1. FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Polygram 98 Biofeedback Application

2. FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Agenda Clinical information in short The biofeedback concept Polygram 98 Biofeedback application EMG

3. FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Which patients? Incontinent patients Constipated patients Patients with other voiding disorders

4. 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

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 Biofeedback q Biofeedback is a therapy, which improves muscular strength and co-ordination of the pelvic floor. q This is done by recording pressure or EMG signals from the anorectal sphincter, the abdomen or the gluteal muscular group q 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 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

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

8. FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Biofeedback Concept

9. FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL

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 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

13. FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL For kids

14. FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL 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

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

16. FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL 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

17. 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