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Control of abdominal muscles.

Abdominal muscles serve many roles; in addition to breathing, especially at higher levels of chemical drive or at increased end-expiratory lung volumes, they are responsible for, or contribute to, such protective reflexes as cough, sneeze, and vomiting, generate the high intra-abdominal pressures necessary for defecation and parturition, are active during postural adjustments, and play an essential role in vocalization in many species. Despite this widespread involvement, however, their control has, with rare exceptions, received little attention for two major reasons. First, in most anesthetized or decerebrate preparations, they are relatively inactive at rest, in part because the position of the preparation (supine or prone with abdomen supported), reduces lung volume and, therefore, their activity. Second, unlike phrenic motoneurons innervating the diaphragm, identification of motoneurons to a particular abdominal muscle is difficult. At the lumbar level, a given motoneuron may innervate any one of the four abdominal muscles; at the thoracic level, they are also intermixed with those innervating the intercostals. The two internal muscles, the internal oblique and the transverse abdominis, respond more to increases in chemical or volume-related drive than the two external muscles, the rectus abdominis and external oblique; the basis for this differential sensitivity is unknown. Segmental reflexes at the thoracic and lumbar levels are sufficient to activate abdominal motoneurons in the absence of descending drive but the basis for these reflex effects is also unknown. Neuroanatomical experiments demonstrate many more inputs to, and outputs from, the nucleus retroambigualis, the brainstem region in which the premotor neurons are located, than can be accounted for by their respiratory role alone. These other connections likely subserve activities other than respiration. Studies of the multifunctional roles of the abdominal muscles, on the basis of recent work, hold considerable promise for improving our understanding of their control.

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Optimal electrode placement for noninvasive electrical stimulation of human abdominal muscles.

Abdominal muscles are the most important expiratory muscles for coughing. Spinal cord-injured patients have respiratory complications because of abdominal muscle weakness and paralysis and impaired ability to cough. We aimed to determine the optimal positioning of stimulating electrodes on the trunk for the noninvasive electrical activation of the abdominal muscles. In six healthy subjects, we compared twitch pressures produced by a single electrical pulse through surface electrodes placed either posterolaterally or anteriorly on the trunk with twitch pressures produced by magnetic stimulation of nerve roots at the T(10) level. A gastroesophageal catheter measured gastric pressure (Pga) and esophageal pressure (Pes). Twitches were recorded at increasing stimulus intensities at functional residual capacity (FRC) in the seated posture. The maximal intensity used was also delivered at total lung capacity (TLC). At FRC, twitch pressures were greatest with electrical stimulation posterolaterally and magnetic stimulation at T(10) and smallest at the anterior site (Pga, 30 +/- 3 and 33 +/- 6 cm H(2)O vs. 12 +/- 3 cm H(2)O; Pes 8 +/- 2 and 11 +/- 3 cm H(2)O vs. 5 +/- 1 cm H(2)O; means +/- SE). At TLC, twitch pressures were larger. The values for posterolateral electrical stimulation were comparable to those evoked by thoracic magnetic stimulation. The posterolateral stimulation site is the optimal site for generating gastric and esophageal twitch pressures with electrical stimulation.

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[Acquired disorders of peritoneal cavity muscles. Abdominal wall denervation in pregnancy, denervation incontinence, and continent and incontinent constipation].

The peritoneal cavity has a fascial skeleton that is kept under tension by permanent variable resting tone maintained by the abdominal muscles. The lateral abdominal muscles, the diaphragm and the pelvic floor are all components of this fasciomuscular support system. Voluntary and reflective changes in muscle tension allow the entry and exit of matter into and out of the spherical abdominal cavity by opening and closing of specialized wall segments called sphincters. We have previously demonstrated the existence of a resting tone in the tail muscles of mammals from which the human pelvic floor muscles are derived. The pelvic floor and its integrated sphincters form the anorectal organ of continence. This organ is much weaker in females than in males. The spinal centers that govern continence, contain in the female significantly fewer ganglion cells than the corresponding centers in the male. Childbirth and a commonly found tendency to develop constipation are additional stressors for the congenitally weaker female organ of continence. We explain in this paper why the abdominal wall and the pelvic floor may suffer stretch-induced denervation injuries during pregnancy and delivery. Such damage may persist in later life and can give rise to incontinence and "flabby abdomen". Based on our work in this field, we found a new differentiation between continent and incontinent constipation. Continent constipation is caused by spasticity of the pelvic floor characterized by abnormally high sphincter activity. This spastic pelvic floor syndrome can be treated successfully by psychotherapeutic techniques. Incontinent constipation, in contrast, is always associated with subnormal activity of the sphincters and may be a cause of rectal prolapse. It can be treated successfully by anterior rectosigmoid resection. Incontinent constipation will also require operative approximation of the levators in many cases. Improvement cannot be expected to result from this procedure, however, unless the pelvic floor shows some residual resting activity.

Abdominal Muscles↗

[Respiratory pattern and activity of the abdominal muscles after upper abdominal surgery].

Because only few data is as yet available concerning abdominal muscle activity following upper abdominal surgery, the present study aimed to investigate the pattern of abdominal muscle activity before and after upper abdominal surgery and to relate any changes to differences in abdominal respiratory movements. Eight ASA I patients (5 women, 3 men), mean age 44 +/- 12 yr, undergoing elective cholecystectomy (midline incision) were investigated. The following parameters were measured, with the patients supine and at rest, on the eve of surgery, and 2, 4, 24 and 72 h afterwards: tidal volume (VT), breathing rate (f), inspiratory time (TI), total cycle time (TT), changes in abdominal (Dab) and thoracic (Drc) circumferences, surface electromyograms of the rectus abdominis and obliquus externus abdominis muscles. The ratio (Dab/Dab + Drc) was used as an index of relative abdominal movement. Anaesthetic management was similar for all patients (thiopentone, fentanyl, vecuronium, halothane and N2O). A significant reduction in VT was found between 2 and 24 h postoperatively, with a significant increase in f between 4 and 24 h after surgery. Both these parameters returned to normal values at the 72nd h. Relative abdominal movement was reduced in the immediate postoperative period (2 and 4 h), slowly improving, but remaining lower than normal at 72 h. Muscle tonus was increased at 2 h and returned to normal at the 4th h. This transient increase suggested a residual effect of fentanyl.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Muscles↗

Activity of lower intercostal and abdominal muscle after upper abdominal surgery.

The decrease in end-expiratory lung volume after upper abdominal surgery has been attributed, in part, to reflex spasm of the abdominal muscles. To examine the influence of abdominal surgery on abdominal muscle tone, electromyographic (EMG) activity of abdominal and lower intercostal muscle was compared before operation with that at 3 hr and at 24 hr after operation in 18 healthy patients undergoing elective gastric or biliary surgery. After operation, EMG activity increased markedly and showed a phasic pattern of activity associated with respiration in most patients. This was characterized by a progressive increase in EMG activity during expiration with an abrupt decrease at the onset of inspiration. We conclude that increased expiratory activity in abdominal and lower intercostal muscle may be responsible for the decrease in lung volumes that occurs after upper abdominal surgery.

Abdomen↗

Mechanical response to hyperinflation of the two abdominal muscle layers.

Abdominal muscle length changes and activity were directly examined in vivo with the use of the techniques of sonomicrometry and electromyography, respectively, in nine supine anesthetized dogs. Expiratory threshold loading was utilized to stimulate recruitment of the abdominal muscles, and lung inflations produced the passive relationships. The internal layer, consisting of the internal oblique and transversus abdominis, shortened more in expiration than the external layer, consisting of the external oblique and rectus abdominis. The internal oblique shortened to approximately 83% of its length at functional residual capacity vs. 98% for the external oblique (P less than 0.05). The results obtained during passive lung inflation indicate these internal muscles are also more influenced by changes in lung volume. The internal oblique lengthened to 115% of its length at functional residual capacity vs. 103% for external oblique at total lung capacity (P less than 0.05). The results suggest that anatomic division of the abdominal muscles into external and internal layers corresponds to functional differences in terms of both passive lengthening and active shortening during ventilation and that these differences imply variable functions of the two layers.

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Electromyographic analysis of abdominal muscle activity using portable abdominal exercise devices and a traditional crunch.

The purpose of this study was to compare the abdominal muscle activity elicited while using 4 portable abdominal training devices vs. a traditional crunch. Thirty-three adults participated in this study. The exercise devices tested included the Ab Roller Plus, Torso Track 2, AB-DOer Pro, and the Perfect Abs. All subjects were tested on the Perfect Abs in both a seated and supine position using low-, medium-, and high-resistance bands. The Torso Track 2 was also tested at low- and high-resistance settings. Surface electromyography (EMG) was recorded from the upper and lower portions of the rectus abdominis, external oblique, and the rectus femoris during each repetition. Statistical analyses were performed on the mean EMG values using a repeated analysis of variance (ANOVA) procedure. There was no significant difference in abdominal muscle activity between the Ab Roller Plus, the Torso Track 2 (high resistance), and a traditional crunch. The mean abdominal muscle activity was significantly lower than a normal crunch, however, when using the AB-DOer, Torso Track (low resistance), and the Perfect Abs seated with the low-resistance band. In contrast, the Perfect Abs, when used in the supine position with the medium- and high-resistance bands, elicited significantly greater mean abdominal muscle activity than a crunch. Of the 4 devices tested, only the Perfect Abs when used in the supine position with the medium- and high-resistance bands, elicited more abdominal activity than a crunch. The results suggest that portable abdominal devices are most effective if they not only mimic the mechanics of a traditional crunch, but also provide external resistance to increase the involvement of the abdominal musculature.

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Association of airway obstruction, sleep, and phasic abdominal muscle activity after upper abdominal surgery.

We recorded nasal gas flow, sleep stage, and abdominal muscle EMG pattern in 11 patients throughout the night after abdominal surgery, to examine the association between phasic activity of the abdominal muscles, sleep stage, and flow disturbance. We used a miniaturized data logging system, and obtained satisfactory records in eight patients. The data were divided into 30-s epochs. Each epoch was classified as either awake or asleep. The epochs were also classified for the presence of phasic activity in the external oblique abdominal muscle, and for evidence of airway obstruction. Association between these features was tested by a quasi likelihood log linear model. Values given are median (quartiles) for the eight subjects. Sleep occurred for 62 (46-69)% of the study time. During sleep, inspiratory flow was normal for 69 (48-81)% of the time, whereas during wakefulness, the flow pattern was normal for 51 (28-77)% of the time. Phasic activity was present 16 (12-25)% of the time during sleep and 24 (19-37)% of the time during wakefulness (P<0.001). In the awake state, when breathing was normal, phasic activity was present 16 (11-30)% of the time. When breathing was obstructed, phasic activity was present 38 (25-44)% of the time (P<0.001). These surprising findings suggest that sleep may be seriously disturbed by airway obstruction, so that a stable sleep state is not reached. We could not confirm previous findings that disturbed breathing in post-operative patients only occurs during sleep.

Abdomen↗

Cournand lecture: Mechanical action of the abdominal muscles.

The abdominal muscles, by causing a rise in abdominal pressure and a cranial displacement of the diaphragm, 1--deflate the lungs (minimize the increase in FRC which normally occurs when adopting the standing posture), 2--exert an expanding force on the lower rib cage, which may counterbalance or even dominate the insertional (expiratory) force they exert on the lower ribs by way of their insertions, 3--improve the pressure-generating ability of the diaphragm. In addition, because they prevent the diaphragmatic dome from descending during inspiration, they also improve the rib cage expanding action of the diaphragm.

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Abdominal muscle activity during the abdominal hollowing manoeuvre in the four point kneeling and prone positions.

This study investigated the pattern of recruitment of the abdominal muscles during the abdominal hollowing manoeuvre (AHM), in four point kneeling and prone. Muscle activity was detected and recorded by surface electromyography (EMG), in 20 healthy subjects, 8 male and 12 female, aged between 19 and 30 during both maximal activity, and the AHM. The degree of activation during hollowing was expressed as a percentage of maximal. There was activity in the internal abdominal oblique (IO) during all hollowing manoeuvres, in both starting positions, whilst only two subjects showed any activity in rectus abdominis (RA). Simultaneous activity in IO and EO occurred both in four point kneeling (45% of the subjects) and especially in prone (75% of the subjects). Across both positions IO activity was significantly greater than EO. There was no significant difference in EO or IO activity comparing across positions. These results suggest that the AHM when performed in four point kneeling and prone always activates IO and rarely activates RA, whilst elimination of activity in EO is more difficult to achieve, particularly in prone. Isolated activity in the deep abdominal muscles may not always be achievable in these starting positions.

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Intercostal and abdominal muscle afferent influence on caudal medullary expiratory neurons that drive abdominal muscles.

Our objective was to determine if caudal ventral respiratory group (VRG) expiratory (E) neurons that drive abdominal expiratory motoneurons in the lumbar cord respond to intercostal and lumbar nerve afferent stimulation. Results showed that 92% of medullary E-neurons that were antidromically activated from the upper lumbar cord reduced their activity in response to stimulation of external and internal intercostal and lumbar nerve afferents. We conclude that afferent information from intercostal and abdominal muscle tendon organs has an inhibitory effect on caudal VRG E-neurons that drive abdominal expiratory motoneurons.

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Rehabilitation of a quadriplegic professional singer. Use of a device to provide abdominal muscle support.

Abdominal muscle support is essential for singing. Nevertheless, it has been possible to rehabilitate a professional singer who sustained a C-5 fracture and quadriplegia. The device that has been developed has restored his ability to support singing and has improved respiratory function substantially. It appears to have potential usefulness for restoring effective coughing in other quadriplegic patients.

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An anatomical analysis of the relationships between the intercostal nerves and the thoracic and abdominal muscles in man. II. Detailed analysis of innervation of the three lateral abdominal muscles.

Minute dissection was performed in one male adult cadaver in order to elucidate the detailed distribution of muscular branches of intercostal nerves within the lateral abdominal muscles as well as the segmental relationships. In the obliquus internus and transversus abdominis, as well as in the upper half of the obliquus externus, each muscle fascicle receives the nerve of the corresponding segmental attachment to the rib. On the other hand, in the lower half, the obliquus externus abdominis receives a twig from the lower adjacent segmental nerve, because within the muscle the corresponding segmental nerve first runs horizontally and enters the upper adjacent fascicle before descending obliquely, parallel to the fiber direction.

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Intraabdominal pressure and trunk muscle activity during lifting--effect of abdominal muscle training in healthy subjects.

Isometric training of the abdominal muscles is recommended as a preventive measure against low back complaints in the hope that the increased strength of the abdominal muscles should result in an increased intraabdominal pressure when lifting. There is, however, neither experimental nor clinical proof of this hypothesis. Twenty healthy young men went through intense isometric training of the abdominal muscles for five weeks. Before and after training the subjects were put through a standardized test programme, measuring the strength of abdominal and back muscles, and a series of lifts, 10, 25, and 40 kg, leg lifts and back lifts. The intraabdominal pressure (IAP), and the EMG activity of the oblique abdominal muscles, and of the erector spinae muscle were recorded. It was found that: The strength of the trunk flexors increased markedly after training. The activity of the oblique abdominal muscles when lifting decreased after training, i.e. motor unit recruitment was not improved. The IAP at lifting was not affected by training. The activity of the oblique abdominal muscles was of no decisive importance to the IAP. The strength of the back muscles increased, but the activity of the back muscles at lifts was not affected by training. In back lifts there was no detectable activity of the back muscles during the beginning of the lifting and during a great part of the lowering. In back lifts the maximum activity of the abdominal muscles appeared long before the peak of the IAP which may be of importance with regard to the pathogenesis of inguinal hernia. Further investigation is needed, both to study the effect of training on patients with back complaints, and to study the factors determining the IAP.

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Muscle fibre orientation of abdominal muscles and suggested surface EMG electrode positions.

The ability of surface electrodes to accurately detect the activity of a particular muscle relies not only on their being placed over the muscle but also on their position in relation to muscle fibre orientation. For optimal pick-up of electromyographic (EMG) signals, surface electrodes are best aligned in parallel with the fibre orientation of the underlying muscle. This study aimed to measure muscle fibre orientation and other parameters of muscle morphology of the abdominal muscles in relation to palpable bony landmarks. Thirty-seven embalmed cadavers (19 males and 18 females) were examined. Results showed that the fibres of obliquus externus abdominis were about 4 degrees more vertical than the lower edge of the eighth rib. Below the rib cage, the muscle fibres of obliquus externus abdominis were approximately 5 degrees closer to vertical than a reference line between the most inferior point of the costal margin and the contralateral pubic tubercle. In the anterolateral abdominal wall area below the anterior superior iliac spine (ASIS), the obliquus internus abdominis was superficial being covered only by the aponeurosis of obliquus externus abdominis. At the level of ASIS, the muscle fibres of obliquus internus abdominis were almost horizontally orientated but at 2 cm below ASIS were aligned about 6 degrees inferomedially to the horizontal. The muscle fibres of upper rectus abdominis were 2 degrees inferolateral to the midline while the lower rectus abdominis muscle fibres deviated inferomedially from the midline by about 8 degrees. The appropriate surface electrode placements which follows the muscle fibre orientation of the obliquus externus abdominis, obliquus internus abdominis and rectus abdominis have been suggested.

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Fiber architecture of canine abdominal muscles.

During respiration, abdominal muscles experience loads, not only in the muscle-fiber direction but also transverse to the fibers. We wondered whether the abdominal muscles exhibit a fiber architecture that is similar to the diaphragm muscle, and, therefore, we chose two adjacent muscles: the internal oblique (IO), with about the same muscle length as the diaphragm, and the transverse abdominis (TA), which is twice as long as the diaphragm. First, we used acetylcholinesterase staining to examine the distribution of neuromuscular junctions on both surfaces of the TA and IO muscles in six dogs. A maximum of four irregular bands of neuromuscular junctions crossed the IO, and as many as six bands crossed the TA, which is consistent with a discontinuous fiber architecture. In six additional dogs, we examined fiber architecture of these muscles by microdissecting 103 fascicles from the IO and 139 from the TA. Each fascicle contained between 20 and 30 muscle fibers. The mean length of nonspanning fibers (NSF) ranged from 2.8 +/- 0.3 cm in the IO to 4.3 +/- 0.5 cm in the TA, and the mean length of spanning fibers ranged from 4.3 +/- 0.5 cm in the IO to 7.6 +/- 1.4 cm in the TA. NSF accounted for 89.6 +/- 1.5% of all fibers dissected from the IO and 99.1 +/- 0.2% of all fibers dissected from the TA. The percentage of NSF with both ends tapered was 6.2 +/- 1.0 and 41.0 +/- 2.3% for IO and TA, respectively. These data show that fiber architecture in either IO or TA is discontinuous, with much more short-tapered fibers in the TA than in the IO. When abdominal muscles are submaximally activated, as during both normal expiration and maximal expiratory efforts, muscle force could be transmitted to the cell membrane and to the extracellular intramuscular connective tissue by shear linkage, presumably via structural transmembrane proteins.

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