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Whether separate layers of PFM activate differently in response to instructions remains unknown.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Aim<\/jats:title>\n                  <jats:p>To test the hypotheses that (i) instructions that aimed to bias activity of a specific muscle layer would increase activation of the targeted layer to a greater extent than the other layer, (ii) activity of individual PFM layers would differ between instructions, and (iii) PFM activity would be symmetrical for all instructions.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Method<\/jats:title>\n                  <jats:p>PFM electromyography (EMG) was recorded using custom-designed surface electrodes in 12 women without PFM dysfunction. The electrode included 4 pairs of recording surfaces orientated to measure EMG from deep and superficial PFM on each side. 3 submaximal contractions were performed for 5 seconds in response to 7 verbal instructions. Root-mean-squared EMG amplitude was calculated for 1 second during the period when participants most closely matched the target activation level. A repeated-measures anova was used to test whether PFM EMG differed between instructions and between regions. The EMG increase of individual muscles relative to that of the reference muscle [deep\/right PFM] was compared to no change with t-tests for single samples.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Main Outcome Measure<\/jats:title>\n                  <jats:p>PFM EMG amplitude.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Superficial PFM EMG was greater than deep PFM for all instructions (P = .039). 2 instructions induced the greatest amplitude of EMG for the superficial PFM: \u201csqueeze the muscles around the vaginal opening as if to purse lips of your mouth\u201d and \u201cdraw the clitoris in a posterior direction\u201d (P = .036). Asymmetry was found in the deeper PFM in 3 instructions designed to bias the superficial PFM.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Strength &amp; Limitations<\/jats:title>\n                  <jats:p>This preliminary study recorded activation of deep and superficial PFM layers in females with a custom-designed novel electrode. Some cross-talk of recording between muscle layers is possible but unlikely to impact the major findings.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Verbal instructions used to teach PFM contractions can influence their pattern of activity. This study provides preliminary evidence that, in a selection of verbal instructions, the superficial PFM activates more than the deep PFM, and that the deep PFM can have asymmetrical activation.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1016\/j.jsxm.2019.02.008","type":"journal-article","created":{"date-parts":[[2019,3,26]],"date-time":"2019-03-26T14:16:11Z","timestamp":1553609771000},"page":"673-679","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":8,"title":["Activity of Deep and Superficial Pelvic Floor Muscles in Women in Response to Different Verbal Instructions: A Preliminary Investigation Using a Novel Electromyography Electrode"],"prefix":"10.1093","volume":"16","author":[{"given":"Rafeef","family":"Aljuraifani","sequence":"first","affiliation":[{"name":"The University of Queensland, Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences , Brisbane , Australia"},{"name":"Princess Noura bint Abdulrahman , Riyadh , Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan E.","family":"Stafford","sequence":"additional","affiliation":[{"name":"The University of Queensland, Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences , Brisbane , Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leanne M.","family":"Hall","sequence":"additional","affiliation":[{"name":"The University of Queensland, Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences , Brisbane , Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul W.","family":"Hodges","sequence":"additional","affiliation":[{"name":"The University of Queensland, Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences , Brisbane , Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,3,26]]},"reference":[{"key":"2024051609554342600_bib1","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1097\/00001703-199408000-00003","article-title":"The anatomy of the pelvic floor","volume":"6","author":"Delancey","year":"1994","journal-title":"Curr Opin Obstet Gynecol"},{"key":"2024051609554342600_bib2","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1111\/j.1447-073x.2005.00109.x","article-title":"Surgical anatomy of the perineal muscles and their role in perineal disorders","volume":"80","author":"Shafik","year":"2005","journal-title":"Anat Sci Int"},{"key":"2024051609554342600_bib3","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.jneumeth.2009.05.027","article-title":"The reliability of surface EMG recorded from the pelvic floor muscles","volume":"182","author":"Auchincloss","year":"2009","journal-title":"J Neurosci Meth"},{"key":"2024051609554342600_bib4","doi-asserted-by":"crossref","first-page":"S13","DOI":"10.1002\/nau.20888","article-title":"Why do women have stress urinary incontinence?","volume":"29","author":"DeLancey","year":"2010","journal-title":"Neurourol Urodyn"},{"key":"2024051609554342600_bib5","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1196\/annals.1389.034","article-title":"Functional anatomy of the female pelvic floor","volume":"1101","author":"Ashton-Miller","year":"2007","journal-title":"Ann N Y Acad Sci"},{"key":"2024051609554342600_bib6","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1097\/00003081-199312000-00015","article-title":"Anatomy and biomechanics of genital prolapse","volume":"36","author":"Delancey","year":"1993","journal-title":"Clin Obstet Gynecol"},{"key":"2024051609554342600_bib7","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1007\/s00192-014-2583-7","article-title":"A strong pelvic floor is associated with higher rates of sexual activity in women with pelvic floor disorders","volume":"26","author":"Kanter","year":"2015","journal-title":"Int Urogynecol J"},{"key":"2024051609554342600_bib8","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1007\/PL00004028","article-title":"The role of the levator ani muscle in evacuation, sexual performance and pelvic floor disorders","volume":"11","author":"Shafik","year":"2000","journal-title":"Int Urogynecol J Pelvic Floor Dysfunct"},{"key":"2024051609554342600_bib9","doi-asserted-by":"crossref","first-page":"1735","DOI":"10.1007\/s00192-015-2749-y","article-title":"Does pelvic floor muscle training improve female sexual function? 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