strength but little objective research exists to substantiate this. The aims of this retrospective study were to compare abdominal muscle strength following free TRAM flap and DIEP flap, to compare both groups with a control group and to establish the effect of both procedures on functional activities. Fifty women (23 with a DIEP flap, 27 with a free TRAM flap) plus 32 non-operated controls underwent assessment of their abdominal and back extensor muscle strength on a KIN COM isokinetic dynamometer. Two questionnaires were used to establish the impact on function. The TRAM flap group had significant weakness of the abdominal and back extensor muscles compared with the DIEP flap group and the control group. The trend was for the DIEP flap group to have weaker abdominal muscles than the control group. There was a higher level of abdominal pain and a greater number of reported functional difficulties in the TRAM flap group than in the DIEP flap group. This study demonstrates that whilst the DIEP flap can reduce the strength deficit caused by the free TRAM flap, abdominal weakness can still result from the DIEP flap. A randomised controlled trial is currently underway to investigate the effect of preoperative abdominal exercises in preventing/minimising postoperative abdominal muscle weakness in this group.
Topics: Abdominal Muscles; Activities of Daily Living; Adult; Analysis of Variance; Female; Humans; Mammaplasty; Middle Aged; Muscle Weakness; Retrospective Studies; Surgical Flaps; Tissue and Organ Harvesting
PubMed: 11000074
DOI: 10.1054/bjps.2000.3427 -
The Journal of Orthopaedic and Sports... Oct 2007Retrospective review.
STUDY DESIGN
Retrospective review.
OBJECTIVES
To describe bilateral thickness of the lateral abdominal muscles at baseline and during an abdominal drawing-in maneuver (ADIM) in individuals with unilateral transtibial (TTA) or transfemoral (TFA) amputations.
BACKGROUND
Although side-to-side symmetry of lateral abdominal muscle thickness has been established in healthy individuals, the degree of symmetry in those with unilateral lower extremity amputations remains unknown. Differences in lateral abdominal muscle thickness may exist based on prior findings of asymmetry and differences measured based on level of amputation in both the size and function of the iliopsoas and back extensor muscles.
METHODS AND MEASURES
Seventy patients (69 males, 1 female) with traumatic unilateral lower extremity amputations (TTA, n = 39; TFA, n = 31) received a rehabilitative ultrasound imaging examination. Absolute thickness of the transversus abdominis (TrA) and the external and internal oblique muscles combined (EO+IO) were assessed bilaterally at baseline and during the ADIM. Symmetry was assessed using relative muscle thickness values at baseline. Percent increase in muscle thickness during the ADIM was used to investigate muscle function. Separate 2-by-2 mixed-model ANOVAs were used to compare both within-group (side of amputation versus nonamputated side) and between-group (TTA versus TFA) differences for thickness and function of the TrA and the EO+IO muscles.
RESULTS
On the side of the amputation, the relative baseline thickness of the EO+IO measurement was greater (P < .05), while the relative baseline thickness of the TrA muscle was smaller (P < .05). But the mean differences side to side were small (1.3%) and unlikely to be clinically significant. Further, there were no differences in baseline muscle thickness between groups for the TrA (P = .95) or the EO+IO (P = .94) muscles. For thickness measurements during the ADIM, the TrA showed no side-to-side (P = .74) or group (P = .07) differences. Similarly, no side-to-side (P = .60) or group (P = .09) differences were found in the EO+IO thickness during the ADIM.
CONCLUSIONS
Despite the limitations of retrospective review, these findings provide an initial reference data set for future studies. Bilateral symmetry of the lateral abdominal wall muscle thicknesses at baseline and during the ADIM for those with unilateral lower extremity amputations is comparable to healthy individuals. Future studies should consider the potential influences of low back pain and gait training on symmetry of muscle thickness and muscle function based on level of amputation.
Topics: Abdominal Muscles; Adult; Amputation, Traumatic; Female; Humans; Lower Extremity; Male; Retrospective Studies; Ultrasonography; United States
PubMed: 17970411
DOI: 10.2519/jospt.2007.2532