FUNCTIONAL DIAGNOSTICSGASTROINTESTINAL

What is Biofeedback?What is Biofeedback?

Provides the patient immediate Auditory and/or Visual information about Physiological Process

It's a Therapy, i.e. type of treatment where people are trained to improve their health by using Signals from their own bodies

By watching the monitor and listening to the sound the patient gets the Feedback information and can adjust thinking and behavior .

The Goal in Lower GI is to Improve Improve Pelvic Floor Dysfunction by teaching patients to change physiologic responses

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Biofeedback in Lower GI Biofeedback in Lower GI

SphincterEMG

AbdominalPressure

Voluntary Sphincter contractions are recorded. Abdominal pressure as well

Feedback sent to patient (display and/or sound)

Patient actions:

To increase sphincter contraction

To decrease abdominal pressureMotor

Internal Sphincter

S2S3S4

External Sphincter

Efferent

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Pelvic Floor Training EMG + PressurePelvic Floor Training EMG + Pressure

EMGUraVagAnal

Pabd

5" 7" 4" 18"Duration Increased

Effort

Straining

EMG curve area

=

Effort Index

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Patient Selection ProcessPatient Selection Process

Evaluate patient - diagnostic tests: AFT/ others

Diagnose patient Incontinence Constipation Others

Evaluate whether this patient would benefit from Biofeedback

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PathologiesPathologies

Incontinence

Stress Fecal Incontinence due to:

Weak external Sphincter

Dyssynergia IS/ES to Rectum

Pelvic Floor Muscles Dysfunction

Constipation Due to Anismus

Non-Neurogenic Origin

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Biofeedback ProcessBiofeedback 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

Etc...

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Sprite moves up/ down according to patient activity

Lane moves right to left

Patient tries to follow the lane

Lane

Sprite

Polygraf ID® ConceptPolygraf ID® Concept

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Protocol SettingsProtocol Settings

Primary (and secondary) channel

Capture display rate

Lane (Squeeze, Relax)

Initial wait Time response Duration

Target level

Tolerance

Number of repetitions

Graphics for lane, above lane,

below lane and sprite (BMP files)

Sound (wave file)

Amplitude

Time

Squeeze

Time response

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Running BiofeedbackRunning Biofeedback

Run non-saving mode

“Monitoring/ Set-up phase”

Change of protocol must be done before you enter saving mode

Run saving mode 1 or more recordings (training paradigms)

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Reviewing BiofeedbackReviewing Biofeedback

ReviewLane displayed

“Hidden” markers - bar

Calculations (mouse over)

ReportProtocol used

Fulfillment in percent

(percentage time within lane)

Relax, squeeze, total

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Polygraf ID

With Polygraf ID®With Polygraf ID®

Various background screens are available

Curves analysis to quantify training and improvement

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Pelvic Floor Training EMG + PressurePelvic Floor Training EMG + Pressure

Anal Sphincter and

Abdominal Pressureactivity

I try to Contract or relaxContract or relax my SphinctersSphincters and keep my

AbdominalAbdominal WallWall Relaxed !Relaxed !

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Pelvic Floor Training Two EMGPelvic Floor Training Two EMG

Sphincter orVaginal EMG

and Suprapubic EMG

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AccessoriesAccessories

Pressure Measurement

1. DPT Pressure Transducer With extension line & flushing syringe

2. Abdominal Catheter a. Opened-end - F8 b. Balloon

1

2a

2b

9021P1091

9021P4221

1. Disposable Surface

3. Reusable Anal Plug With Abdominal catheter insertion lumen

2. Disposable Anal and Vaginal Sponge

1

2

3

EMG Electrodes

9013K07829013K0792

9013L48119021L0203

9021S02319013S0221

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Polygram Net Biofeedback ApplicationPolygram Net Biofeedback Application

Enhancement wishes with the migration:

A count-down window showing performed/to go procedures (in capture)

Fine tuning of the track directly from the education view - by moving the lane/track to the

patients performance level

Progress report that evaluate the patients

improvements over time.

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FUNCTIONAL DIAGNOSTICS

Thanks!Thanks!