{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T15:07:26Z","timestamp":1792595246231,"version":"4.5.0"},"reference-count":36,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2024,10,29]],"date-time":"2024-10-29T00:00:00Z","timestamp":1730160000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Canadian Foundation for Innovation","award":["MSH-258993"],"award-info":[{"award-number":["MSH-258993"]}]},{"name":"Canadian Institutes of Health Research","award":["MSH-258993"],"award-info":[{"award-number":["MSH-258993"]}]},{"name":"Fonds de la recherche du Qu\u00e9bec\u2014Sant\u00e9","award":["MSH-258993"],"award-info":[{"award-number":["MSH-258993"]}]},{"name":"Centre de recherche de l\u2018Institut universitaire de g\u00e9riatrie de Montr\u00e9al","award":["MSH-258993"],"award-info":[{"award-number":["MSH-258993"]}]},{"name":"NSERC Canada and Westlake University, China","award":["MSH-258993"],"award-info":[{"award-number":["MSH-258993"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>The first line of treatment for urinary incontinence is pelvic floor muscle (PFM) training, aimed at reducing leakage episodes by strengthening these muscles. However, many women struggle with performing correct PFM contractions or have misconceptions about their contractions. To address this issue, we present a novel PFM contraction quality assessment system. This system combines a PFM contraction detector with a maximal PFM contraction performance classifier. The contraction detector first identifies whether or not a PFM contraction was performed. Then, the contraction classifier autonomously quantifies the quality of maximal PFM contractions across different features, which are also combined into an overall rating. Both algorithms are based on artificial intelligence (AI) methods. The detector relies on a convolutional neural network, while the contraction classifier uses a custom feature extractor followed by a random forest classifier to predict the strength rating based on the modified Oxford scale. The AI algorithms were trained and tested using datasets measured by vaginal dynamometry, combined in some cases with digital assessment results from expert physiotherapists. The contraction detector was trained on one dataset and then tested on two datasets measured with different dynamometers, achieving 97% accuracy on the first dataset and 100% accuracy on the second. For the contraction performance classifier, the results demonstrate that important clinical features can be extracted automatically with an acceptable error. Furthermore, the contraction classifier is able to predict the strength rating within a \u00b11 scale point with 97% accuracy. These results demonstrate the system\u2019s potential to enhance PFM training and rehabilitation by enabling women to monitor and improve their PFM contractions autonomously.<\/jats:p>","DOI":"10.3390\/s24216937","type":"journal-article","created":{"date-parts":[[2024,10,29]],"date-time":"2024-10-29T08:42:09Z","timestamp":1730191329000},"page":"6937","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Improving Pelvic Floor Muscle Training with AI: A Novel Quality Assessment System for Pelvic Floor Dysfunction"],"prefix":"10.3390","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8121-282X","authenticated-orcid":false,"given":"Batoul","family":"El-Sayegh","sequence":"first","affiliation":[{"name":"Department of Electrical Engineering, Polytechnique Montreal, Montreal, QC H3T 1J4, Canada"},{"name":"Research Center, Institut Universtaire de G\u00e9riatrie de Montr\u00e9al, Montreal, QC H3W 1W5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chantale","family":"Dumoulin","sequence":"additional","affiliation":[{"name":"Research Center, Institut Universtaire de G\u00e9riatrie de Montr\u00e9al, Montreal, QC H3W 1W5, Canada"},{"name":"School of Rehabilitation, Faculty of Medicine, Universit\u00e9 de Montr\u00e9al, Montreal, QC H3T 1J4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5528-8510","authenticated-orcid":false,"given":"Fran\u00e7ois","family":"Leduc-Primeau","sequence":"additional","affiliation":[{"name":"Department of Electrical Engineering, Polytechnique Montreal, Montreal, QC H3T 1J4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4137-7272","authenticated-orcid":false,"given":"Mohamad","family":"Sawan","sequence":"additional","affiliation":[{"name":"Department of Electrical Engineering, Polytechnique Montreal, Montreal, QC H3T 1J4, Canada"},{"name":"CenBRAIN Neurotech, School of Engineering, Westlake University, Hangzhou 310024, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,10,29]]},"reference":[{"key":"ref_1","first-page":"5","article-title":"An International Urogynecological Association (IUGA)\/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction","volume":"21","author":"Rogers","year":"2010","journal-title":"Neurourol. Urodyn."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"354","DOI":"10.5489\/cuaj.12248","article-title":"2012 update: Guidelines for adult urinary incontinence collaborative consensus document for the Canadian urological association","volume":"5","author":"Bettez","year":"2012","journal-title":"Urol. Assoc. J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1111\/j.1532-5415.1991.tb02903.x","article-title":"The quality of life in women with urinary incontinence as measured by the sickness impact profile","volume":"39","author":"Hunskaar","year":"1991","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_4","first-page":"455","article-title":"Cost effectiveness of training incontinent elderly in nursing homes: A randomized clinical trial","volume":"25","author":"Hu","year":"1990","journal-title":"Health Serv. Res."},{"key":"ref_5","unstructured":"Booth, J., Cacciari, L., Campbell, P., Dumoulin, C., Hagen, S., Homsi, J., Morin, M., Marked, S., Nahon, I., and Pang, R. (2023). Conservative management of UI and POP in adults including neurological patients. Incontinence, International Continence Society. [7th ed.]."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1002\/nau.22922","article-title":"An International Urogynecological Association (IUGA)\/International Continence Society (ICS) joint report on the terminology for female Pelvic Organ Prolapse (POP): International Urogynecological Association (IUGA)","volume":"35","author":"Haylen","year":"2016","journal-title":"Neurourol. Urodyn."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1002\/nau.23107","article-title":"An International Urogynecological Association (IUGA)\/International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction","volume":"36","author":"Bo","year":"2017","journal-title":"Neurourol. Urodyn."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1002\/nau.24214","article-title":"Do women have an accurate perception of their pelvic floor muscle contraction? A cross-sectional study","volume":"39","author":"Uechi","year":"2020","journal-title":"Neurourol. Urodyn."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1111\/ajo.12133","article-title":"Why are some women with pelvic floor dysfunction unable to contract their pelvic floor muscles?","volume":"53","author":"Kim","year":"2013","journal-title":"Aust. New Zeal. J. Obstet. Gynaecol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1007\/s00192-014-2483-x","article-title":"Pelvic floor awareness and the positive effect of verbal instructions in 958 women early postdelivery","volume":"26","author":"Vermandel","year":"2015","journal-title":"Int. Urogynecol. J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1097\/SPV.0000000000000145","article-title":"Correct contraction of Pelvic Muscle Exercises in Women Reporting Prior Knowledge","volume":"21","author":"Kandadai","year":"2015","journal-title":"Female Pelvic Med. Reconstr. Surg."},{"key":"ref_12","first-page":"261","article-title":"Knowledge about and ability to correct pelvic floor muscle exercises in women with urinary stress incontinence","volume":"7","author":"Firet","year":"1988","journal-title":"Neurourol. Urodyn."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1231","DOI":"10.1007\/s00192-011-1628-4","article-title":"High prevalence of pelvic floor muscle dysfunction in hospitalized elderly women with urinary incontinence","volume":"23","author":"Talasz","year":"2012","journal-title":"Int. Urogynecol. J."},{"key":"ref_14","first-page":"680","article-title":"Women who cannot contract their pelvic floor muscles;avulsion or denervation?","volume":"28","author":"Sarma","year":"2009","journal-title":"Neurourol. Urodyn."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1097\/SPV.0b013e31827ab9d0","article-title":"Can Women Correctly Contract Their Pelvic Floor Muscles Without Formal Instruction?","volume":"19","author":"Henderson","year":"2013","journal-title":"Female Pelvic Med. Reconstr. Surg."},{"key":"ref_16","first-page":"478","article-title":"The state of pelvic floor muscle dynamometry: A scoping review","volume":"42","author":"Cacciari","year":"2022","journal-title":"Neurourol. Urodyn."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1109\/JTEHM.2022.3223258","article-title":"Portable Dynamometer-Based Measurement of Pelvic Floor Muscle Force","volume":"11","author":"Dumoulin","year":"2023","journal-title":"IEEE J. Transl. Eng. Health Med."},{"key":"ref_18","first-page":"33","article-title":"Development of a dynamometer for measuring the isometric force of the pelvic floor musculature","volume":"23","author":"Dumoulin","year":"2003","journal-title":"Neurourol. Urodyn."},{"key":"ref_19","first-page":"014004","article-title":"Unsupervised convolutional autoencoders for 4D transperineal ultrasound classification","volume":"10","author":"Manzini","year":"2023","journal-title":"J. Med. Imaging"},{"key":"ref_20","first-page":"8","article-title":"Pelvic floor muscle exercise technique guidance using PeriCoach system","volume":"Volume 121","author":"Cornelius","year":"2018","journal-title":"BJU International"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1717","DOI":"10.1002\/nau.24439","article-title":"Reliability and validity of a mobile home pelvic floor muscle trainer: The Elvie Trainer","volume":"39","author":"Czyrnyj","year":"2020","journal-title":"Neurourol. Urodyn."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1038\/nature14539","article-title":"Deep learning","volume":"521","author":"LeCun","year":"2015","journal-title":"Nature"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1002\/nau.24542","article-title":"Pelvic floor morphometrical and functional changes immediately after pelvic floor muscle training and at 1-year follow-up, in older incontinent women","volume":"40","author":"Cacciari","year":"2021","journal-title":"Neurourol. Urodyn."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1284","DOI":"10.1001\/jamainternmed.2020.2993","article-title":"Group-Based vs Individual Pelvic Floor Muscle Training to Treat Urinary Incontinence in Older Women: A Randomized Clinical Trial","volume":"180","author":"Dumoulin","year":"2020","journal-title":"JAMA Intern. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1186\/s13063-017-2261-4","article-title":"Group physiotherapy compared to individual physiotherapy to treat urinary incontinence in aging women: Study protocol for a randomized controlled trial","volume":"18","author":"Dumoulin","year":"2017","journal-title":"Trials"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Guimar\u00e3es, V., Oliveira, E., Carvalho, A., Cardoso, N., Emerich, J., Dumoulin, C., Swinnen, N., De Jong, J., and de Bruin, E.D. (2021). An Exergame Solution for Personalized Multicomponent Training in Older Adults. Appl. Sci., 11.","DOI":"10.3390\/app11177986"},{"key":"ref_27","first-page":"171","article-title":"A survey of forecast error measures","volume":"24","author":"Shcherbakov","year":"2013","journal-title":"World Appl. Sci. J."},{"key":"ref_28","first-page":"100945","article-title":"An exergame combining strength, balance and cognitive training with pelvic floor muscle exercises to treat older women with urgency urinary incontinence: A pre-post pilot study","volume":"7","author":"Swinnen","year":"2023","journal-title":"Proc. ICS Annu. Meet."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.1002\/nau.24658","article-title":"An International Continence Society (ICS) report on the terminology for pelvic floor muscle assessment","volume":"42","author":"Frawley","year":"2021","journal-title":"Neurourol. Urodyn."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1016\/S0031-9406(05)61108-X","article-title":"Pelvic Floor Muscle Assessment: The PERFECT Scheme","volume":"87","author":"Laycock","year":"2001","journal-title":"Physiotherapy"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1016\/j.physio.2010.06.007","article-title":"Inter-rater reliability study of the modified Oxford Grading Scale and the Peritron manometer","volume":"97","author":"Ferreira","year":"2011","journal-title":"Physiotherapy"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1427","DOI":"10.1016\/j.ipm.2009.03.002","article-title":"A systematic analysis of contraction measures for classification tasks","volume":"45","author":"Sokolova","year":"2009","journal-title":"Inf. Process. Manag."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1002\/nau.1930090504","article-title":"Pelvic floor muscle exercise for the treatment of female stress urinary incontinence: II. Validity of vaginal pressure measurementsof pelvic floor muscle strength","volume":"9","author":"Bo","year":"1990","journal-title":"Neurourol. Urodyn."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1722","DOI":"10.1016\/j.ajog.2004.11.050","article-title":"Does vaginal closure force differ in the supine and standing positions?","volume":"192","author":"Morgan","year":"2005","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1007\/s001920170059","article-title":"The use of perineal ultrasound to quantify levator activity and teach pelvic floor muscle exercises","volume":"12","author":"Dietz","year":"2001","journal-title":"Int. Urogynecol. J."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"101629","DOI":"10.1016\/j.jogoh.2019.101629","article-title":"Utility of 2D-ultrasound in pelvic floor muscle contraction and bladder neck mobility assessment in women with urinary incontinence","volume":"49","author":"Jamard","year":"2020","journal-title":"J. Gynecol. Obstet. Hum. Reprod."}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/24\/21\/6937\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:23:13Z","timestamp":1760113393000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/24\/21\/6937"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,29]]},"references-count":36,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2024,11]]}},"alternative-id":["s24216937"],"URL":"https:\/\/doi.org\/10.3390\/s24216937","relation":{},"ISSN":["1424-8220"],"issn-type":[{"value":"1424-8220","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,29]]}}}