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Cerebellar plasticity is a critical mechanism for optimal feedback control. While Purkinje cell activity of the oculomotor vermis predicts eye movement speed and direction, more lateral areas of the cerebellum may play a role in more complex tasks, including decision-making. It is still under question how this motor-cognitive functional dichotomy between medial and lateral areas of the cerebellum plays a role in optimal feedback control. Here we show that elite athletes subjected to a trajectory prediction, go/no-go task manifest superior subsecond trajectory prediction accompanied by optimal eye movements and changes in cognitive load dynamics. Moreover, while interacting with the cerebral cortex, both the medial and lateral cerebellar networks are prominently activated during the fast feedback stage of the task, regardless of whether or not a motor response was required for the correct response. Our results show that cortico-cerebellar interactions are widespread during dynamic feedback and that experience can result in superior task-specific decision skills.

Aim: Children born extremely preterm are at risk of visual processing problems related to brain damage. Damage in visual pathways can remain undetected by conventional magnetic resonance imaging (MRI) and functional consequences cannot always be predicted. The aim of this study was to assess the efficacy of processing visual information in infants born extremely preterm at a corrected age of 1 year using a communication-free visual function test based on eye tracking., Method: Infants born extremely preterm (<29wks' gestation) without apparent white and grey matter damage on conventional MRI at 30 weeks' postmenstrual age were included (19 males, 1.01y [0.96-1.24] (median [25th-75th centiles]); 11 females, 0.99y [0.98-1.01]). At the corrected age of 1 year, reaction times to fixation (RTF) of specific visual properties displayed on an eye-tracker monitor were quantified and compared with results from a comparison group (eight males, 1.28y [1.01-1.33]; nine females, 1.10y [0.90-1.20])., Results: The infants in the preterm group had longer response times in detecting colour patterns (red-green) and motion compared with infants in the comparison group. No impairments were detected in oculomotor functions (saccades, pursuit, and fixations)., Interpretation: The data suggest that delays in processing visual information can be identified in children born extremely preterm. The delays might be ascribed to deficits in neuronal connectivity in visual pathways at a microstructural level., (© 2016 Mac Keith Press.)

Purpose: Measurements of visual and oculomotor functions are essential for providing tailored support to visually impaired children. In young or intellectually disabled children these measurements can be difficult or even impossible to perform. Recordings of orienting gaze in response to specific visual information, made with eye tracking, may offer a solution. The aim of this study was to observe and quantify eye tracking (ET)-based gaze responses to provide information about visual and oculomotor functioning, and to compare this information with standard visual function assessments (VFA)., Methods: One hundred and twenty-six visually impaired children from 1-14 years underwent a VFA. Next they underwent a remote ET test. Four aspects of oculomotor control (nystagmus, fixation, saccades, pursuit) and three visual functions (visual field, contrast, colour) were selected to compare both methods. Performance was assessed (1) during VFA using standard behavioural observation and test scores and (2) after ET by observing and scoring the eye movement recordings. Validity, in terms of agreement between results, was measured by correlation analyses. From the orienting gaze responses, quantitative parameters (gain, fixation duration and directional saccades) were calculated to characterize visual performance., Results: Good agreement between the two test methods was found for observational assessment of oculomotor control and visual functions (correlations ranging from rs  = 0.39 to rs  = 0.69). The quantitative parameters of visual performance showed distinct results between children with and without specific functional impairments, both in children aged 1-6 and 7-14 years., Conclusion: Eye tracking-based gaze recordings are a promising tool to assess oculomotor and visual performance in a communication-free manner. Calculating quantitative parameters from specific gaze responses could assist in the characterization of functional visual performance in children, independent of age. Gaze responses are a useful addition to standard VFA in clinical practice., (© 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Background: Displaying screen savers with gain-framed messages are effective to improve hand hygiene, but the design of screen savers has not been studied yet., Methods: Based on the literature, scientific propositions were developed for the design of screen savers, exploring 2 strategies to subconsciously influence hand hygiene behavior; the first was to gain attention, and the second was to exert peer pressure. The designed screen savers were tested for attention with an eye-tracking study (N = 27) and for the influence of peer pressure with a questionnaire (N = 25)., Results: Twenty-five propositions for gaining attention concerned the format and color of the screen saver itself and color, position, and style of visual and text elements. Seven propositions for peer pressure concerned the influence of peers, role models, and feelings of being watched. Eye-tracking measurements showed that text on the 4 screen savers based on propositions gained more, earlier, and longer attention and the visual elements gained earlier and longer attention than the control screen savers. The questionnaire results showed that feelings of peer pressure were evoked by 3 screen savers; of these, one was not based on propositions., Conclusions: Screen savers designed according to scientific propositions for visual attention and peer pressure have the potential to alter hand hygiene behavior., (Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Visual problems that occur early in life can have major impact on a child's development. Without verbal communication and only based on observational methods, it is difficult to make a quantitative assessment of a child's visual problems. This limits accurate diagnostics in children under the age of 4 years and in children with intellectual disabilities. Here we describe a quantitative method that overcomes these problems. The method uses a remote eye tracker and a four choice preferential looking paradigm to measure eye movement responses to different visual stimuli. The child sits without head support in front of a monitor with integrated infrared cameras. In one of four monitor quadrants a visual stimulus is presented. Each stimulus has a specific visual modality with respect to the background, e.g., form, motion, contrast or color. From the reflexive eye movement responses to these specific visual modalities, output parameters such as reaction times, fixation accuracy and fixation duration are calculated to quantify a child's viewing behavior. With this approach, the quality of visual information processing can be assessed without the use of communication. By comparing results with reference values obtained in typically developing children from 0-12 years, the method provides a characterization of visual information processing in visually impaired children. The quantitative information provided by this method can be advantageous for the field of clinical visual assessment and rehabilitation in multiple ways. The parameter values provide a good basis to: (i) characterize early visual capacities and consequently to enable early interventions; (ii) compare risk groups and follow visual development over time; and (iii), construct an individual visual profile for each child.

The early stages of neurodegenerative disorders such as Alzheimer's disease (AD) and Parkinson's disease (PD) involve deterioration of specific (visuo)motor functions. The aim of the current study was to investigate differences in visuomotor behavior between age-matched groups of 17 patients with AD, 17 patients with PD, and 20 healthy control subjects across three eye-hand-coordination tasks of different cognitive complexity. In two of three tasks, timing and execution parameters of eyes and hand significantly differed between groups. Timing and execution parameters of the eyes and hands could potentially give a quantitative description of disease specific deficits in the spatial and temporal domains and may serve as a tool to monitor disease progression in AD and PD populations.

Development of visuospatial attention can be quantified from infancy onward using visually-guided eye movement responses. We investigated the interaction between eye movement response times and salience in target areas of visual stimuli over age in a cohort of typically developing children. A preferential looking (PL) paradigm consisting of stimuli with six different visual modalities (cartoons, contrast, form, local motion, color, global motion) was combined with the automated measurement of reflexive eye movements. Effective salience was defined as visual salience of each target area relative to its background. Three classes of PL stimuli were used: with high- (cartoon, contrast), intermediate- (local motion, form), and low-effective salience (global motion, color). Eye movement response times to the target areas of the six PL stimuli were nonverbally assessed in 220 children aged 1-12 years. The development of response times with age was influenced by effective salience: Response times to targets with high salience reached stable values earlier in development (around 4 years of age) than to targets with low salience (around 9 years of age). Intra-individual response time variability was highest for low-salient stimuli, and stabilized later (around 4 years) than for highly salient stimuli (2 years). The improvement of eye movement response times to visual modalities in PL stimuli occurred earlier in development for highly salient than for low-salient targets. The present age-dependent and salience-related results provide a quantitative and theoretical framework to assess the development of visuospatial attention, and of related visual processing capacities, in children from 1 year of age.

We recently introduced a method based on quantification of orienting responses toward visual stimuli to assess the quality of visual information processing in children. In the present study, we examined the relationship between orienting responses and factors that are associated with visual processing impairments in current clinical practice. Response time and fixation quality to visual features such as form, contrast, motion, and color stimuli were assessed in 104 children from 1 to 12 years attending special education for the visually impaired. Using regression analysis, we investigated whether these parameters were affected by clinical characteristics of children. Response times significantly depended on stimulus type. Responses to high-contrast cartoons were significantly slower in children with a clinical diagnosis of cerebral visual impairment. Fixation quality was significantly affected by visual acuity and nystagmus. The results suggest that the quantitative measurement of orienting responses is strongly related to cerebral visual impairment in children., (© The Author(s) 2014.)

Purpose. To determine how different grades of cataract affect sensitivity threshold and saccadic reaction time (SRT) in eye movement perimetry (EMP). Methods. In EMP, the visual field is tested by assessing the saccades that a subject makes towards peripheral stimuli using an eye tracker. Forty-eight cataract patients underwent pre- and postoperative EMP examination in both eyes. The subjects had to fix a central stimulus presented on the eye tracker monitor and to look at any detected peripheral stimulus upon its appearance. A multilevel mixed model was used to determine the factors that affected the sensitivity threshold and the SRT as a function of cataract grade. Results. We found no effect of cataract severity (LOCS III grades I through IV) on SRT and the sensitivity thresholds. In cataract of LOCS III grade V, however, we found an increase by 27% and 21% (p < 0.001), respectively, compared to the SRT and the sensitivity threshold in LOCS III grade I. Eyes that underwent cataract surgery showed no change in mean SRTs and sensitivity thresholds after surgery in LOCS III grade IV and lower. Conclusion. The present study shows that EMP can be readily used in patients with cataract with LOCS III grade IV and below.

Background/aims: Recent evidence shows that early dementia patients have deficits in manual reaching tasks. It is important to understand the impact of these functional disabilities on their quality of life. The aim of this study was to investigate if there is an association between manual reaching and measures of (instrumental) activities of daily living (IADL) in a group of patients with cognitive complaints., Methods: The manual reaching performance of 27 patients was assessed in detail with eye and hand tracking devices. Patients were divided into three groups based on self-reported loss of IADL function. Parameters describing hand response and movement times were compared between groups., Results: Patients with loss of IADL function in ≥1 domain had delayed hand response and hand movement times towards visible targets compared to patients with no loss of IADL function., Conclusion: Delays in manual reaching movements are related to the degree of loss of IADL function in early dementia patients., (© 2015 S. Karger AG, Basel.)

Quantification of orienting responses can be used to differentiate between children with cerebral visual impairment and infantile nystagmus syndrome. To further improve the sensitivity of this method, we compared orienting responses to a Cartoon stimulus, which contains all sorts of visual information, to stimuli that contain only Contrast, Form coherence, Motion coherence, Color and Motion detection. The stimuli were shown on an eye tracker monitor using a preferential looking paradigm. We found that both groups of children showed general slowing in orienting responses compared to controls. The children with cerebral visual impairment had significantly prolonged responses to Cartoon compared to the children with nystagmus, whereas the children with nystagmus had prolonged responses to Motion detection and larger fixation areas. Previously reported differences in orienting responses to Cartoon were replicated. Application of specific visual information did not alter the sensitivity of the method to distinguish between children with visual processing deficits., (© The Author(s) 2013.)

Aim: In diagnostics of Alzheimer's disease (AD), the Mini-Mental State Examination (MMSE) questionnaire is frequently used to test cognitive decline. The final subtest of the MMSE, in which patients have to copy two interlocking pentagons, tests a variety of visuomotor functions. Recent imaging studies suggest that visuomotor function could decline in early stage AD, as a result of degeneration of the brain networks involved. The goal of the present study was to compare memory and visuomotor function in AD patients, reflected by the MMSE subscores for orientation, recall and interlocking pentagons., Methods: The MMSE subscores for orientation, recall and interlocking pentagons of 125 AD patients was extracted from their medical history. Patients were divided into three groups based on disease duration. Using related-samples Wilcoxon signed-rank tests, the performance between subtests using normalized subscores was compared within each group., Results: In all three groups, the subscores of recall and interlocking pentagons were significantly lower than orientation. No differences were found between the subscores of recall and interlocking pentagons., Conclusions: The presented data suggest that memory function and visuomotor function are equally impaired in the present study population. This could indicate that visuomotor dysfunction might be a more important clinical feature of AD than is currently assumed. This knowledge can be used to develop new tests and markers for AD reflecting deficits in visuomotor functions, such as quantification of eye and hand movements., (© 2013 Japan Geriatrics Society.)

Background: From the need for a quantitative method to examine visual processing in young children, we measured ocular orienting responses to visual stimuli (form, motion, expansion, color, contrast, cartoons). Reliability and applicability of this method were assessed., New Method: 80 children (1-12 years) with visual impairments and a reference group of 118 typically developing children (1-6 years) completed two sessions. Test-retest reliability was measured by calculating differences in reaction time and fixation accuracy between the two sessions. For applicability, the cumulative percentage of children that fell within a pre-defined reliability interval was plotted against the mean number of responses., Results: In typically developing children none of the outcome measures significantly differed between sessions. In the children with visual impairments similar results were obtained, except for motion. This stimulus elicited significantly faster reaction times in the second session. In at least 80% of the children reliable reaction times could be calculated if 4 responses to a cartoon stimulus and 1 or 2 responses to the other stimuli were measured., Comparison With Existing Method(s): The existing method to quantify visual information processing has been refined: the range of visual functions was extended and a criterion for reliable assessment of orienting response times was established., Conclusions: Objective measurement of orienting responses is a reliable method to test the initial stage of visual processing in children with and without visual impairments. A set minimum number of responses for each stimulus warrants the reliability of measurements obtained with this functional method in clinical practice., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Children with visual impairments are very heterogeneous in terms of the extent of visual and developmental etiology. The aim of the present study was to investigate a possible correlation between prevalence of clinical risk factors of visual processing impairments and characteristics of viewing behavior. We tested 149 children with visual information processing impairments (90 boys, 59 girls; mean age (SD)=7.3 (3.3)) and 127 children without visual impairments (63 boys and 64 girls, mean age (SD)=7.9 (2.8)). Visual processing impairments were classified based on the time it took to complete orienting responses to various visual stimuli (form, contrast, motion detection, motion coherence, color and a cartoon). Within the risk group, children were divided into a fast, medium or slow group based on the response times to a highly salient stimulus. The relationship between group specific response times and clinical risk factors was assessed. The fast responding children in the risk group were significantly slower than children in the control group. Within the risk group, the prevalence of cerebral visual impairment, brain damage and intellectual disabilities was significantly higher in slow responding children compared to faster responding children. The presence of nystagmus, perceptual dysfunctions, mean visual acuity and mean age did not significantly differ between the subgroups. Orienting responses are related to risk factors for visual processing impairments known to be prevalent in visual rehabilitation practice. The proposed method may contribute to assessing the effectiveness of visual information processing in children., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background: The antisaccade (AS) paradigm is frequently used to assess errors in reflexive behavioral responses in Parkinson's disease (PD) patients. Although PD pathology of frontal-striatal circuits suggests increased errors, reports on sensitivity and specificity of the AS task are lacking. We increased the level of cognitive complexity by adding to the AS task an antitapping instruction, i.e. an antisaccade and antitapping (ASAT) task., Objective: In this study, we compared saccadic error rates between PD patients and age-matched controls in 1) an AS task, using only eye movements and 2) an ASAT task, using eye and hand movements., Methods: 30 PD patients en 30 healthy age-matched controls performed an AS task and an ASAT task. The measurement setup consisted of a touch screen, an eye tracking system and a motion capture system. Error rates and eye - and hand latencies were compared between groups., Results: PD patients show higher error rates in the ASAT task, but not in the AS task compared to controls. In correctly performed ASAT task trials, PD patients are on average 60 milliseconds faster to initiate an eye movement. Subject classification based on error rates and eye latencies in the ASAT task results in a sensitivity of 0.77 and a specificity of 0.63., Conclusions: The results suggest that saccadic error rates and eye latencies in the cognitively more demanding ASAT task are sensitive measures to differentiate PD patients from controls. This task is a potentially useful addition to current methods to investigate visuomotor deficits in PD.

Background: Assessment of higher visual processing functions mostly requires active cooperation of participants, which is problematic in children with intellectual disabilities (ID). To circumvent this, we applied remote eye tracking to quantify (ab)normal visual orienting responses in children with ID in terms of reaction times to visual stimuli., Methods: We presented visual stimuli (cartoon, coherent form, and coherent motion) to 127 children (2-14 years) with developmental and/or ID (risk group) and simultaneously measured their orienting ocular motor responses. Reaction times to fixation (RTF) in the risk group were compared with RTF values of an age-matched control group., Results: Overall, in 72% of the children in the risk group, RTF values to cartoon were delayed, in 47% to form, and in 38% to motion. The presence of delayed reaction times was highest in the group of children >4 years with ID., Conclusion: Our data show that a majority of children with developmental and/or ID have delayed visual orienting responses. This suggests that this group has increased risk for higher visual processing dysfunctions. Future studies are planned to correlate abnormal orienting responses to type of brain damage and to dissociate the responses from ocular motor disorders., (© 2012 The Authors. Journal of Intellectual Disability Research © 2012 John Wiley & Sons Ltd, MENCAP & IASSID.)

Purpose: To assess the validity and repeatability of saccadic reaction times (SRT) across the visual field up to 30° using eye movement perimetry (EMP)., Methods: Eighteen subjects (36 eyes) were shown a central stimulus on a flat monitor screen. Next, peripheral stimuli were shown using an overlap paradigm. Subjects were instructed to look at detected peripheral stimuli and then refixate the central stimulus again. In three repetitive measurement series, a total of 288 visual stimuli (3 series × 24 locations × 4 contrast levels) were presented. Levene's test for equality of variances was applied to test the effect of stimulus location and measurement series on SRT variance. A Wilcoxon signed ranks test was used to compare SRTs between measurement series., Results: A total of 26 eyes were included in the study (72%). On average, 90.5% of the peripheral stimuli were labeled as 'seen' based on eye movement responses. Between the series, the mean SD of SRT differences was approximately 100 ms. Significantly faster SRTs were only found at contrast level 0.8 in series III compared with series II. In series I, SRT variance was independent in 75% of all locations. Across the three series, SRT variance was independent in 87.5% of all locations., Conclusions: The present study demonstrates low variability of SRT across the visual field up to 30° eccentricity and across measurement series., Translational Relevance: SRT as a measure for visual field responsiveness may be a potential marker to detect risk areas in specific parts of the visual field.

Quantification of eye-hand coordinated behaviour is a relatively new tool to study neurodegeneration in humans. Its sensitivity depends on the assessment of different behavioural strategies, multiple task testing and repeating tasks within one session. However, large numbers of repetition trials pose a significant burden on subjects. To introduce this method in large-scale population studies, it is necessary to determine whether reducing the number of task repetitions, which will lower subject burden, still leads to acceptable measurement accuracy. The objective of this study was to investigate the validity and reliability of eye-hand coordination outcome parameters in eight healthy volunteers using a test-retest approach. Subjects were assessed during a shortened test procedure consisting of eight repetitions of three behavioural tasks: a reflex-based tapping task, a planning-based tapping task and a memory-based tapping task. Eye-hand coordination was quantified in terms of timing (eye and hand latencies), kinematics and accuracy. Eye and hand latencies were found within a normal range (between 150 and 450ms). A paired samples t-test revealed no differences in timing parameters between the first and second measurements. It was concluded that eight trial repetitions are sufficient for quantifying eye-hand coordination in terms of timing, kinematics and accuracy. This approach demonstrates the testing of multiple visuomotor behaviours within a reasonable time span of a few minutes per task., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Purpose: Visual orientation toward remembered or visible visual targets requires binocular gaze shifts that are accurate in direction (version) and ocular distance (vergence). We determined the accuracy of combined version and vergence movements and the contribution of the abducting and adducting eye during gaze shifts toward memorized and visual targets in three-dimensional space., Methods: Subjects fixated either a "far" (94 cm) or "near" (31 cm) fixation light-emitting diode (LED) placed in front of the left eye. Next, in the memory-guided experiment, a target LED was lit for 80 ms (13 cm to the left or right and at 45 cm viewing distance). Subjects were instructed to make a saccade to the (remembered) target LED location. In the visually guided experiment, the target LED remained illuminated during the task. In both conditions, gaze shifts consisted of version and vergence movements., Results: Visually guided gaze shifts had both a fast intrasaccadic and a slow postsaccadic vergence component and were most accurate. During memory-guided gaze shifts, the abducting eye was more accurate than the adducting eye. Distance correction was achieved by slow postsaccadic vergence of the adducting eye. Memory-guided gaze shifts that required convergence lacked an intrasaccadic vergence component and were less accurate compared to memory-guided gaze shifts that required divergence., Conclusions: Visually guided binocular gaze shifts are faster and more accurate than memory-guided binocular gaze shifts. During memory-guided gaze shifts, the abducting eye has a leading role, and an intrasaccadic vergence enhancement during convergence is reduced.

The aim of this study was to quantify processing of different types of coherent motion in terms of ocular motor response times in a group of normally-developing children (age 0-12+ years old) using remote eye tracking. Motion coherence was applied in three different types of Random Dot Kinematograms (RDKs): vertical (RDK1) and diagonal (RDK2) motion and expansion (RDK3). Orienting eye movements were quantified using the Reaction Time to the first Fixation (RTF). The children were divided into two groups: the "youngest group" between 0-3+ years and the "oldest group" between 4-12+ years old. The results showed that RTF was significantly prolonged in the "youngest group" compared to the "oldest group" for each RDK. In the "oldest group", RTF was significantly affected by the type of RDK shown. The presented results suggest that, based on ocular motor responses, age-dependence of processing different types of coherent motion may be revealed.

Objective: Many daily activities involve intrinsic or extrinsic goal-directed eye and hand movements. An extensive visuomotor coordination network including nigro-striatal pathways is required for efficient timing and positioning of eyes and hands. The aim of this study was to investigate how Parkinson's disease (PD) affects eye-hand coordination in tasks with different cognitive complexity., Methods: We used a touch screen, an eye-tracking device and a motion capturing system to quantify changes in eye-hand coordination in early-stage PD patients (H&Y < 2.5) and age-matched controls. Timing and kinematics of eye and hand were quantified in four eye-hand coordination tasks (pro-tapping, dual planning, anti-tapping and spatial memory task)., Results: In the pro-tapping task, saccade initiation towards extrinsic goals was not impaired. However, in the dual planning and anti-tapping task initiation of saccades towards intrinsic goals was faster in PD patients. Hand movements were differently affected: initiation of the hand movement was only delayed in the pro-tapping and dual planning task. Overall, hand movements in PD patients were slower executed compared to controls., Interpretation: Whereas initiation of saccades in an extrinsic goal-directed task (pro-tapping task) is not affected, early stage PD patients have difficulty in suppressing reflexive saccades towards extrinsic goals in tasks where the endpoint is an intrinsic goal (e.g. dual planning and anti-tapping task). This is specific for eye movements, as hand movements have delayed responses in the pro-tapping and dual planning task. This suggests that reported impairment of the dorsolateral prefrontal cortex in early-stage PD patients affects only inhibition of eye movements. We conclude that timing and kinematics of eye and hand movements in visuomotor tasks are affected in PD patients. This result may have clinical significance by providing a behavioral marker for the early diagnosis of PD.

Purpose: Brain damage or brain development disorders can affect (the maturation of) visual processing functions, such as form and motion detection. The aim of our study was to investigate visual orienting responses of children to a coherent form and motion stimulus as a measure for maturation of visual information processing., Methods: The 213 typically developing children aged 0-12 years included in this study were shown a 100% coherent form and motion expansion stimulus on a remote eye tracking monitor. Orienting eye movements were quantified in terms of ocular motor reaction time to fixation (RTF). Children were divided in age groups, and their performance was compared to 30 healthy adults with a mean age of 24.49 years (SD 3.62 years)., Results: The RTF values of coherent form in children up to six years old were significantly higher compared to the adult group (P < 0.05, Dunnett post-hoc test). For motion, mature levels were reached at eight years old. RTF values depended on stimulus type (F(1,168) = 240.8, P < 0.001) and age (F(11,168) = 25.8, P < 0.001), and there was a significant age by stimulus type interaction (F(11,168) = 2.2, P < 0.05)., Conclusions: Remote eye tracking may provide objective insight into the maturation of visual information processing of coherent form and motion without complex instructions or active cooperation. The quantification of typical visual orienting behavior in childhood may be used as a reference for children with brain dysfunction.

The goal of this study was to compare the acute effects of whole-body vibration (WBV) delivered by 3 devices with different mechanical behavior on jump force (JF) and jump rate of force development (JRFD). Twelve healthy persons (4 women and 8 men; age 30.5 ± 8.8 years; height 178.6 ± 7.3 cm; body mass 74.8 ± 9.7 kg) were exposed to WBV for 15 and 40 seconds using 2 professional devices (power plate [PP; vertical vibration] and Galileo 2000 [GA; oscillatory motion around the horizontal axis in addition to vertical vibration]) and a home-use device [Power Maxx, PM; horizontal vibration]). The JF and JRFD were evaluated before, immediately after, and 5 minutes after WBV. The JF measured immediately after 40 seconds of vibration by the GA device was reduced (3%, p = 0.05), and JRFD measured after 5 minutes of rest after 40 seconds of vibration by the PM device was reduced (12%, p < 0.05) compared with the baseline value. The acute effects of WBV (15 or 40 seconds) on JF and JRFD were not significantly different among the 3 devices. In conclusion, our hypothesis that WBV devices with different mechanical behaviors would result in different acute effects on muscle performance was not confirmed.

The current definition of Cerebral Visual Impairment (CVI) includes all visual dysfunctions caused by damage to, or malfunctioning of, the retrochiasmatic visual pathways in the absence of damage to the anterior visual pathways or any major ocular disease. CVI is diagnosed by exclusion and the existence of many different causes and symptoms make it an overall non-categorized group. To date, no discrimination is made within CVI based on types of perceptive visual dysfunctions. The aim of this review was to outline which perceptive visual dysfunctions are to be expected based on a number of etiologies of brain damage and brain development disorders with their onset in the pre-, peri- or postnatal period. For each period two etiologies were chosen as the main characteristic brain damage. For each etiology a main search was performed. The selection of the articles was based on the following criteria: age, etiology, imaging, central pathology and perceptive visual function test. The perceptive visual functions included for this review were object recognition, face recognition, visual memory, orientation, visual spatial perception, motion perception and simultaneous perception. Our search resulted in 11 key articles. A diversity of research history is performed for the selected etiologies and their relation to perceptive visual dysfunctions. Periventricular Leukomalacia (PVL) was most studied, whereas the main tested perceptive visual function was visual spatial perception. As a conclusion, the present status of research in the field of CVI does not allow to correlate between etiology, location and perceptive visual dysfunctions in children with brain damage or a brain development disorder. A limiting factor could be the small number of objective tests performed in children experiencing problems in visual processing. Based on recent insights in central visual information processing, we recommend an alternative approach for the definition of CVI that is based on functional visual processing, rather than anatomical landmarks. This could be of benefit in daily practice to diagnose CVI., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Human orienting behaviour requires a complex interaction between the visual and the oculomotor system. We present orienting gaze data measured in children using a remote eye tracking system. The aim of the study was to validate a data analysis method which did not require off-line correction of data gaps due to eye blinking or inadequate gaze tracking. In two sessions, blocks of short movies, amongst others cartoons, were shown to 35 children (2-9 years) for a test-retest analysis. The cartoons were subsequently shown in one of the monitor corners. Orienting eye movements were analysed on the basis of saccadic reaction time (SRT), reaction time to fixation (RTF) of cartoon and gaze fixation area (GFA) Differences were tested for significance using the Wilcoxon-signed ranks test and reliability was assessed using the intraclass correlation coefficient (ICC). SRT values could be calculated in approximately 50% of gaze data and ranged between 150(30)ms (mean(SD)) and 390(190)ms (average SRT(min) and SRT(max) values of all subjects). RTF values could be derived in approximately 90% of gaze data with an average RTF(min) of 210(30)ms and RTF(max) of 570(160)ms. Test-retest analysis showed a significant increase of GFA during the second session with approximately 5% (P<0.05). The reliability of RTF(min) and GFA was best with an ICC of 0.84 and 0.80, respectively (P<0.0001). We conclude that remote eye tracking is well suited for quantification of timing and executing oculomotor fixations during orienting behaviour tasks. The presented method may be applied in young children with developmental disorders or brain damage., (Copyright (c) 2010 Elsevier B.V. All rights reserved.)

Physical whole-body vibration (WBV) exercises become available at various levels of intensity. In a first series of measurements, we investigated 3-dimensional platform accelerations of three different WBV devices without and with three volunteers of different weight (62, 81 and 100 kg) in squat position (150 degrees knee flexion). The devices tested were two professional devices, the PowerPlate and the Galileo-Fitness, and one home-use device, the PowerMaxx. In a second series of measurements, the transmission of vertical platform accelerations of each device to the lower limbs was tested in eight healthy volunteers in squat position (100 degrees knee flexion). The first series showed that the platforms of two professional devices vibrated in an almost perfect vertical sine wave at frequencies between 25-50 and 5-40 Hz, respectively. The platform accelerations were slightly influenced by body weight. The PowerMaxx platform mainly vibrated in the horizontal plane at frequencies between 22 and 32 Hz, with minimal accelerations in the vertical direction. The weight of the volunteers reduced the platform accelerations in the horizontal plane but amplified those in the vertical direction about eight times. The vertical accelerations were highest in the Galileo (approximately 15 units of g) and the PowerPlate (approximately 8 units of g) and lowest in the PowerMaxx (approximately 2 units of g). The second series showed that the transmission of vertical accelerations at a common preset vibration frequency of 25 Hz were largest in the ankle and that transmission of acceleration reduced approximately 10 times at the knee and hip. We conclude that large variation in 3-dimensional accelerations exist in commercially available devices. The results suggest that these differences in mechanical behaviour induce variations in transmissibility of vertical vibrations to the (lower) body.

Background: It has been suggested that sustained contraction of the deep neck muscles may reduce axial cervical range of motion (CROM) and radial artery blood flow velocity (vrad.art.mean). No studies have reported both phenomena in relation to acute hand, shoulder or neck trauma., Procedures: The CROM and vrad.art.mean were measured in 20 police officers prior to and immediately after a 2-hours drive on a motorcycle and immediately after a 1-minute writing exercise using biofeedback. The CROM was measured using separate inclinometers and the vrad.art.mean was measured in both arms just proximal to the wrist using echo-Doppler., Findings: During the study, one officer had a motorcycle accident resulting in acute symptoms of neck trauma. His vrad.art.mean was acutely reduced by 73% (right arm) and 45% (left arm). Writing with biofeedback increased his vrad.art.mean by 150% (right arm) and 80% (left arm). In the remaining 19 officers, the CROM to the right was significantly increased after the 2-hours driving task (p<0.05; paired subject t-test). Writing with biofeedback increased their CROM in both directions and vrad.art.mean in both arms (p<001)., Conclusions: A 2-hours drive showed modest physical changes in the upper extremities. Biofeedback in writing tasks might relate to the influence of relaxation and diverting attention for neck mobility and arterial blood flow improvement.

Objectives: Elderly men are prone to developing lower urinary tract symptoms (LUTS) possibly caused by bladder outlet obstruction (BOO). The most frequently used method to diagnose this condition is an invasive and time-consuming pressure-flow study. We are developing a novel non-invasive method to diagnose BOO in men with LUTS based on perineal sound recording., Methods: A biophysical model urethra was made from polyvinyl alcohol (PVA) cryogel with viscoelastic properties comparable to those of the male pig urethra. To this model different degrees of obstruction were applied and sound was recorded at different positions downstream of the obstruction. In a study in 16 healthy male volunteers the variability and repeatability of perineal sound recording was tested., Results: In the model three parameters, derived from the frequency spectrum of the recorded sound (i.e., weighted average frequency, standard deviation and skewness) are uniquely related to the degree of obstruction (linear regression, P<0.001). The variability of perineal sound recording in healthy male volunteers was found to be smaller within volunteers than between volunteers (Kruskal-Wallis, P<0.001) and the repeatability was comparable to that of the maximum flow rate., Conclusions: We conclude that perineal sound recordings are significantly different between volunteers. In combination with the unique relations found in the model-experiments these results increase the probability that perineal sound recording can be used as a simple and cheap non-invasive method to diagnose BOO. Clinical testing of this method is therefore strongly indicated.

Objectives: A non-invasive method to measure the bladder pressure in males using a condom catheter has been developed. The measurement technique, its validation and limitations, a diagnostic nomogram to non-invasively diagnose bladder outlet obstruction (BOO), and results of large-scale application are discussed., Methods: Modified incontinence condoms are attached to the penis. During voiding the flow of urine is mechanically interrupted. The subsequent maximum pressure in the condom reflects the isovolumetric bladder pressure. The method was validated in a group of 46 patients with lower urinary tract symptoms who were simultaneously studied invasively and non-invasively. Subsequently it was applied in a non-invasive epidemiological study in 1020 healthy males., Results: The reproducibility of the measured isovolumetric bladder pressure is comparable to that of conventional pressure-flow parameters. The measured pressure can be used to diagnose bladder outlet obstruction with a diagnostic accuracy (Area Under receiver operator characteristic curve) of 0.98, which compares most favorably with the area under the curve of 0.79 of Q(max) in the same population. During condom catheter measurements, both the involuntary interruption of voiding and the forced diuresis increase post-void residual volume. This increase does not affect the accuracy of the pressure measurements., Conclusions: We conclude that in males bladder pressure can successfully be measured non-invasively using the condom catheter method. By combining the measured volumetric bladder pressure with a separately measured free flow rate, BOO can non-invasively and accurately be diagnosed.

Effective stabilization of the sacroiliac joints (SIJ) is essential, since spinal loading is transferred via the SIJ to the coxal bones, and further to the legs. We performed a biomechanical analysis of SIJ stability in terms of reduced SIJ shear force in standing posture using a validated static 3-D simulation model. This model contained 100 muscle elements, 8 ligaments, and 8 joints in trunk, pelvis, and upper legs. Initially, the model was set up to minimize the maximum muscle stress. In this situation, the trunk load was mainly balanced between the coxal bones by vertical SIJ shear force. An imposed reduction of the vertical SIJ shear by 20% resulted in 70% increase of SIJ compression force due to activation of hip flexors and counteracting hip extensors. Another 20% reduction of the vertical SIJ shear force resulted in further increase of SIJ compression force by 400%, due to activation of the transversely oriented M. transversus abdominis and pelvic floor muscles. The M. transversus abdominis crosses the SIJ and clamps the sacrum between the coxal bones. Moreover, the pelvic floor muscles oppose lateral movement of the coxal bones, which stabilizes the position of the sacrum between the coxal bones (the pelvic arc). Our results suggest that training of the M. transversus abdominis and the pelvic floor muscles could help to relieve SI-joint related pelvic pain.

Many patients with low back and/or pelvic girdle pain feel relief after application of a pelvic belt. External compression might unload painful ligaments and joints, but the exact mechanical effect on pelvic structures, especially in (active) upright position, is still unknown. In the present study, a static three-dimensional (3-D) pelvic model was used to simulate compression at the level of anterior superior iliac spine and the greater trochanter. The model optimised forces in 100 muscles, 8 ligaments and 8 joints in upright trunk, pelvis and upper legs using a criterion of minimising maximum muscle stress. Initially, abdominal muscles, sacrotuberal ligaments and vertical sacroiliac joints (SIJ) shear forces mainly balanced a trunk weight of 500N in upright position. Application of 50N medial compression force at the anterior superior iliac spine (equivalent to 25N belt tension force) deactivated some dorsal hip muscles and reduced the maximum muscle stress by 37%. Increasing the compression up to 100N reduced the vertical SIJ shear force by 10% and increased SIJ compression force with 52%. Shifting the medial compression force of 100N in steps of 10N to the greater trochanter did not change the muscle activation pattern but further increased SIJ compression force by 40% compared to coxal compression. Moreover, the passive ligament forces were distributed over the sacrotuberal, the sacrospinal and the posterior ligaments. The findings support the cause-related designing of new pelvic belts to unload painful pelvic ligaments or muscles in upright posture.

In patient studies the correlation between maximum urethral closure pressure (MUCP) and Valsalva leak point pressure (LPP) is meagre at best (r = 0.22-0.50). We therefore studied the relation between MUCP and LPP in a flexible and extensible model urethra. We applied differently sized pressure zones and different degrees of resistance to a biophysical model urethra by stepwise inflating three types of blood pressure cuff placed around the model. At each degree of resistance we measured detrusor LPP, an in vitro equivalent of Valsalva LPP. Subsequently, we recorded the Urethral Pressure Profile using a water-perfused 5F end-hole catheter at four withdrawal rates and five perfusion rates and calculated MUCP. We tested the dependence of LPP on pressure zone length and MUCP on perfusion rate, withdrawal rate and pressure zone length using analysis of variance. We tested the correlation between LPP and MUCP using Pearson's correlation coefficient and Linear Regression. LPP did not significantly depend on the pressure zone length (P = 0.80) and increased linearly with increasing cuff pressure. MUCP also increased with increasing cuff pressure, however, MUCP significantly depended (P < 0.01) on perfusion rate, withdrawal rate and pressure zone length. MUCP increased with increasing perfusion rate, and decreased with increasing withdrawal rate. In our model urethra MUCP only accurately reflected urethral resistance for a very limited number of combinations of perfusion rate and withdrawal rate. LPP reflected urethral resistance independent of the type of pressure zone.

A novel, non-invasive method to diagnose bladder outlet obstruction involves the recording of noise with a contact microphone pressed against the perineum (between anus and scrotum). This noise results from flow-generated vortices caused by prostatic obstruction. We developed a computational fluid dynamic (CFD) urethral model including urethral geometry to study the relation between generated noise and the degree of obstruction. This model comprised a bladder, bladder neck, prostate and urethra. Calculations were carried out at four bladder pressures, five degrees of obstruction and three obstruction shapes. For each of the sixty simulations, the velocity and pressure distributions along the urethra were calculated including wall shear stresses to localize flow transition from disturbed to normal. Negative pressures at the obstruction outlet induced recirculation of flow. The location of transition was independent of the applied bladder pressure, but it depended primarily on the degree and secondarily on the shape of the obstruction. Based on the presented results, we hypothesize that the location of the maximum amplitude of perineal noise mainly depends on the degree and shape of the prostatic obstruction. Our future aim is to test our hypothesis in male patients and to extend the presented model to 3D with a viscoelastic urethral wall to calculate the fluid-wall interaction.

Introduction: When muscle is allowed to shorten during an active contraction, the maximum force that redevelops after shortening is smaller than the isometric force at the same muscle length without prior shortening. We studied the course of force redevelopment after shortening in smooth muscle to unravel the mechanism responsible for this deactivation., Method: In a first series of measurements the shortening velocity was varied resulting in different shortening amplitudes. In a second series, the duration of stimulation before shortening (shortening delay) was varied. In a third series, the stimulation was interrupted for a certain duration immediately after shortening. Force, muscle length and stimulation were continuously recorded. Time constants were calculated to describe the rate of force development before and after shortening., Results: With increasing shortening amplitude and with increasing shortening delay, force redevelopment decreased. Redevelopment increased with an increase in the interruption time. After stimulus interruption force redeveloped mono-exponentially with a time constant similar to that of isometric contractions (approximately 3s). Without the interruption of stimulation, the redevelopment of force immediately after shortening was best described by two time constants; one similar to and one about 3-5 times faster than the isometric time constant., Discussion: Force (re)development is caused by a cascade of events leading to the cycling of cross-bridges. In smooth muscle, isometric force development is described by a time constant of about 3s. Force redevelopment immediately after shortening involves a second process which takes place at a faster rate (time constant about 1s). We assume that this process is faster due to the immediate availability of cytoplasmic calcium released during active shortening. Deactivation presumably is caused by disorganization of filaments during shortening.

Purpose: We established the urine flow rate and the effect of surgical correction on that rate in patients with hypospadias., Materials and Methods: The urine flow rate, voided volume and residual urine were measured using an ultrasound flow probe and bladder scan in boys with distal hypospadias before operative correction in 42 with a mean age of 16 months, 3 and 9 months after operative correction in 28 and 11, respectively, and in a control group of 51 boys 0 to 3 years old (mean age 11 months). Long-term flow data were obtained retrospectively from the records of 63 patients with hypospadias 1 to 10 years after operation., Results: Of the controls 37% had mainly intermittent and sometimes fractionated flows, 4% had a plateau phase flow and 59% had mainly bell-shaped flow curves. The average maximum flow rate +/- SD was 6.8 +/- 4.1 ml per second and maximum flow rate/voided volume was 0.26 +/- 0.11 l per second. Of the boys with distal hypospadias 76% produced intermittent flows (fractionated in the majority) before correction. After correction this percent decreased to 50%. The average maximum flow rate was 7.5 +/- 2.5 ml per second before correction, and 6.6 +/- 2.8 and 7.2 +/- 1.8 ml per second 3 and 9 months after operation, respectively. Average maximum flow rate/voided volume was 0.22 +/- 0.12 l per second before, and 0.16 +/- 0.09 and 0.16 +/- 0.09 l per second 3 and 9 months after operation, respectively. In the long-term group maximum flow rate/voided volume was 0.13 +/- 0.11 l per second. The number of patients voiding with a plateau phase increased from 6% before to 13% and 17% after correction, respectively. An obstructive pattern was also observed in 41% of the long-term followup group., Conclusions: An intermittent flow pattern is common in 0 to 3-year-old boys. It appears to be more common and more pronounced or fractionated in boys with distal hypospadias at the same ages. In relation to voided volume patients with hypospadias already produce an abnormally low urine flow rate before correction and even more so thereafter in the short and intermediate term. The corrective procedure increases the occurrence of flows with an obstructive pattern.

Purpose: A low flow rate without clinical symptoms is commonly found in boys after hypospadias correction. Urethral calibration usually shows no abnormalities. We investigated whether this impairment might be caused by increased neo-urethral wall stiffness., Methods: From polyvinyl alcohol cryogel two models of the urethra were made, hypospadias and control; both had a constant and equal inner diameter and equal compliance. The hypospadias model had a less compliant distal segment mimicking the distal neo-urethra after hypospadias correction. In both models, flow rate was recorded as a function of bladder pressure. To test whether the length of the less compliant segment had an effect on the flow rate, both models were shortened by cutting off 1-cm segments., Results: In a physiological range of bladder pressures (10-130 cmH(2)O) the mean flow rate (+/-1 SEM) in the hypospadias model was 2.8+/-0.3 ml/s, significantly lower (P<0.05) than in the control model (5.4+/-0.6 ml/s). Shortening of the hypospadias model showed some increase in flow rate, but this was not statistically significant. In the control model there was also no significant variation in flow rate., Conclusion: A low-compliant segment of a urethral model reduced the flow rate. Extrapolating these results to asymptomatic boys with a low urinary flow rate after hypospadias repair might justify a watchful waiting policy.

Aims: To compare the contractile properties of proximal urethral and bladder muscle of the female pig., Materials and Methods: In two proximal segments (I and II) of the urethra, small muscle bundles were excised to measure the force-length (maximum force) and the force-velocity (unloaded shortening velocity) relation using the stop-test. The rate of force development was calculated using phase plots. Contractile properties of urethral and bladder segments were statistically compared using the Mann-Whitney U-test. Immunohistochemical staining of whole circumference urethral cross sections was used to identify the location of smooth and striated muscle fibres., Results: On isometric force development, the urethral muscle bundles revealed a fast ( approximately 0.5 sec) and a slow ( approximately 2.1 sec) time constant, whereas in bladder only a slow ( approximately 2.3 sec) component was measured. On average, isometric force was highest in bladder. The length range over which force was produced was smallest in urethral segment II, followed by urethral segment I and finally bladder. The unloaded shortening velocity was 0.15, 0.25 and 0.35 1/sec, respectively. Histological preparations showed that smooth as well as striated muscle was present in proximal urethra. In urethral muscle bundles, spontaneous contractions were measured with a frequency of 0.4 Hz., Conclusions: Differences in contractility found between urethra and bladder may be ascribed to the presence of striated muscle in the proximal urethra. The regulation of tone and spontaneous contractions may be part of the continence mechanism in the female pig urinary tract., ((c) 2005 Wiley-Liss, Inc.)

Aims: We aim at developing a non-invasive method for grading and diagnosing urinary bladder outlet obstruction, based on noise recording with a perineal contact microphone during voiding. We found that the noise production during voiding depends amongst others on the viscoelastic properties of the urethral wall. To further test our method, we need a realistic biophysical model of the male urethra., Methods: We made various model urethras with different viscoelastic properties from a 10% aqueous solution of polyvinyl alcohol cryogel. We measured the viscoelastic properties of each model and compared them to those of the male pig urethra. The male pig urethra was used, as it is physiologically comparable to the human male urethra. The viscoelastic properties of both model and pig urethras were measured by applying strain to the urethral wall in a stepwise manner and recording the pressure response. We fitted the step-response of a mechanical model to this pressure response and derived the viscoelastic properties from the coefficients of this response., Results: A uniform model urethra that was freeze-thawed three times, with a Y-shaped flow channel was found to best represent the male pig urethra., Conclusions: We consider the three times freeze-thawed model urethra with a Y-shaped flow channel the best model of the human male urethra. And we therefore use this model urethra for studying the relation between noise recording during urine flow and the degree of bladder outlet obstruction.

Like in the human detrusor, the pig urinary detrusor muscle consists of two layers: compactly arranged smooth muscle bundles on the mucosal side (inner layer) and loosely arranged smooth muscle bundles on the serosal side (outer layer). The contractile properties of muscle bundles of both layers were measured using the stop test followed by an isometric contraction. Total and passive forces were measured in ten muscle bundles from the inner and outer muscle layers. Active force was defined as the difference between total and passive force. The curvature and the unloaded shortening velocity of the force-velocity relation were calculated from the shortening forces measured during the stop test. The rate of force development was calculated from the isometric contraction. Differences in contractile properties between both layers were pairwise tested using the Wilcoxon Signed Ranks test. Percentage wise, the outer layer muscle bundles produced the highest active isometric force. The shortening forces were also higher in the outer layer bundles. As a result, both the curvature and the unloaded shortening velocity, derived from the average force-velocity relations fitted to the data sets, were higher in the muscle bundles from this layer. Finally, the outer layer muscle bundles contracted significantly faster than those of the inner layer. Muscle bundles from the outer layer of pig detrusor were found to be faster and stronger (more phasic) than the weaker and slower (more tonic) bundles from the inner layer, suggesting that during bladder contraction the outer layer of the detrusor does more work than the inner layer.

Aims: At present, an invasive pressure flow study is recommended to diagnose urinary bladder outlet obstruction. This method induces the risk of urinary tract infection and urethral trauma. We studied perineal noise recording as an alternative, non-invasive diagnostic method in three flexible/extensible model urethras and two silicone tubes., Methods: The flexible/extensible model urethras were made of a 10% aqueous solution of polyvinyl alcohol (PVA) and differed in wall- stiffness, the silicone tubes differed in diameter and wall-thickness. Three degrees of obstruction were applied by inflating a cuff placed around the PVA-urethras and by compressing the silicone tubes with an adjustable clamp. Noise, produced during flow, was recorded at three positions distal to the obstruction using a piëzoceramic contact microphone., Results: The average amplitude of the noise and the essential frequency of the power spectrum of each noise recording depended significantly on the degree of obstruction, the position of the microphone and the wall-stiffness in PVA-urethras and the diameter in silicone tubes., Conclusions: Based on the results of this study perineal noise recording shows good potential as an alternative method for diagnosing bladder outlet obstruction., (Copyright (c) 2005 Wiley-Liss, Inc.)

Objectives: To report on the applicability, reproducibility, and adverse events of the noninvasive condom catheter method in the first 730 subjects of a longitudinal survey of changes in urinary bladder contractility secondary to benign prostatic hyperplasia, in which 1300 men will be evaluated three times in 5 years using this method., Methods: Subjects were recruited by general practitioners, general publicity, and e-mail. Only those meeting the study criteria were entered in the study. If the free flow rate exceeded 5.4 mL/s, at least two consecutive condom pressure measurements were attempted using the condom catheter method. The condom pressure measured reflected the isovolumetric bladder pressure, a measure of urinary bladder contractility. The reproducibility of the method was quantified by a difference plot of the two maximal condom pressures measured in each subject., Results: In 618 (94%) of 659 eligible participants, one condom pressure measurement was completed; two measurements were done in 555 (84%). The maximal condom pressure ranged from 28 to 228 cm H2O (overall mean 101, SD 34). A difference between the two pressures of less than +/-21 cm H2O was found in 80%. The mean difference was -1 cm H2O (SD 18), significantly different from 0. Some adverse events such as terminal self-limiting hematuria were encountered., Conclusions: The condom catheter method is very suitable for large-scale use. It has a success rate of 94% and a reproducibility comparable to that of invasive pressure flow studies.

We developed a condom-type catheter to non-invasively measure the bladder pressure during interruption of the flow rate. The aim of the present study was to establish a minimum flow rate value at which a reliable bladder pressure measurement can be made with this catheter. We reanalysed data from 43 patients who completed a pressure-flow study and a non-invasive test. The patients voided without straining. During the test, we simultaneously measured the bladder pressure (invasively) and the condom pressure (non-invasively). The pressure increase in the condom after interruption of the flow rate was analysed in 40 of the 43 patients. A plot of the difference between the bladder pressure and the maximum condom pressure as a function of the flow rate revealed that in 70% of the patients who voided with a maximum flow rate exceeding 5.4 ml/s, the condom pressure accurately reflected the bladder pressure (+/-14 cmH2O). We conclude that to accurately and non-invasively measure the bladder pressure with a condom-type catheter, the maximum flow rate should exceed 5.4 ml/s.

To diagnose bladder outlet obstruction in male patients with lower urinary tract symptoms (LUTS), it is necessary to measure the bladder pressure via a transurethral (or suprapubic) catheter. This procedure incurs some risk of urinary tract infection and urethral trauma and is sometimes painful to the patient. We developed an external condom catheter to measure non-invasively the bladder pressure and developed a strategy to classify bladder outlet obstruction (BOO) based on this measurement. Seventy-five patients with a wide range of urological diagnoses underwent a pressure-flow study followed by a non-invasive study. We tested five different strategies to classify the patients using the provisional International Continence Society (ICS) method for definition of obstruction as the gold standard. Leakage of the external catheter occurred in eight (40%) of the first 20 tested patients. In the remaining 55 patients, only five (9%) of the measurements failed because of leakage. Of the 75 patients, 56 were successfully tested non-invasively. According to the ICS nomogram, the PFS showed that 22 of these patients were non-obstructed, 12 patients were equivocal, and 22 patients were obstructed. Ten of these 56 patients strained, and we found that the relatively high abdominal pressures in these patients were not reflected in the externally measured bladder pressure. Of the remaining 46 patients, 12 of 13 non-obstructed patients and 30 of 33 combined equivocal and obstructed patients could be correctly classified. We developed a simple, non-invasive classification strategy to identify BOO in those male patients who did not strain during voiding., (Copyright 2002 Wiley-Liss, Inc.)