Movement Control Research Articles

Passive activity enhances residual control ability in patients with complete spinal cord injury.

JOURNAL/nrgr/04.03/01300535-202508000-00024/figure1/v/2024-09-30T120553Z/r/image-tiff Patients with complete spinal cord injury retain the potential for volitional muscle activity in muscles located below the spinal injury level. However, because of prolonged inactivity, initial attempts to activate these muscles may not effectively engage any of the remaining neurons in the descending pathway. A previous study unexpectedly found that a brief clinical round of passive activity significantly increased volitional muscle activation, as measured by surface electromyography. In this study, we further explored the effect of passive activity on surface electromyographic signals during volitional control tasks among individuals with complete spinal cord injury. Eleven patients with chronic complete thoracic spinal cord injury were recruited. Surface electromyography data from eight major leg muscles were acquired and compared before and after the passive activity protocol. The results indicated that the passive activity led to an increased number of activated volitional muscles and an increased frequency of activation. Although the cumulative root mean square of surface electromyography amplitude for volitional control of movement showed a slight increase after passive activity, the difference was not statistically significant. These findings suggest that brief passive activity may enhance the ability to initiate volitional muscle activity during surface electromyography tasks and underscore the potential of passive activity for improving residual motor control among patients with motor complete spinal cord injury.

A Performance Analysis of a Two Way Stop Control (TWSC) Intersection under Mixed Traffic Conditions

Intersections are road traffic infrastructure on highways installed to help settle directional movement that could result in conflict while vehicular trips are made. Evaluation of the challenges faced by different automobile users at the Araromi junction (A three Leg at-grade Intersection) located in Akure is the main objective of this paper. To achieve this objective, traffic flow data were collected on the spot by video recording and then the data were manually counted. While, the highway Capacity manual 2010 methodology was adopted to analyse The entry flow rates, Potential Capacities, Movement Capacities, Movement Control Delay, Approach Intersection Control and 95th Percentile Quene Length of the intersection. Findings shows that an average entry flow rate of 357 pc/h occurs for all the legs of the intersection, the North bound left turning movement of the intersection was not within the allowable limit, the average potential capacity by lane for the intersection is 445 pc/h, and the average movement capacity by lane 473 Pc/h, the various legs of the intersection has a level of service of ‘A’ and ‘C’ except the left turning minor street movement that has an ‘F’ LOS. Due to the influence of high traffic flow around the intersection, the analysis of the real-time traffic flow results reveals the need to diverge the high right turning movement into other route to cater for low left turning movement causing delay and poor LOS and a need to introduce Signal on the intersection in other to improve on her functionality.

Comparison of treatment effects between clear aligners and fixed appliances in patients treated with miniscrew-assisted molar distalization.

The biomechanics in achieving molar distalization may differ between fixed appliances and clear aligners in the control of tooth movement. The objective of this study was to compare the treatment effects between clear aligners (CA) and fixed appliances (FA) in patients treated with miniscrew-assisted molar distalization. The sample consisted of 46 subjects with mild-to-moderate crowding. A total of 22 patients treated with clear aligners (age, 25.66 ± 6.11 years old) and 24 patients treated with fixed appliances (age, 24.04 ± 4.95 years old) for miniscrew-assisted molar distalization were included in this study. The dental and skeletal changes were evaluated by the pre- and post-treatment lateral cephalograms. Significant changes were found with the vertical variables SN-OP angle (2.24 ± 3.22°, P < .05) and SN-MP angle (0.73 ± 1.15°, P < .05) for the FA group when compared with the CA group (SN-OP angle 0.41 ± 2.26° and SN-MP angle -0.21 ± 1.38°, P > .05). Both treatment groups achieved a 2-3mm. molar distalization with significant intrusion of the upper molars. The CA group showed significantly less distal tipping of molars (U6^PP angle -2.29 ± 3.29° and L6^MP angle -2.92 ± 2.49°, P < .05) compared to the FA group (-5.24 ± 4.28° and -5.53 ± 5.03°, P < .05). In addition, significant retraction and lingual inclination of the upper and lower incisors were found in both groups. The changes of tooth position were evaluated by 2D lateral cephalograms, not 3D measurements. Compared to fixed appliances, clear aligners seemed to have better control of vertical dimension and distal tipping of molars in patients treated with miniscrew-assisted molar distalization.

The complementary dominance hypothesis: a model for remediating the 'good' hand in stroke survivors.

The complementary dominance hypothesis is a novel model of motor lateralization substantiated by decades of research examining interlimb differences in the control of upper extremity movements in neurotypical adults and hemisphere-specific motor deficits in stroke survivors. In contrast to earlier ideas that attribute handedness to the specialization of one hemisphere, our model proposes complementary motor control specializations in each hemisphere. The dominant hemisphere mediates optimal control of limb dynamics as required for smooth and efficient movements, whereas the non-dominant hemisphere mediates impedance control, important for countering unexpected mechanical conditions and achieving steady-state limb positions. Importantly, this model proposes that each hemisphere contributes its specialization to both arms (though with greater influence from either arm's contralateral hemisphere) and thus predicts that lesions to one hemisphere should produce hemisphere-specific motor deficits in not only the contralesional arm, but also the ipsilesional arm of stroke survivors - a powerful prediction now supported by a growing body of evidence. Such ipsilesional arm motor deficits vary with contralesional arm impairment, and thus individuals with little to no functional use of the contralesional arm experience both the greatest impairments in the ipsilesional arm, as well as the greatest reliance on it to serve as the main or sole manipulator for activities of daily living. Accordingly, we have proposed and tested a novel intervention that reduces hemisphere-specific ipsilesional arm deficits and thereby improves functional independence in stroke survivors with severe contralesional impairment.

The influence of smoothness and speed of stand-to-sit movement on joint kinematics, kinetics, and muscle activation patterns.

Stand-to-sit (StandTS) is an important daily activity widely used in rehabilitation settings to improve strength, postural stability, and mobility. Modifications in movement smoothness and speed significantly influence the kinematics, kinetics, and muscle activation patterns of the movement. Understanding the impact of StandTS speed and smoothness on movement control can provide valuable insights for designing effective and personalized rehabilitation training programs. How do the smoothness and speed of StandTS movement affect joint kinematics, kinetics, muscle activation patterns, and postural stability during StandTS? Twelve healthy younger adults participated in this study. There were two StandTS conditions. In the reference condition, participants stood in an upright position with their feet positioned shoulder-width apart on the force plate. Upon receiving a visual cue, participants performed StandTS at their preferred speed. In the smooth condition, participants were instructed to perform StandTS as smoothly as possible, aiming to minimize contact pressure on the seat. Lower leg kinetics, kinematics, and coordination patterns of muscle activation during StandTS were measured: (1) angular displacement of the trunk, knee, and hip flexion; (2) knee and hip extensor eccentric work; (3) muscle synergy pattern derived from electromyography (EMG) activity of the leg muscles; and (4) postural sway in the anterior-posterior (A-P), medio-lateral (M-L), and vertical directions. Compared to the reference condition, the smooth condition demonstrated greater eccentric knee extensor flexion and increased joint work in both the knee and hip joints. Analysis of specific muscle synergy from EMG activity revealed a significant increase in the relative contribution of hip joint muscles during the smooth condition. Additionally, a negative correlation was observed between knee extensor and vertical postural sway, as well as hip extensor work and M-L postural sway. Smooth StandTS facilitates enhanced knee eccentric control and increased joint work at both the hip and knee joints, along with increased involvement of hip joint muscles to effectively manage falling momentum during StandTS. Furthermore, the increased contributions of knee and hip joint work reduced postural sway in the vertical and M-L directions, respectively. These findings provide valuable insights for the development of targeted StandTS rehabilitation training.

Readiness to Continue Online Learning Post Covid-19 Among Students of Politeknik Jeli Kelantan

The Covid-19 pandemic has prompted the Ministry of Education to transition entirely to online learning method. All schools and higher education institutions are no exception in embracing this shift. However, the drastic change, executed without adequate preparation, has led to numerous challenges and setbacks, resulting in a decline in student performance. Consequently, once the movement control order was fully lifted, the ministry promptly reverted to traditional face-to-face learning method completely. Polytechnics followed suit, mirroring this approach. Despite the problems and complaints that surfaced, dismissing the role of virtual technology in education is unjustified, given the considerable effort and preparation invested to improve the online learning effectiveness during the Covid-19 pandemic. Hence, this study was conducted to assess students' readiness to continue online learning post-Covid-19. A total of 293 students from Politeknik Jeli Kelantan participated as respondents, and the collected data was statistically analyzed using SPSS V22 software. The study's findings revealed that majority of respondents expressed a strong willingness and motivation to engage in online teaching and learning sessions. Moreover, these respondents exhibited confidence in the potential and effectiveness of online teaching and learning methods. These research findings are anticipated to assist relevant parties involved, particularly educators and educational institutions, in formulating comprehensive teaching modules and policies that integrate both face-to-face and online learning methods seamlessly.

Imprecise perception of hand position during early motor adaptation.

Localizing one's body parts is important for movement control and motor learning. Recent studies have shown that the precision with which people localize their hand places constraints on motor adaptation. Although these studies have assumed that hand localization remains equally precise across learning, we show that precision decreases rapidly during early motor learning. In three experiments, healthy young participants (n = 92) repeatedly adapted to a 45° visuomotor rotation for a cycle of two to four reaches, followed by a cycle of two to four reaches with veridical feedback. Participants either used an aiming strategy that fully compensated for the rotation (experiment 1), or always aimed directly at the target, so that adaptation was implicit (experiment 2). We omitted visual feedback for the last reach of each cycle, after which participants localized their unseen hand. We observed an increase in the variability of angular localization errors when subjects used a strategy to counter the visuomotor rotation (experiment 1). This decrease in precision was less pronounced in the absence of reaiming (experiment 2), and when subjects knew that they would have to localize their hand on the upcoming trial, and could thus focus on hand position (experiment 3). We propose that strategic reaiming decreases the precision of perceived hand position, possibly due to attention to vision rather than proprioception. We discuss how these dynamics in precision during early motor learning could impact on motor control and shape the interplay between implicit and strategy-based motor adaptation.NEW & NOTEWORTHY Recent studies indicate that the precision with which people localize their hand limits implicit visuomotor learning. We found that localization precision is not static, but decreases early during learning. This decrease is pronounced when people apply a reaiming strategy to compensate for a visuomotor perturbation and is partly resistant to allocation of attention to the hand. We propose that these dynamics in position sense during learning may influence how implicit and strategy-based motor adaption interact.

Development and design approach of an sEMG-based Eye movement control system for paralyzed individuals

Development and design approach of an sEMG-based Eye movement control system for paralyzed individuals

Anthropomorphic Tendon-Based Hands Controlled by Agonist-Antagonist Corticospinal Neural Network.

This article presents a study on the neurobiological control of voluntary movements for anthropomorphic robotic systems. A corticospinal neural network model has been developed to control joint trajectories in multi-fingered robotic hands. The proposed neural network simulates cortical and spinal areas, as well as the connectivity between them, during the execution of voluntary movements similar to those performed by humans or monkeys. Furthermore, this neural connection allows for the interpretation of functional roles in the motor areas of the brain. The proposed neural control system is tested on the fingers of a robotic hand, which is driven by agonist-antagonist tendons and actuators designed to accurately emulate complex muscular functionality. The experimental results show that the corticospinal controller produces key properties of biological movement control, such as bell-shaped asymmetric velocity profiles and the ability to compensate for disturbances. Movements are dynamically compensated for through sensory feedback. Based on the experimental results, it is concluded that the proposed biologically inspired adaptive neural control system is robust, reliable, and adaptable to robotic platforms with diverse biomechanics and degrees of freedom. The corticospinal network successfully integrates biological concepts with engineering control theory for the generation of functional movement. This research significantly contributes to improving our understanding of neuromotor control in both animals and humans, thus paving the way towards a new frontier in the field of neurobiological control of anthropomorphic robotic systems.

Movement and binding control strategy based on a new type of rebar-binding robot

PurposeThe paper focuses on the issue of manual rebar-binding tasks in the construction industry, which are marked by high labor intensity, high costs and inefficient operations. The rebar-binding robots that are currently available are not fully mature. Most of them can only bind one or two nodes in one position, which leads to significant time wastage in movement. Based on a new type of rebar-binding robot, this paper aims to propose a new movement and binding control that reduces manpower and enhances efficiency.Design/methodology/approachThe robot is combined with photoelectric sensors, travel switches and other sensors. It is supposed to move accurately and run in a limited area on the rebar mesh through logical judgment, speed control and position control. Machine vision is used by the robot to locate the rebar nodes and then adjusts the binding-gun position to ensure that multiple rebar nodes are bound sequentially.FindingsBy moving on the rebar mesh with accuracy, the robot meets the positioning accuracy requirements of the binding module, with experimental testing accuracy within 5 mm. Furthermore, its ability to bind four rebar nodes in one place results in a high efficiency and a binding effect that meets building standards.Originality/valueThe innovative design of the robot can adapt itself to the rebar mesh, move accurately to the target position and bind four nodes at that position, which reduces the number of movements on the mesh. Repetitive and heavy rebar-binding tasks can be efficiently completed by the robot, which saves human resources, reduces worker labor intensity and reduces construction overhead. It provides a more feasible and practical solution for using robots to bind rebar nodes.

A neighbor discovery protocol with adaptive collision alleviation for wireless robotic networks

Recently, several movement control algorithms have been proposed to move robots to the desired locations and complete various collaborative tasks. These algorithms usually require information exchange among robots, which in turn relies on efficient neighbor discovery. However, neighbor discovery of robots is a challenging problem due to limited communication range and beacon collision. Here, how to set the time slot length and contention window to alleviate the beacon collisions is a major issue: too large or too small slot length and contention window values cannot achieve good performance in the robotic network. Therefore, we propose a neighbor discovery protocol with an adaptive collision alleviation mechanism, i.e. ND-ACA. ND-ACA adopts a simple mechanism to detect and avoid potential collisions before sending beacon, and adaptively adjusts both slot length and backoff window according to the number of historical beacon collections and beacon collisions. Extensive simulation results show the efficiency of our proposed approach. To the best of our knowledge, this is the first work in the literature that explore the joint implementation effects that simultaneously consider the robot mobility model and neighbor discovery.

The effect of a neck-specific exercise program on cervical kinesthesia for patients with chronic whiplash-associated disorders: a case-control study

IntroductionCervical kinesthesia is an important part of movement control and of great importance for daily function. Previous research on kinesthesia in whiplash-associated disorders (WAD) has focused on grades I-II. More research is needed on WAD grade III. The aim of this study was to investigate cervical kinesthesia in individuals with WAD grades II-III before and after a neck-specific exercise intervention and compare them to healthy controls.MethodsA prospective, case-control study with a treatment arm (n = 30) and a healthy control arm (n = 30) was conducted in Sweden. The WAD group received a neck-specific exercise program for 12 weeks. The primary outcome to evaluate kinesthesia was neck movement control (the Fly test). Secondary outcomes were neck disability, dizziness and neck pain intensity before and after the Fly test. Outcomes were measured at baseline and post-treatment. The control arm underwent measurements at baseline except for the dizziness questionnaire. A linear mixed model was used to evaluate difference between groups (WAD and control) and over time, with difficulty level in the Fly test and gender as factors.ResultsBetween-group analysis showed statistically significant differences in three out of five kinesthetic metrics (p = 0.002 to 0.008), but not for the WAD-group follow-up versus healthy control baseline measurements. Results showed significant improvements for the WAD-group over time for three out of five kinaesthesia metrics (p < 0.001 to 0.008) and for neck disability (p < 0.001) and pain (p = 0.005), but not for dizziness (p = 0.70).ConclusionsThe exercise program shows promising results in improving kinesthesia and reducing neck pain and disability in the chronic WAD phase. Future research might benefit from focusing on adding kinesthetic exercises to the exercise protocol and evaluating its beneficial effects on dizziness or further improvement in kinesthesia.Impact statementKinesthesia can be improved in chronic WAD patients without the use of specific kinesthetic exercises.Trial registrationClinicalTrials.gov (NCT03664934), first registration approved 11/09/2018.

Motor Control in Parkinson’s Disease During the Performance of Multi-Joint Reversal Movements

We tested if the movement slowness of individuals with Parkinson’s disease is related to their decreased ability to generate adequate net torques and linearly coordinate them between joints. This cross-sectional study included ten individuals with Parkinson’s disease and ten healthy individuals. They performed planar movements with a reversal over three target distances. We calculated joint kinematics of the elbow and shoulder using spatial orientation. The muscle, interaction, and net torques were integrated into the acceleration/deceleration phases of the fingertip speed. We calculated the linear correlations of those torques between joints. Both groups modulated the elbow and shoulder net torques with target distances. They linearly coupled the production of torques. Both groups did not modulate the interaction torques. The movement slowness in Parkinson’s disease was related to the difficulty in generating the appropriate muscle and net torques in the task. The interaction torques do not seem to play any role in movement control.

Multimodal convergence in the pedunculopontine tegmental nucleus: Motor, sensory and theta-frequency inputs influence activity of single neurons.

The pedunculopontine tegmental nucleus of the brainstem (PPTg) has extensive interconnections and neuronal-behavioural correlates. It is implicated in movement control and sensorimotor integration. We investigated whether single neuron activity in freely moving rats is correlated with components of skilled forelimb movement, and whether individual neurons respond to both motor and sensory events. We found that individual PPTg neurons showed changes in firing rate at different times during the reach. This type of temporally specific modulation is like activity seen elsewhere in voluntary movement control circuits, such as the motor cortex, and suggests that PPTg neural activity is related to different specific events occurring during the reach. In particular, many neuronal modulations were time-locked to the end of the extension phase of the reach, when fine distal movements related to food grasping occur, indicating strong engagement of PPTg in this phase of skilled individual forelimb movements. In addition, some neurons showed brief periods of apparent oscillatory firing in the theta range at specific phases of the reach-to-grasp movement. When movement-related neurons were tested with tone stimuli, many also responded to this auditory input, allowing for sensorimotor integration at the cellular level. Together, these data extend the concept of the PPTg as an integrative structure in generation of complex movements, by showing that this function extends to the highly coordinated control of the forelimb during skilled reach to grasp movement, and that sensory and motor-related information converges on single neurons, allowing for direct integration at the cellular level.

A Study to Find Out Effect of Trunk Training Exercises on Trunk Control by using Swiss Ball in Parkinson’s Patients: An Experimental Study

Background: The trunk being central key point of body, proximal trunk control is a pre-requisite for distal limb movement control, balance and functional activities. Sufficient trunk stability and control of trunk movements are essential for postural stability and normal gait as the upper body constitutes two thirds of the total body weight. In Parkinson’s disease approximately 13% to 33% of patients present with postural instability as their initial motor symptom. So, purpose of this study was to compare the effect of Swiss ball trunk training exercise and trunk exercise on a bed for trunk control in Parkinson’s patients. Method: Total 30 Parkinson’s patient were selected for the study as per selection criteria and divided into two groups (15 in each group). group A was treated with trunk exercise on Swiss ball and group B was treated with trunk exercise on bed. each subject received treatment for 3 weeks,4 days/week.an assessment was done prior to treatment and after 3 weeks using Trunk Impairment Scale test. Inter-group analysis by unpaired t-test showed statistically significant improvement on Trunk Impairment Scale. (P value ≤0.05) Conclusion: The Swiss ball trunk training exercise and trunk exercise on a bed had a significant effect on trunk control. Out of the two treatment Swiss ball trunk training had a more significant effect on improving trunk control.

Reliability of the Hand-Eye Coordination Test among Adults Using a Software: A Longitudinal Follow-up Study

This study aims to determine the reliability of the hand-eye coordination Software. The integrated control of hand and eye movements, as well as the processing of visual information to support attainment and acquisition and the use of hand proprioception to guide the eyes, are known as hand-eye coordination. Thus, this study aims to determine the reliability of the tests, so the research was conducted thrice with an interval of 6-7 days (test-retest). 28 Young Adults (18- 35 years of age) have participated in the study. The analysis includes finger-pointing tasks performed only with the use of Hand-eye coordination software prepared by the Software engineer.In this Software, Visual targets in the form of a ball then appeared on the screen on the left, on the right, or in the center in random order., and participants were asked to point an index finger of the leading hand as rapidly and precisely as possible at all targets on the screen. After touching the target (indicated by its disappearance), the participant immediately placed his/her hand back in the designated starting position (touchpad).Each participant was required to repeat this finger-pointing task. The accuracy value after 1 minute was recorded and the average accuracy value was calculated and used in the analysis A smaller value indicates greater touch accuracy. In addition, the average reaction time (in milliseconds) was also measured. Based on the data analysis, the reliability score is 0.806 (Cronbach’s Alpha), which indicates a high level of internal Consistency.

Effects of passive ankle exoskeletons on neuromuscular function during exaggerated standing sway

Wearable robotic exoskeletons designed to assist human movement should integrate with the neuromusculoskeletal system. This means assisting movement while not perturbing motor control. We sought to test if passive ankle exoskeletons, which have been shown to successfully assist human gait, affect neuromuscular control of an exaggerated anterior–posterior standing sway task. Participants actively swayed while wearing an ankle exoskeleton that provided 0, 42 or 85 Nm rad −1 of additional stiffness to the ankle joint in resistance to dorsiflexion. Sway amplitude was controlled via biofeedback to elicit similar ankle angle displacements across conditions. With greater exoskeleton stiffness, participants swayed at lower sway-cycle frequencies and slower centre of pressure speeds. Furthermore, increasing exoskeleton stiffness resulted in longer operating lengths of the medial gastrocnemius and overall reduced plantar flexor muscle activation. For the soleus, there was also a temporal shift in the cross-correlation of its electromyogram with the centre of pressure displacement, meaning that muscle activation peaked later than anterior sway displacement. Together, these data suggest that assistive ankle exoskeletons influence neuromuscular control of ankle-based sway tasks. Changes in fascicle lengths could influence afferent feedback signals and the short-range stiffness of ankle muscles, while shifts in muscle activation timing suggest changes in neural control. The observed neuromuscular adaptations to exoskeleton assistance demonstrate the potential implications for standing balance and overall movement control, prompting future investigations.

Assessment of Oculomotor Functions as a Biomarker in Mild Traumatic Brain Injury.

Mild traumatic brain injury (mTBI), or concussion, is a major public health problem, and ambiguity still exists regarding its diagnosis. While functional magnetic resonance imaging (fMRI) has been identified as a helpful screening tool for concussion, its limited accessibility in clinical or field settings necessitates a more efficient alternative. Oculomotor function deficit is an often-reported pathology in mTBI. Due to the neuroanatomical overlap between eye-movement circuitry and mTBI pathophysiology, visual deficits are expected. In this study, we investigate the possibility of using an oculomotor assessment tool for finding biomarkers in concussion. We used fMRI with tasks evaluating oculomotor functions: smooth pursuit (SP), saccades, anti-saccades, and optokinetic nystagmus (OKN). Before the scanning, the testing with a system of virtual reality goggles with integrated eye- and head-tracking was used where subjects performed the same tasks as those used in fMRI. Twenty-nine concussed symptomatic adults (CSA) within 1-month postconcussion and 29 age- and sex-matched healthy controls (HCS) were tested to examine blood oxygen level-dependent (BOLD) fMRI alterations associated with performances in oculomotor function after mTBI and evaluate the efficacy of the oculomotor assessment in detecting oculomotor and gaze deficits following mTBI. Comparing CSA with HCS, significant differences were observed in anti-saccades and OKN performance. CSA group exhibited elevated %BOLD signal change on each task compared with HCS: in the superior frontal gyrus during the smooth pursuit, inferior frontal gyrus during the saccades, putamen and dorsolateral prefrontal cortex (DLPFC) during the anti-saccades, and lingual gyrus and IFG during the OKN. Key findings include the following: (1) oculomotor deficits in concussed subjects compared with controls, (2) abnormal activation patterns in areas related to the regulation and control of oculomotor movements, suggesting concussion-induced disruptions, and (3) the potential of oculomotor assessment as a promising approach for mTBI biomarkers, with anti-saccades and OKN identified as the most sensitive tasks.

Advancing women's pelvic floor muscle function diagnosis: the EFSMAP examination and its reliability evaluation

BackgroundThe accurate diagnosis of pelvic floor muscle impairments is essential. The plethora of terms and the lack of evidence to support widely used pelvic floor muscle function (PFMF) measurements hinder diagnostic labels. ObjectiveTo structure an examination of PFMF using visual observation and digital palpation and terms consistent with the ICF terminology, and to test its intra and interrater reliability/agreement. MethodsA panel of 9 physical therapists applied Delphi method to structure the PFMF exam under ICF terminology and to verify its measurements reproducibility. For reliability and agreement, a convenience sample of women aged 51.2 ± 14.7 years had the sensitivity to pressure, pain, muscle tone, involuntary movement reaction, control of voluntary movement (contraction/relaxation), coordination, strength, and endurance examined by two raters, in the same day for interrater (n = 40), and one week apart, for intrarater reliability (n = 25). Percent agreement, linear weighted kappa, intraclass correlation coefficient, and Bland-Altman's limits of agreement were calculated (alpha = 0.05). ResultsFour round Delphi discussion structured the PFMF exam, named EFSMAP (Exame das Funções Sensoriais e Motoras do Assoalho Pélvico/Examination of Pelvic Floor Sensory and Motor Functions), set a list of concepts and instructions targeted at reproducibility and established PFMF diagnostic labels. Reliability, except for pain and tone, were moderate to excellent (Kw= 0.67–1.0 and ICC=0.48–0.82). Agreement was substantial for most PFMF features (0.64–1.00), except pain. ConclusionsThe EFSMAP was successfully developed as a valid and reliable exam to be used in research and clinical practice; it provides labels for the diagnosis of pelvic floor muscle impairments. It might be easily adopted worldwide as it uses ICF terminology.

Creative biomechanics for complex cases

Orthodontic biomechanics play a crucial role in achieving successful outcomes, especially in complex cases requiring precise control of tooth movements. This article explores force system analysis based on the moments and forces around the center of resistance and emphasizes traditional and contemporary approaches in orthodontic biomechanics, focusing on key tooth movements such as bite opening, space closure, retraction, protraction, intrusion, and extrusion.In complex borderline cases involving nonsurgical treatment, this article addresses the significance of total arch distalization for maximum retraction, total arch intrusion for vertical control, total arch extrusion for enhancing maxillary incisor display, lever arm mechanics for achieving incisor torque control, and total arch protraction for improving the maxillary incisor show.Patient-specific factors, efficient biomechanics, and a comprehensive understanding of the limitations of treatment modalities are emphasized in pursuit of optimal orthodontic outcomes.