functional diagnostics gastrointestinal polygram 98 biofeedback application

FUNCTIONAL DIAGNOSTICSGASTROINTESTINAL

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

Evaluate patient - diagnostic tests: AFT/others

Diagnose patient Incontinence Constipation Others

Evaluate whether this patient would benefit from Biofeedback


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


BiofeedbackBiofeedback 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 Improve Pelvic Floor FFunction by teaching patients to change physiologic responses

Motor

Anal kanalAnal kanalS2S3S4

Descending


Polygram 98 Biofeedback Application

Separate Polygram 98 Application

Pelvic floor retraining evaluation using the Polygraf ID and EMG or pressure sensors.


Biofeedback Concept


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)

1 2 3

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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


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


For kids


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


EMG measurements in general

What is measured? Muscle electrical activity over a bundle of muscle

fibers



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



How does the EMG filter in Polygram 98 work? Rectifies incoming signals Signal smoothing:

High pass filter 0.2 second time constant

functional diagnostics gastrointestinal polygram 98 biofeedback application

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