2. FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL FUNCTIONAL DIAGNOSTICS Biofeedback Copyright MFD 2001 - Any kind of reproduction is prohibited

3. FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Biofeedback q Provides the patient immediate Auditory and/or Visual information about Physiological Process q It's a Therapy, i.e. type of treatment where people are trained to improve their health by using Signals from their own bodies q By watching the monitor and listening to the sound the patient gets the Feedback information and can adjust thinking and behavior. Improve q The Goal in Lower GI is to Improve Pelvic Floor Dysfunction by teaching patients to change physiologic responses

4. FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Biofeedback q It's a Therapy, i.e. type of treatment where people are trained to improve their health by using Signals from their own bodies. q Provides the patient immediate Visual information about Physiological Process. q By watching the monitor the patient gets the Feedback q information and he can adjust his thinking and behavior. Improve F q The Goal is to Improve Pelvic Floor Function by teaching patients to change physiologic responses Motor Anal kanal S2 S3 S4 Descending

5. FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL 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. FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL The Patient Selection Process Evaluate patient - diagnostic tests: AFT/others Diagnose patient Incontinence Constipation Others Evaluate whether this patient would benefit from Biofeedback (patient must be capable to cooperate)

7. FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Pathologies Incontinence q Stress Fecal Incontinence q Weak external Sphincter q Dyssynergia IS/ES to Rectum q Pelvic Floor Muscles Dysfunction q Constipation q Due to Anismus Non-Neurogenic Origin

8. FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Polygraf ID With Polygraf ID ® q Various background screens are available q Curves analysis to quantify training and improvement

9. FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Biofeedback Marketing package; Product flyer Summaries of reference articles Sample reports Example Data Export files Training program

10. FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL 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) 123 5 4

11. FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL 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

12. FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Pelvic Floor Training constipation Contract or relax Sphincters AbdominalWallRelaxed ! I try to Contract or relax my Sphincters and keep my Abdominal Wall Relaxed ! Sphincter and Abdominal Muscle activity SPHINCTER ABDOMINAL

13. FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL EMG measurements in general What is measured? Muscle electrical activity over a bundle of muscle fibers

14. FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL EMG measurements in general How is it measured? Absolute: Pre-calibrated with a known amplifier and sensor sensitivity. Measured in mV Relative Patient relaxation and maximum squeeze is the calibration points. Measured in percent

15. FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL 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

16. FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Reviewing Biofeedback q Review Lane displayed Hidden markers - bar Calculations (mouse over) q Report Protocol used Fulfillment in percent (percentage time within lane) Relax, squeeze, total

17. FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Accessories 1. Disposable Surface 3. Reusable Anal Sphincter With Abdominal catheter insertion lumen 2. Disposable Anal and Vaginal 1 2 3 EMG Electrodes Pressure Catheters Anorectal

18. FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL FUNCTIONAL DIAGNOSTICS Thanks !