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Polygram 98 Biofeedback Application

Polygram 98 Biofeedback Application. Agenda. Clinical information in short The biofeedback concept Polygram 98 Biofeedback application EMG . Which patients?. Incontinent patients Constipated patients Patients with other voiding disorders. The Patient Selection Process.

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Polygram 98 Biofeedback Application

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  1. Polygram 98 Biofeedback Application

  2. Agenda • Clinical information in short • The biofeedback concept • Polygram 98 Biofeedback application • EMG

  3. Which patients? • Incontinent patients • Constipated patients • Patients with other voiding disorders

  4. The Patient Selection Process • Evaluate patient - diagnostic tests: AFT/others • Diagnose patient • Incontinence • Constipation • Others • Evaluate whether this patient would benefit from Biofeedback

  5. The biofeedback process • Perform first biofeedback training in clinic • Help patient train at home • Perform biofeedback assessment in clinic to evaluate progress • Change difficulty level • More home training • Biofeedback assessment to evaluate progress • Change difficulty level

  6. Biofeedback • Biofeedback is a therapy, which improves muscular strength and co-ordination of the pelvic floor. • This is done by recording pressure or EMG signals from the anorectal sphincter, the abdomen or the gluteal muscular group • Watching a real-time monitor display provides both the patient and the physician with immediate information about the patient’s muscular strength and the co-ordination of different muscular groups • The Goal is to Improve Pelvic Floor Functionby teaching patients to change physiologic responses Descending Anal kanal S2 S3 S4 Motor

  7. Polygram 98 Biofeedback Application • Separate Polygram 98 Application • Pelvic floor retraining evaluation using the Polygraf ID and EMG or pressure sensors.

  8. Biofeedback Concept

  9. Biofeedback Protocol Settings • Primary (and secondary) channel • Capture display rate • Track (Squeeze, Relax) 1) Initial wait 2) Response time 3) Duration 4) Target level 5) Tolerance 6) Number of repetitions • Graphics for lane, above lane, below lane and sprite (BMP files) • Sound (wave file) 5 4 1 2 3

  10. Running Biofeedback • Run non-saving mode • Important: Change of protocol must be done before you enter saving mode • Run saving mode • 1 or more recordings (training paradigms) • Review • Lane displayed • “Hidden” markers - bar • Calculations (mouse over) • Report • Protocol used • Fulfillment in percent (percentage time within lane) • Relax, squeeze, total

  11. The Biofeedback Application • Non-saving/ Saving mode • Full screen track • Graphics (defined by user) • Several recordings • 1 or 2 channels • EMG • Pressure • Protocol settings • Fast review - saving on the fly

  12. For kids

  13. Market feedback • Children center, Odense University Hospital, DK • The patients understood the concept and put a lot of interest/effort into it • The parents approved it • Very easy to make customized programs • Wish for more “life” to the graphics

  14. EMG measurements in general • What is measured? • Muscle electrical activity over a bundle of muscle fibers

  15. EMG measurements in general • How is it measured? • Absolute: • Pre-calibrated with a known amplifier and sensor sensitivity. • Measured in V • Relative • Patient relaxation and maximum squeeze is the calibration points. • Measured in percent

  16. EMG measurements in general • How does the EMG filter in Polygram 98 work? • Rectifies incoming signals • Signal smoothing: • High pass filter • 0.2 second time constant

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