@misc{AdlerFoerstlSuessetal., author = {Adler, Ina and F{\"o}rstl, Nikolas and S{\"u}ß, Franz and Dendorfer, Sebastian}, title = {Biomechanical exposition of the factors influencing the pelvic floor muscle activity}, series = {ESB 2024, 29th Congress of the European Society of Biomechanics, 30 June-3 July 2024, Edinburgh, Scotland}, journal = {ESB 2024, 29th Congress of the European Society of Biomechanics, 30 June-3 July 2024, Edinburgh, Scotland}, abstract = {Introduction About 40 \% of the women worldwide suffer from Pelvic Floor Dysfunctions [1]. In previous studies, musculoskeletal simulations helped to understand and facilitate the complex issues of musculoskeletal disorders in several different branches [2, 3]. A fundamental prerequisite for the generation of these models is to have a basic understanding of the stresses acting on the pelvic floor. The aim of this study is to investigate the biomechanical factors influencing the activity of the pelvic floor muscles by establishing a parameterised model. Methods To identify the factors that affect the pelvic floor muscles, the process is divided into several stages. The first step is to investigate the loads acting on the pelvic floor. For this, a simplified sagittal cross-sectional model of the upper body is analysed. The discretization of the abdominal cavity is presented with resulting force vectors representing the organs in the abdominal and pelvic region, the tensile force of the structures that fixate the organs as well as the intraabdominal pressure. A second step is the examination of the basic mechanics of the pelvic floor muscles. As the functional anatomy of these muscles demonstrate differences compared to other muscle groups [4], the understanding of how they differ is crucial for the construction of musculoskeletal models. After a static examination of loads on a simplified muscle model, an extended model including the physiological properties of a muscle must be involved in the considerations. Therefore, the influence of parameters such as the ideal muscle strength and fibre length, as well as elasticity or passive stiffness of the elements must be taken into account. The influencing factors of the variables can be analysed in a simplified pelvic floor muscle model by systematically changing the parameters. Results The process of analysing the factors influencing the activity of the pelvic floor muscles follows two main strategies. The review of the effects of the whole body identifies the forces acting on the pelvic floor muscles and effect their activity. With the examination of the basic mechanics of a simplified pelvic floor muscle model a better understanding is achieved of how the pelvic floor muscles absorb the loads acting in the body. Discussion This process results in the main influence factors on the activity of the pelvic floor. The consequent parameters form the basis for a biomechanically justified construction of musculoskeletal simulation models of the pelvic floor. Nevertheless, it must be considered, that these mechanical studies represent simplifications of the reality. References 1. Wang et al, Front Public Health, 10:975829, 2022. 2. Bulat et al., Curr Sports Med Rep, 18(6):210-216, 2019 3. Melzner et al., Eur J Obstet Gynecol Reprod Biol, 264:306-313, 2021 4. Ashton-Miller et al., Ann N Y Acad Sci, 1101:266-96, 2007}, language = {en} } @article{FoerstlAdlerSuessetal., author = {F{\"o}rstl, Nikolas and Adler, Ina and S{\"u}ß, Franz and Dendorfer, Sebastian}, title = {Technologies for Evaluation of Pelvic Floor Functionality: A Systematic Review}, series = {Sensors}, volume = {24}, journal = {Sensors}, number = {12}, publisher = {MDPI}, doi = {10.3390/s24124001}, abstract = {Pelvic floor dysfunction is a common problem in women and has a negative impact on their quality of life. The aim of this review was to provide a general overview of the current state of technology used to assess pelvic floor functionality. It also provides literature research of the physiological and anatomical factors that correlate with pelvic floor health. This systematic review was conducted according to the PRISMA guidelines. The PubMed, ScienceDirect, Cochrane Library, and IEEE databases were searched for publications on sensor technology for the assessment of pelvic floor functionality. Anatomical and physiological parameters were identified through a manual search. In the systematic review, 114 publications were included. Twelve different sensor technologies were identified. Information on the obtained parameters, sensor position, test activities, and subject characteristics was prepared in tabular form from each publication. A total of 16 anatomical and physiological parameters influencing pelvic floor health were identified in 17 published studies and ranked for their statistical significance. Taken together, this review could serve as a basis for the development of novel sensors which could allow for quantifiable prevention and diagnosis, as well as particularized documentation of rehabilitation processes related to pelvic floor dysfunctions.}, language = {en} } @misc{FoerstlAdlerSuessetal., author = {F{\"o}rstl, Nikolas and Adler, Ina and Suess, Franz and Čechov{\´a}, Hana and Jansov{\´a}, Magdalena and Cimrman, Robert and Vychytil, Jan and Dendorfer, Sebastian}, title = {Workflow for the development of a non-invasive feedback device to assess pelvic floor contractions}, series = {ESB 2024, 29th Congress of the European Society of Biomechanics, 30 June-3 July 2024, Edinburgh, Scotland}, journal = {ESB 2024, 29th Congress of the European Society of Biomechanics, 30 June-3 July 2024, Edinburgh, Scotland}, abstract = {Introduction Pelvic floor disorders affect about 40\% of women worldwide [1]. Pelvic floor muscle (PFM) training is both a preventive and a therapeutic intervention. Current PFM training devices are invasive and have little scientific evidence. The idea is to develop a noninvasive feedback device to assess adequate PFM contraction. Therefore, evidence-based female musculoskeletal models, non-invasive data acquisition, sensor technology and artificial intelligence (AI) will be combined. This work presents the workflow to achieve such a feedback device and describes the interaction of the technologies used. Methods Exercises that induce PFM contractions have been evaluated and defined. Motion capture of these exercises will provide input for female musculoskeletal models. A combination of biomechanical rigid body and FEM simulations will be used to estimate PFM contractions. In addition, a non-invasive sensor will measure pelvic floor activity. The simulated and measured data will be used to develop an AI model that provides feedback on PFM contractions based on non-invasive data collection. Results The AMMR (AnyBody Managed Model Repository) of the AnyBody modelling system (AMS, Aalborg, Denmark) serves as the initial model for performing inverse dynamic simulations of the exercises. To calculate the PFM forces, the full-body model must be supplemented with the relevant pelvic floor structures and a mass model of the internal organs. A modified abdominal pressure model must also be incorporated. The AMS calculates the PFM activities caused by the internal organ loads and the generated abdominal pressure during the exercises. The muscle activities are transferred to a FEM model of the female pelvic floor (SfePy, simple finite elements in Python). The identical pelvic floor structures were integrated into the FEM model as in the AMS. Active PFM contractions can be simulated using the FEM model. Movement of the coccyx due to PFM contractions has been reported in the literature [2,3]. Therefore, a noninvasive coccyx motion sensor will be developed to provide additional information on PFM contractions. The measured data (coccyx motion sensor, motion capture) and the simulation results of the models will be combined to create an AI feedback model using Python. The final feedback device will consist of the AI model and the developed coccyx motion sensor, which can reproduce the resulting PFM contractions based on the sensor data and simplified motion tracking. Discussion The creation of the AMS and the FEM model is a prerequisite for the development of the feedback device. The relevant structures in the models are located inside the body. This limits the ability to observe the structures during the exercises, which can lead to difficulties in model validation. The development of a user-friendly sensor with sufficient measuring accuracy of the coccyx motion is another challenge. Nevertheless, the workflow represents a promising approach to develop a noninvasive feedback system to assess PFM contraction. References 1. Wang et al, Front Public Health, 10:975829, 2022. 2. B{\o} et al, Neurourol Urodyn, 20:167-174, 2001. 3. Fujisaki et al, J Phys Ther Sci, 30:544-548, 2018. Acknowledgements This work was supported by the project no. BYCZ01-014 of the Program INTERREG Bavaria - Czechia 2021-2027.}, language = {en} } @article{KieningerSchneiderAueretal., author = {Kieninger, Martin and Schneider, Corinna and Auer, Simon and Reinker, Lukas and Adler, Ina and Dendorfer, Sebastian and Rosenberger, Johanna and Popp, Daniel and Eissnert, Christoph and Ludsteck, Dominik and Cyrus, Christopher and Hoffmann, Johannes and Morag, Sarah and Graf, Bernhard and Kieninger, B{\"a}rbel}, title = {Transport von schwer verletzten Traumapatienten im Rettungswagen mit und ohne starre Halsorthese: vergleichende biomechanische Messungen}, series = {Die Anaesthesiologie}, volume = {73}, journal = {Die Anaesthesiologie}, number = {10}, publisher = {Springer Nature}, doi = {10.1007/s00101-024-01462-w}, pages = {668 -- 675}, abstract = {Hintergrund: Der tats{\"a}chliche Stellenwert der pr{\"a}hospitalen Immobilisation der Halswirbels{\"a}ule (HWS) bei schwer verletzten Traumapatienten ist weiterhin unklar. In Anbetracht m{\"o}glicher negativer Implikationen durch das Anbringen einer starren HWS-Orthese muss deren Anwendung w{\"a}hrend der gesamten pr{\"a}hospitalen Phase kritisch hinterfragt werden. Ziel der Arbeit: Es sollten vergleichende biomechanische Messungen zur Beweglichkeit der HWS bei Immobilisation mittels Vakuummatratze mit und ohne zus{\"a}tzliches Anbringen einer starren HWS-Orthese nach Lagerung auf der Trage durchgef{\"u}hrt werden. Material und Methoden: Die Bewegungen der HWS beim Ein- und Ausladeprozess in einen modernen RTW sowie w{\"a}hrend der Fahrt entlang eines vordefinierten Parkours wurden mit einem Motion-Capture-System aufgezeichnet. Die Probandin, an der die Messungen durchgef{\"u}hrt wurden, wurde auf einer Vakuummatratze mit der M{\"o}glichkeit zur seitlichen Fixierung des Kopfes sowie Kinn- und Stirngurt auf einer elektrohydraulischen Fahrtrage immobilisiert. Bei der einen H{\"a}lfte der Versuche erfolgte die zus{\"a}tzliche Immobilisation der HWS mittels starrer Orthese, bei der anderen wurde auf die Anwendung einer HWS-Orthese verzichtet. Ergebnisse: Statistisch signifikante Unterschiede ergaben sich nur bei einigen biomechanischen Parametern in der sagittalen Ebene (Flexion und Extension). F{\"u}r die anderen Bewegungsrichtungen (axiale Rotation, laterale Beugung) wurden keine signifikanten Unterschiede f{\"u}r die gemessenen Parameter ermittelt. Generell wurden sowohl bei den Versuchen mit HWS-Orthese als auch ohne HWS-Orthese nur sehr geringe Winkelauslenkungen (im Mittel bei axialer Rotation und Flexion/Extension im Bereich von einem bis 2 Grad, bei der lateralen Beugung h{\"o}chstens 3 Grad) gemessen. Schlussfolgerung: Bei einer korrekt durchgef{\"u}hrten Immobilisation mittels einer Vakuummatratze mit der M{\"o}glichkeit zur seitlichen Stabilisierung des Kopfes sowie Kinn- und Stirngurt auf einer elektrohydraulischen Fahrtrage mit Beladesystem ergeben sich f{\"u}r den Ein- und Ausladeprozess sowie w{\"a}hrend der Fahrt in einem modernen RTW mit luftgefederter Tragenlagerung und Luftfederung der Hinterachse keine relevanten Vorteile bez{\"u}glich der Einschr{\"a}nkung der Bewegung der HWS durch die zus{\"a}tzliche Verwendung einer starren HWS-Orthese.}, language = {de} } @misc{FoerstlAdlerSuessetal., author = {F{\"o}rstl, Nikolas and Adler, Ina and S{\"u}ß, Franz and Jansov{\´a}, Magdalena and Vychytil, Jan and Dendorfer, Sebastian}, title = {Evaluating the loads on the female pelvic floor during full-body activities using computational models}, abstract = {This work investigated the loads on the female pelvic floor during various full-body movements using computational models to calculate abdominal pressure and organ dynamic loads. While high-impact exercises resulted in higher loads, other movements showed lower loads, potentially indicating, which movements may be performed without risking pelvic floor overload and subsequent dysfunctions.}, language = {en} } @misc{AdlerFoerstlČechovaetal., author = {Adler, Ina and F{\"o}rstl, Nikolas and Čechov{\´a}, Hana and Nov{\´a}ček, V{\´i}t and S{\"u}ß, Franz and Dendorfer, Sebastian}, title = {Mechanistic analysis of pelvic floor functionality using musculoskeletal simulation}, series = {ISB 2025 - The XXX Congress of the International Society of Biomechanics, 27-31 July 2025, Stockholm}, journal = {ISB 2025 - The XXX Congress of the International Society of Biomechanics, 27-31 July 2025, Stockholm}, doi = {10.35096/othr/pub-8729}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:898-opus4-87294}, pages = {1}, abstract = {There is consensus that knowledge about the fundamentals of the pelvic floor remains incomplete, particularly regarding the sensitivity of individual pelvic floor muscles to posture variations. This study aimed to investigate the effects of variations in pelvic tilt and the point of force application induced by changes in posture on pelvic floor activity using musculoskeletal simulation. A parameter study analysed various loading cases, highlighting the coherent response of individual pelvic floor muscles to loads. Muscle activities and forces were compared across different force application points and pelvic tilt angles. A key finding was identifying peak muscle activity conditions that could help better understand the causes of pelvic floor disorders.}, language = {en} } @article{KrausKnipferJacobetal., author = {Kraus, Richard and Knipfer, Maximilian and Jacob, Matthias and Kienninger, Baerbel and Alikhani, Jasmine and Ghamsary, Parham Heydarzadeh and Reinker, Lukas and Adler, Ina and Dendorfer, Sebastian and Kieninger, Martin}, title = {Effectiveness and safety of techniques for cervical spine immobilization in mountain rescue}, series = {Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine}, volume = {34}, journal = {Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine}, publisher = {Springer}, doi = {10.1186/s13049-025-01530-z}, pages = {10}, abstract = {Background Cervical spine injuries in alpine sports require immediate immobilization at the site of the accident to avoid possible secondary damage caused by transportation. Using special sensor technology, this study investigated whether a cervical spine orthosis (cervical collar, Stifneck collar (Laerdal Medical GmbH, Puchheim, Germany)) provides greater stability than a vacuum mattress alone. Methods Using one male test person, we simulated transporting a patient with a spinal injury in steep alpine terrain. A wireless motion capture system (Xsens Technologies, Movella™ Inc., Henderson, USA) was used to record motion in three-dimensional space within a standardized environment. All tests were performed on a set course by the Bavarian Mountain Rescue Service. The test person lay on a mountain rescue stretcher and was immobilized with a vacuum mattress, either with or without a cervical orthosis. The axes of cervical spine movements were analyzed separately. Results There were no significant differences between immobilization with and without a cervical orthosis with regard to lateral flexion (max. 3.7° compared to 3.0°) in the frontal plane and maximum excursion in flexion (max. 1.6° compared to 2.8°) or extension (max. -1.6° compared to -1.7°). There was significantly greater rotation movement around the craniocaudal axis without an orthosis (max. 2.4° compared to 1.3°). Conclusion During mountain rescues, the cervical spine can be immobilized without a rigid cervical spine orthosis. Future research should explore the fundamental benefits of cervical spine immobilization, while the findings of this work contribute to the safe care of patients by avoiding the disadvantages associated with rigid cervical orthoses.}, language = {en} }