MyoTrac3 Hardware & BioGraph Infiniti Continence Suite 3.1

Transcription

1 MyoTrac3 Hardware & BioGraph Infiniti Continence Suite 3.1 Thought Technology Ltd Belgrave Avenue, Montreal, QC H4A 2L8 Canada Tel: (800) ٠ (514) Fax: (514) Webpage:

2 0413 The Manufacturer: Product Name: Product #: Device Name: Device #: Thought Technology Ltd Belgrave Avenue Montreal, Quebec, Canada H4A 2L8 MYOTRAC 3 INFINITI CONTINENCE SYSTEM T9910 MYOTRAC 3 SA9900 MyoTrac 3 Continence Suite 2

3 CLASSIFICATION Type BF Equipment Internally powered equipment Continuous operation Read Instruction Manual CAUTION US Federal Law restricts this device to sale by or on order of licensed health care practitioners. WARNING Do not operate Active sensors within 10 feet of an operating cellular phone, similar radio transmitting device, other powerful radio interference producing sources such as arc welders, radio thermal treatment equipment, x-ray machines or any other equipment that produces electrical sparks etc. All encoders are totally isolated from line (110 or 220VAC) power due to battery operation and fiber optic connections to computers. However, many hospitals and the FDA require that computers, printers and any other equipment used with medical devices be electrically isolated from line voltage to UL or CSA medical safety standards. Do not connect inputs or outputs of the encoder or sensors to line powered devices, except through the fiber optic cable. All Encoders are totally isolated from line (110 or 220VAC) power due to battery operation and fiber optic connections to computers. However, many hospitals and the FDA require that computers, printers and any other equipment used with medical devices be electrically isolated from line voltage to UL or CSA medical safety standards. The PC used with MYOTRAC 3 must be placed outside the patient/client environment (more than 3 meters or 10 feet) or the PC must comply with EN (system safety). After use, the Disposable Electrodes may be a potential biohazard. Handle, and when applicable, dispose of these materials in accordance with accepted medical practice and any applicable local, state and federal laws and regulations. To diminish the risk of spreading communicable diseases, always use good hygiene practices with re-usable EEG electrodes, particularly if abrasive substances are used. In all cases, refer to your facility s infection control procedure. Radiated radio frequency electromagnetic fields can cause performance degradation in the MyoScan-Pro EMG sensor. In the worst case, an RF field strength of 22mV/M can cause an increase of 1μV in the signal reading from a MyoScan-Pro sensor. Be sure to keep in mind that a very relaxed muscle should provide an EMG reading of approximately 1-3μV. Radiated radio frequency electromagnetic fields can cause performance degradation in the Myoscan-Pro EMG sensors. In the worst case, an RF field strength of 22mV/M can cause a degradation of 1μV in the signal from the Myoscan-Pro sensors. Be sure to keep in mind that a very relaxed muscle should provide an EMG reading of approximately 1-3μV. Do not use in the presence of a flammable anesthetic mixture with air or with Oxygen or Nitrous Oxide. Not to be immersed in water. ATTENTION To prevent static discharge from damaging the sensor and/or encoders, use anti-static mats or sprays in your working area. A humidifier may also be used to help prevent static environments by conditioning hot, dry air. Not for Diagnostic Purposes. Not Defibrillator Proof. Not for Critical Patient Monitoring. To prevent voiding warranty by breaking connector pins, carefully align white guiding dot on sensor plug with slot on sensor input. Sharp bends or winding the fiber optic cable in a loop smaller than 4 inches (10cm) may destroy the cable MyoTrac 3 Continence Suite 3

4 destroy the cable. A fiber optic cable not fully pushed into its receptacle may cause the unit not to operate; make sure that both ends of the cable are fully inserted into their receptive jacks and the nuts are tightened firmly. Make sure to remove electrodes from sensor snaps immediately after use. Apply conductive gel only to electrodes, never put gel directly on sensor snaps. Always use electrodes between the subject and the sensor. Do not plug third party sensors directly into instrument inputs. Plug only Thought Technology Active Sensor cable connectors into instrument inputs. All EMG electrodes and third party sensors must be connected to Active sensors, either directly or through an adapter. Remove batteries when the device is not being used for extended period of time. Please dispose of battery following national regulations. MyoTrac 3 Continence Suite 4

5 INTENDED PURPOSE Biofeedback, Relaxation & Muscle Re-Education purposes. CONTRAINDICATIONS None NOTE Wipe encoder with a clean cloth. No preventive inspections required, qualified personnel must perform maintenance. The supplier will make available, upon request, circuit diagrams, component parts lists and description or other information required for the repair of product by qualified personnel. Manual SA7979 V.3.1 MyoTrac 3 Continence Suite 5

6 TABLE OF CONTENTS INTRODUCTION... 9 CONTINENCE SUITE FOR MYOTRAC OVERVIEW... 9 SPECIAL THANKS... 9 INSTALLATION AND SYSTEM REQUIREMENTS Update Information SETTING UP THE MYOTRAC3 EMG SYSTEM GLOBAL SETUP SETTING UP OF THE MYOTRAC3 DEVICE Configuring the internal switches Internal Switch Settings: Inserting the Battery Connecting the MyoTrac3 Device to the Computer USING THE SENSORS Cleaning and Caring for Your Sensors Using the Vaginal Sensor Using the Rectal Sensor Using the Long Extender Cables for Perianal Placement Using Short Extender Cables (45 cm) for Channel B Placement CONNECTING THE SENSORS TO THE MYOTRAC3 DEVICE QUICK START RECORDING SESSIONS Starting the Program First Time Run: Notch Filter Options To Start Recording a Session Script Session Select an existing Client o To record with a new script: o To record with a previously recorded script: Create a new Client Open Display Session First Time Run: Entering Key Codes STOPPING A SESSION REPLAYING SESSIONS REVIEWING SESSIONS Review Reports TOOL BAR OPTIONS Toggling Between Screens Adjusting Scales and Threshold MODIFYING SCREENS WITH SCREEN EDITOR LITE MyoTrac 3 Continence Suite 6

7 CHANGING SCRIPT SETTINGS SUITE DESCRIPTION INCONTINENCE TUTORIAL INCONTINENCE EVALUATON SCREENS Assessment/ Review M3 UFI - 1Ch Linegraph for Review M3 UFI - 2Ch 2 linegraphs M3 UFI - 2Ch bargraphs-no sound M3 UFI - 2Ch Multi-linegraph l-r scale M3 UFI - 2Ch single-multi-linegraphs Relaxation M3 UFI - 1Ch bargraph M3 UFI - 1Ch Earth Puzzle M3 UFI - 1Ch filled line-bar graphs M3 UFI - 1Ch Growing Fractal M3 UFI - 1Ch Parrot Puzzle M3 UFI - 1Ch Parrot Puzzle bargraph M3 UFI - 1Ch Smiley M3 UFI - 2Ch line-filled graphs M3 UFI - 2Ch Relaxation Green light M3 UFI - 2Ch Relaxation with DVD Strengthening M3 UFI - 1Ch Dolphin Puzzle M3 UFI - 1Ch Fractal M3 UFI - 1Ch Jumping Car M3 UFI - 1Ch Jumping Puppet M3 UFI - 2Ch Butterflies M3 UFI - 2Ch Conditional DVD M3 UFI - 2Ch Drying Lake M3 UFI - 2Ch Fading Mouse M3 UFI - 2Ch Filled linegraph M3 UFI - 2Ch filled linegraphs M3 UFI - 2Ch Flower Explosion M3 UFI - 2Ch Hero Morph-fast M3 UFI - 2Ch Hero Morph-slow M3 UFI - 2Ch Turtle Training M3 UFI - 2Ch Animal game M3 UFI - 2Ch Car race M3 UFI - 2Ch Green light M3 UFI - 2Ch Growing Sphere M3 UFI - 2Ch Maze M3 UFI - 2Ch template M3 UFI - 2Ch template M3 UFI - 2Ch template M3 UFI - 2Ch template M3 UFI - 2Ch template M3 UFI - 2Ch template M3 UFI - 2Ch template M3 UFI - 2Ch template M3 UFI - 2Ch template M3 UFI - 2Ch template M3 UFI - 2Ch template M3 UFI - 2Ch template SCRIPTS Pelvic Muscle Dysfunction Assessment Script Pelvic Muscle Dysfunction Work-Rest Script Perineal Work-Rest Scripts M3 UFI 2 Ch line-bar graph M3 UFI 2Ch 5 cycles 4-4sec template M3 UFI 2Ch 5 cycles 4-8sec template M3 UFI 2Ch 5 cycles 6-6sec template MyoTrac 3 Continence Suite 7

8 M3 UFI 2Ch 5 cycles 6-12sec template M3 UFI 2Ch 5 cycles 10-10sec template Perineal Training Scripts M3 Controlled Perineal Contraction 0_ M3 Held Perineal Contractions 0_ M3 PC Hypertonicity 0_ M3 PC Hypotonicity 0_ M3 Perineal Control End-treatment 0_ M3 Perineal Control Mid-treatment 0_ M3 Perineal Control Start-treatment 0_ M3 Postpartum Perineal Tonicity 0_ M3 Relaxation of Perineal Muscles 0_ M3 Stress Incontinence 0_ TEMPLATES AND TEMPLATE TRAINING Perineal Training Templates Controlled Perineal Contractions Held Perineal Contractions PC Hypertonicity PC Hypotonicity Perineal Control End-Treatment Perineal Control Mid-Treatment Perineal Control Start-Treatment Postpartum Perineal Tonicity Relaxation of Perineal Muscles Stress Incontinence REQUIRED FILES FOR THE MYOTRAC3 CONTINENCE SUITE Channel Set Screens Scripts Animations MIDI Pictures (Background) Prompts Sounds Templates Waves Sample Data SPECIFICATIONS AND SUPPORT TECHNICAL SUPPORT AND ORDER PLACING Returning Equipment TECHNICAL SUPPORT PRODUCT NUMBERS & ACCESSORIES MyoTrac3 EMG System Components PLACING ORDERS SPECIFICATIONS Waranty Repair Return Form MyoTrac 3 Continence Suite 8

9 INTRODUCTION CONTINENCE SUITE FOR MYOTRAC3 Welcome to the MyoTrac3 Continence Suite. This suite is a collection of scripts (protocols) and open display screens for tutoring, evaluating and training. Some of the scripts and open display screens use templates that will guide the user in the frequency and intensity of contractions. OVERVIEW The first half of this manual will help you get your MyoTrac3 system up and running, and to provide you with the basics of how to use the main features of the BioGraph Infiniti software: Installation and System Requiremnets Quick Start The second half gives descriptions of the screens and scripts along with some guidelines and suggestions on how to use them : Screens Scripts Templates and Template Training SPECIAL THANKS We would like to thank Nancy Schully for her valuable contribution of Assessment-Review, Relaxation, Strengthening and Training screens, as well as for her part in writing this manual. Nancy Schully: Southern Biofeedback Corp. Please contact southernbio@charter.net for more details. MyoTrac 3 Continence Suite 9

10 INSTALLATION AND SYSTEM REQUIREMENTS If you do not have the BioGraph Infiniti software setup in your computer, please follow the Installation Instructions provided to install the program. Then follow similar steps to install the Continence Suite. Please make sure that your computer has the following requirements before installing the BioGraph Infiniti software: Recommended IBM PC compatible (Intel/Pentium/Celeron family or AMD K6/Athlon/Duron family, CPU P4 speed 3 GHz or higher), Desktop or Laptop with two monitor capability Windows 2000/XP Professional or Home edition gigabytes hard disk space for video recording and processing. (The software needs 2.5 gigabytes to install and run on available hard drive space) Memory, 512 MB of RAM or more CD ROM or DVD drive SVGA graphic card (1024 x 768) or higher resolution adapter & monitor 32 bit Sound Blaster compatible sound card & speakers 1 to 4 USB ports, depending on the desired number of MYOTRAC INFINITI U- CONTROL encoders Mouse or compatible pointing device MS Word 97 or higher (for printing purposes) Compact Flash Reader (For use with compact flash card only) Webcam 30 frames per second (for video purposes only) NOTE: When using certain more complex screens, you must adhere to the Recommended Computer Requirements. Update Information Periodically updates may become available for the BioGraph Infiniti software. Please contact your local distributor or visit our website for further information on how to obtain updates. MyoTrac 3 Continence Suite 10

11 SETTING UP THE MYOTRAC3 EMG SYSTEM GLOBAL SETUP The following pictures illustrate the connection of the entire MyoTrac3 EMG system. See the following pages for details about how to attach the sensors to the patient and the MyoTrac3 device, then how to connect the MyoTrac3 device to the computer. TT-USB interface fiber optic cable USB cable to computer MyoTrac3 device Channel A: Vaginal/ Rectal sensors or Extender cables pre-gelled electrode Channel B: Extender cables Electrode and extender cable connections MyoTrac 3 Continence Suite 11

12 Connection to PC Connection to laptop SETTING UP OF THE MYOTRAC3 DEVICE Configuring the internal switches The MyoTrac3 device allows you to set the bandwidths for Channel A and Channel B by using the dipswitches in the battery compartment. Channel A represents the pelvic muscles sensor (vaginal or rectal sensor or perianal extender cable) and Channel B represents the extender cable you have placed on the abdomen, thigh or gluteal muscles. The default manufacture setting for the filter dips witches is on the ON position. This defines a wide bandwidth of Hertz (Hz) for both channels. This is the recommended filter setting. Switching to the narrow bandwidth ( Hz) on channel B will be preferable when using an abdominal electrode placement since activity resulting from the heart muscle might be picked up and create unwanted interfering signals. The narrow bandwidth will filter this out. Note: Using the narrow bandwidth for the vaginal, rectal or perianal sensor may cause important information to be missed. Channel A's dipswitch should always be set to the wide bandwidth (position 1, up) as it is used for measuring the pelvic floor muscles. The third switch is used to define the notch filter. This will remove any noise interference caused by nearby electrical devices. The usual notch filter setting for North America is 60Hz. The electrical power system of most European countries function at 50Hz and so the switch setting would have to be changed. Internal Switch Settings: a) Dip1 ON - Filter CH A, Hz Dip1 OFF - Filter CH A, Hz MyoTrac 3 Continence Suite 12

13 b) Dip2 ON - Filter CH B, Hz Dip2 OFF - Filter CH B, Hz c) Dip3 ON - Line Filter 50Hz Dip3 OFF - Line Filter 60Hz d) Dip4 Reserved for future use. Inserting the Battery The MyoTrac3 device requires one 9 Volt battery for power. The device operates best when you use alkaline batteries, since Nickel-Cadmium (Ni-Cad) rechargeable batteries generally do not provide sufficient sustained charge. 1. Slide the bottom panel towards the back of the device. 2. Insert the 9 Volt battery in the compartment, making sure to properly orient the positive (+) and negative (-) contacts of the battery on the springs in the compartment. 3. Replace the cover. You can test the battery installation by turning the device on. The small LED between the Channel connectors will light up. Upon power-up the MyoTrac3 Device will read the settings of the switches in the battery compartment and set the internal filters accordingly. Connecting the MyoTrac3 Device to the Computer The MyoTrac3 EMG system is an extremely sensitive device. Ensure that all connections are correct and secure before turning your computer on and using the system. Incorrect or insecure connections can produce improper readings. You must connect the MyoTrac3 device to the available USB port of your computer. 1. Loosen the Data Out jack collar on the MyoTrac3 device and insert the fiber optic cable into the jack. When the jack is loose, the cable should be inserted up to the ring marked on the fiber optic cable (about ¾ of an inch). Note: Ensure that the cable is inserted all the way into the jack and that the jack collar is screwed down firmly, but do not over tighten. Be sure that the ends of the fiber optic cable are cut cleanly and evenly, otherwise you may not get a proper connection (if necessary, do this with a sharp razor blade or X-acto blade; do not cut with scissors). 2. Insert the other end of the fiber optic cable into the TT-USB Interface. MyoTrac 3 Continence Suite 13

14 Caution: Do not bend sharply or wind the fiber-optic cable in a loop tighter than about 4 inches. Doing so can damage the cable and prevent the MyoTrac3 device from functioning properly. 3. Plug the TT-USB Interface into the USB port of your computer. See GLOBAL SETUP (p.11) above for an illustration of the entire system and its connections. 4. Turn on the MyoTrac3 device and the computer and follow the instructions in the following section. MyoTrac3 device and TT-USB interface connections USING THE SENSORS The Thought Technology sensors are designed with unique plugs with protected pins and are approved for use with the MyoTrac3 device. Use of other manufacturers' sensors with the MyoTrac3 EMG system, although possible, is not recommended. Do not alter or modify the sensor cable and/or connector since it may affect the product's safety and invalidate the warranty. These sensors must be used under the care of a clinician. These sensors are intended for a single patient, and were designed to monitor electromyographic (EMG) activity of the pelvic musculature for rehabilitation and relaxation. Note: The instructions provided here are only intended as a guideline. Be sure to read the instructions for use that are supplied with the individual sensors. The vaginal and rectal sensors are intended for single patient use, and are reusable only by the same patient. Cleaning and Caring for Your Sensors The vaginal and rectal sensors should be cleaned before they are first used, and immediately after every use. Wash and lather your hands with soap in flowing lukewarm water and then liberally apply the same lather to the sensor. Rinse all soapy residue from the sensor and your hands. Take care not to wash or wet the sensor cable connector. Dry the sensor with a clean cloth or paper towel and allow it to air-dry completely. Store it in its original plastic bag or in a clean plastic bag. Never submerge the sensor in water or subject it to extreme temperatures or abrasive detergents. Do not boil or autoclave the sensor. Using the Vaginal Sensor Before beginning to use the vaginal sensor, it should be cleaned as outlined in the previous section. MyoTrac 3 Continence Suite 14

15 1. Instruct your patient to empty her bladder (and bowels, if necessary) before you begin your session to avoid being interrupted later. 2. You may need to instruct your patient to lightly lubricate the tip of the sensor with a watersoluble lubricant such as K-Y jelly, which is widely available at pharmacies. Place a dab of K-Y jelly on a paper towel, then touch the sensor tip to the lubricant. Usually, only the tip of the sensor must be lubricated to facilitate insertion. Note: Using too little lubricant may make insertion difficult. Using too much may impede proper measurement and cause the sensor to slide out as soon as your patient contracts her muscles. Never use Vaseline or any other petroleumbased lubricants with the vaginal sensor. The T-base of the sensor ensures that it cannot be inserted too deeply, while the bulb ensures that it stays seated during the patient's contractions. 3. Instruct your patient to hold the sensor by the T-base and gently, but firmly, insert it into her vagina. The wire end of the T- base should exit upwards towards the patient's abdomen. 4. Snap a Uni-Gel electrode onto the reference wire snap. Place the reference electrode in an area that has little or no hair (thigh, abdomen, or back). For instructions on how to attach the vaginal sensor to the MyoTrac3 device, see "Connecting the Sensors to the MyoTrac3 Device", p.17. Vaginal sensor 5. To remove the vaginal sensor, grip the T-base and gently pull downward. Instruct your patient not to grasp the wire when she is removing the sensor. Be sure to follow the cleaning and care instructions (p.14) above. Using the Rectal Sensor Before beginning to use the rectal sensor, follow the cleaning and care instructions on "Cleaning and Caring for Your Sensors" (p.14). 1. Instruct your patient to empty his/her bowels (and bladder, if necessary) before you begin your session to avoid being interrupted later. 2. You may need to instruct your patient to lightly lubricate the tip of the sensor with a watersoluble lubricant such as K-Y jelly, which is widely available at pharmacies. Place a dab of K- Y jelly on a paper towel, then touch the sensor tip to the lubricant. Usually only the tip of the sensor must be lubricated to facilitate insertion. Note: Using too little lubricant may make insertion difficult. Using too much may impede proper measurement and cause the sensor to slide out as soon as your patient contracts his/her muscles. Never use Vaseline or any other petroleumbased lubricants with the rectal sensor. MyoTrac 3 Continence Suite 15

16 The T-base of the sensor ensures that it cannot be inserted too deeply, while the bulb ensures that it stays seated during the patient's contractions. 3. Instruct your patient to hold the sensor by the T- base and gently, but firmly insert it into his/her rectum. The wire end of the T-base should exit upwards towards the patient's abdomen or back. 4. Snap a Uni-Gel electrode onto the reference wire snap (see the picture above, p.11). Place the reference electrode in an area that has little or no hair (thigh, abdomen, or back). For instructions on how to attach the rectal sensor to the MyoTrac3 device, see "Connecting the Sensors to the MyoTrac3 Device", p.17. Rectal sensor 6. To remove the rectal sensor, grip the T-base and gently pull downward. Instruct your patient not to grasp the wire when he/she is removing the sensor. Be sure to follow the cleaning and care instructions (p.14) above. Using the Long Extender Cables for Perianal Placement You can also use surface electrodes with patients who are not candidates for vaginal or rectal sensors. 1. Prior to placing the electrodes, cleanse the perianal area with a mild soap. A variety of perianal cleansing solutions are available commercially. 2. Snap Uni-Gel electrodes to the U-Control extender cable. Snap on the pre-gelled electrodes before you apply the electrodes to the skin surface. Perianl placement of extender cables 3. Using universal precautions, the (+) and (-) gray surface electrodes can be applied perianally at the 3 o'clock and 9 o'clock positions, as close to the rectal opening (and external rectal sphincter) as possible. 4. Position the black reference electrode on either the thigh, buttocks or lower back region. For instructions on how to attach the U-Control extender cables to the MyoTrac3 device, see "Connecting the Sensors to the MyoTrac3 Device", p.17. MyoTrac 3 Continence Suite 16

17 Using Short Extender Cables (45 cm) for Channel B Placement You can use Channel B to measure co-contractions from any accessory muscle group. Channel B: Electrode placement 1. The reference electrodes should be placed above the sensor, on the patient's abdomen at belly-button level on the side (about 3 inches away from the bellybutton itself). 2. Place the gray electrodes (marked + and -) at the top and the bottom of the three electrodes, see diagram. The reference electrode (black) should be placed in the middle of the other two electrodes, adjacent to the belly button. You can change the placement of these electrodes to meet your specific needs. The diagram is intended only as an example of placement. For instructions on how to attach the short extender cables (45 cm) to the MyoTrac3 device, see "Connecting the Sensors to the MyoTrac3 Device" below. CONNECTING THE SENSORS TO THE MYOTRAC3 DEVICE 1. Plug the vaginal or rectal sensor (or U-Control Extender Cable) in the Channel A connector on the front of the MyoTrac3 unit. 2. For recording co-contractions of accessory muscle groups, attach the short extender cable to the Channel B connector on the MyoTrac3 device. 3. Insert pre-gelled electrodes on the electrode snaps of the sensor and extender cable. Channel connector Note: The sensor cables have a white guiding-dot on the plug; this dot should be aligned to fit the notch into the small crevice in the top of the jack on the MyoTrac3 (see diagram). Forcing the plug in the jack in any other position may damage your equipment. MyoTrac 3 Continence Suite 17

18 QUICK START The purpose of this guide is to provide you with a rapid overview of the main functions of the BioGraph Infiniti program as well as the Screen Editor Lite. Please refer to the on-line help manual for a more detailed description of all the functions and features of the program. To open the on-line help, simply press the F1 function key, on your keyboard, from any dialog box in the program. Because the on-line help manual is designed to provide contextual information, it will be automatically opened at the section that discusses the dialog box from which the help was called. Also, please consult the manual that came with your MyoTrac3 unit. RECORDING SESSIONS With the BioGraph Infiniti software, two types of sessions can be recorded: Open Display and Script sessions. Open Display sessions are generally used for biofeedback training, when flexibility is important and you need to be able to rapidly change the session parameters, depending on the client's reactions. Script sessions, on the other hand, are important for recording assessment or follow-up sessions, where a standardized and constant approach is more appropriate. While both open display and script sessions can be used for trend reports, script sessions generally generate more comparable sessions. Starting the Program After making the necessary connections briefly described above, turn on your MyoTrac3 unit. Start the BioGraph Infiniti software, which has the Continence suite installed. To start the program, simply double-click on the BioGraph Infiniti icon, on the Desktop, or find it in the Start Menu under Program Files\Thought Technology\Infiniti\: MyoTrac 3 Continence Suite 18

19 The program always starts by showing the Main Menu screen: Main Menu Screen First Time Run: Notch Filter Options Before you start to record, make sure to set up the global notch filter to block certain frequencies caused by electrical interference from showing up in your data. Select Options at the top left of the main screen. Select Notch Filter from the drop-down menu. Set Notch Filter Options to EMG and the frequency to 50 or 60 Hz depending on your region. This setting will remain until you change it. Notch Filter dialog box To Start Recording a Session Click on Start Script Session or Start Open Display Session. Select a Client file or create a new entry from the Start Session window. MyoTrac 3 Continence Suite 19

20 Start Session window Please refer to the BioGraph Infiniti Quick Start manual for other options by clicking on the BioGraph Infiniti Docs & Editors icon, p.18. Script Session Select Start Script Session from the Main Menu Screen, and then select a Client or create a new Client entry. Select an existing Client o To record with a new script: Click Select New Script to open the Script Database window. Select MyoTrac3 as the encoder communication protocol from the drop-down menu at the top. Choose a script from the list, and click OK. A thumbnail of screens used in the chosen script is available by enabling Picture View. o To record with a previously recorded script: Highlight a previously recorded script under the column Session from the Start Session window. This allows you to use the same display screens and any other changes you made during a previous session (see CHANGING SCRIPT SETTINGS, p.18). Create a new Client o by clicking on Add New Client, and fill in the name at minimum. Then, follow the steps to record with a new script above. MyoTrac 3 Continence Suite 20

21 Click OK to go to the recording screen. If you are using your unit for the first time, you are required to enter key codes (see First Time Run: Entering Key Codes, p.22) Begin the script by clicking on the Start button, and follow the on-screen instructions. Script Database window Open Display Session Select Start Open Display Session from the main screen. Highlight your client s name or add it to the list (see Create a new Client, p.20). Select Define New Session to open the Select up to 5 Screens for Open Display mode window. Choose MyoTrac3 as the encoder communication protocol. Highlight the channel set MyoTrac3 Continence on the left. Choose a Screen from the list on the right. A thumbnail of screens is available by enabling Picture View (See display screens, p.32). Screens are listed by category. Pick a category by clicking on the drop down menu just above the screen list. You can select up to 5 screens by pressing down the CTRL key while clicking with the left mouse button. MyoTrac 3 Continence Suite 21

22 Select up to 5 Screens for Open Display Mode window Click OK to go to the recording screen. If you are using your unit for the first time, you are required to enter key codes (see First Time Run: Entering Key Codes below). Start recording by clicking on the Start button. First Time Run: Entering Key Codes If it is the very first time you are using your MyoTrac3 unit with your computer, you are required to enter key codes. A dialog box will appear after you have chosen the screens or script you want to record with and clicking OK on the Select up to 5 Screens for Open Display Mode or Script Database windows respectively. When the Encoder Key Codes dialog box opens, click to highlight your unit s serial number in the left table (ex. EA1010. This is the same serial number you can see on the back of the unit). Type in the Encoder Key Code (found inside the battery compartment) in the Key Code text box. Click on the > arrow button to move the serial number from the left table to the right table. The Serial number should now appear in the Configuration Table. When done, click OK. MyoTrac 3 Continence Suite 22

23 Now enter the Application Key Code for your system. This number is found with the encoder key code. Enter the number and click OK when done: Note: If you are using more than one encoder, you only need to enter one Application Key Code. If the key codes have been entered properly and there is no problem with your encoder setup or your sensor connections, you should now be seeing the recording screen: STOPPING A SESSION To end recording a session, click the Stop button: The program asks if you want to save the recorded data. You can decide to save the session in a compressed format, but, unless you are really tight on hard drive space or you do not need to review the saved sessions, we recommend that you always Save, which will use the non-compressed format: Then the Session Notes pop-up appears so you can enter, if you want, a treatment code, a session description and some notes: MyoTrac 3 Continence Suite 23

24 Click OK to continue. Next, you are asked if you would like to review the session right away. You can switch to the review mode or the replay mode. If you click No, the program asks if you want to record another session with the same settings: If you click No, the program reminds you to turn your encoder off: Clicking OK, takes you back to the Main Menu Screen. MyoTrac 3 Continence Suite 24

25 REPLAYING SESSIONS Select Database from the main screen. Highlight the client whose session you wish to view from the Main Database window. Main Database window Select a session on the right. A script session has the name of the script ending in.prt, and an open display session has the name of the channel set ending in.chs. Click on Replay Session at the bottom. o If you are replaying a Script Session: close the Edit Channel Set Setting for Current Client window to go into replay mode. o Or if you are replaying an Open Display Session: Click on Select Screens from the Review/Replay Session Confirmation window. Review/Replay Session Confirmation window From the Select Screens window highlight up to 5 screens, then click OK. MyoTrac 3 Continence Suite 25

26 Select Screens window Click OK on the Review/Replay Session Confirmation window to go into replay mode. Click on the Start button to begin. REVIEWING SESSIONS After recording a session you can analyze the data by going into review mode. This mode allows you to scroll through the graphs, look at statistics, and print out a report displaying the data in graphical and/or statistical form. Review Select Database from the main screen. Highlight the client whose session you want to review from the Main Database window (p.19). Highlight a session on the right. A script session has the name of the script ending in.prt, and an open display session has the name of the channel set ending in.chs. Click on Review/Report to open the Review/Replay Session Confirmation window. Click on Select Screens to open the Select Screens window (p.22). Click on the column heading for Category to reoder the screens into groups, and scroll down to Assessment-Review screens and highlight up to 5 screens. Click OK. MyoTrac 3 Continence Suite 26

27 Click OK on the Review/Replay Session Confirmation window to go into review mode. Reports Click on Options at the top of the display screen in review mode. Select Set Open Display Statistics from the drop-down menu. Choose Show only channels marked as statistics, and highlight the statistics you wish to show. Note: This option is disabled for script sessions since the statistics are predefined. Press the print icon located on the top right. The Print Session window will appear; make selections as to what you wish to show. Click Print, and an MS Word file will open; you can then print your report. Print Session window TOOL BAR OPTIONS While recording, replaying or reviewing an open display session there are certain options that are available on a tool bar found near the top of the display screen. To learn more about the tool bar, refer to the online help by pressing F1 while the mouse is resting on one of the tool bar buttons (see picture of tool bar below). Toggling Between Screens If you have chosen more than one screen you can view each one by clicking on the numerical buttons on the toolbar at the top. Only up to five screens can be viewed (in the example below, there are four, where the third screen is currently on display). Adjusting Scales and Threshold By clicking on a graph instrument you can enable any of the scale and threshold options on the toolbar shown below. MyoTrac 3 Continence Suite 27

28 Vertical scale: the minimum and maximum scale values can be changed by clicking on the up and down arrows to the right of the text boxes labeled with Max and Min. The numbers increase or decrease by 0.1, but when you click on the button numbers change by 1., the Multi line-graph Y1 and Y2 axes toggle: the multi-linegraph has a left and a right vertical scale that can be adjusted independently of each other by clicking on the toggle button. o Left vertical scale enabled: o Right vertical scale enabled: Threshold: the threshold line on a bargraph, linegraph and animation scale can be adjusted in the same way as the vertical scale. The text box labeled Thr1 is for single threshold graphs, while Thr2 is for double threshold graphs like the multi-linegraph that can have up to two guidelines. Time scale: the default time for all the screens is 30 seconds. You can select a new time scale by clicking on the drop-down menu. MODIFYING SCREENS WITH SCREEN EDITOR LITE Display screens can be modified with the Screen Editor Lite program. You can change certain instrument settings, sounds and text without going into the details of the full Screen Editor. To learn more about the Screen Editor Lite please refer to the manual provided by clicking on the BioGraph Infiniti Docs & Editors icon (p.18). CHANGING SCRIPT SETTINGS The number and duration of activities in a given script session can be modified within the BioGraph Infiniti software. You may want to change the screens that appear in a script as well as the duration of the session. The changes are made just before the recording. To learn more about this feature please refer to the manual provided by clicking on the BioGraph Infiniti Docs & Editors icon (p.18). MyoTrac 3 Continence Suite 28

29 Highlight the script you wish to modify from the Script Database window. Click on Edit Script Settings (see picture below). Highlight the activity to access the step(s) you wish to change. Highlight the step and click on Change Screen to use a different screen, or Step Duration to change the time length. Depending on the type of step, any of these buttons may be disabled. Note: The changes are only saved for that particular session. Edit Script Settings window MyoTrac 3 Continence Suite 29

30 SUITE DESCRIPTION Most incontinence problems can be improved by biofeedback. Patients can acquire more control over their pelvic floor muscle through strengthening, reducing excessive muscle activity or using the muscles appropriately. The screens and scripts of this suite are designed to meet this goal. To start, are two scripts, Incontinence Tutorial.prt and Incontinence Evaluation.prt, that give you an overview of the system and allow you to practice recording a script session. What follows are screens grouped into categories: Assessment-Review Relaxation Strengthening Training The rest are screens with templates grouped under Perineal Reeducation and are described along with the training and work-rest scripts that use them (see Scripts, p.46). There is a final set of screens under the category Open Display. These consist of displays from the other groups; mostly from Perineal Reeducation, and some from Training and Assessment- Review. Their names start with M3 od. You willl notice that they are mostly the template screens except that these templates are repeated endlessly until the recording is stopped. Technically, all the screens in this suite can be used for Open Display sessions. However for faster access when choosing a screen to record an open session, these particular ones were grouped under this category. Also, you will find that not all of the screens have been renamed to go into the Open Display category. Most of the screens show statistics where (1) some are calculated progressively and (2) the rest are calculated periodically. The template screens have statistics that are of the first type, so when the recording stops you get statistics over the whole session. The screens with no templates show statistics of the second type and at the end of the session they show statistics of the last time period. The kinds of feedback found on these screens are various types of audio, such as music, tones, sounds and voice prompts. There are also visual media, such as animations, and different graphs that change colour when the signals pass their threshold markers. MyoTrac 3 Continence Suite 30

31 INCONTINENCE TUTORIAL This tutorial will guide you on how to use the sensors and highlight what events to look for in an assessment. The screens shots below are shown in sequence as in the script. To view the incontinence tutorial: Follow the steps above on how to replay a script, p.24. Select the client name, Incontinence TUTORIAL, Select the session, 17/07/2006 4:04:57 PM M3 Incontinence Tutorial.prt 00:00: (M3 Incontinence Tutorial). MyoTrac 3 Continence Suite 31

32 INCONTINENCE EVALUATON This script will guide you through the process of evaluating incontinence, and is to be used after the incontinence tutorial. The second screen, M3 UFI - Description EVAL.scr summarizes the electrode placement and the script. The third screen, M3 UFI - Linegraph EVAL.scr can be used in open display mode. SCREENS The objective of using an open display is to provide variety and engage the patient in more challenging feedback. Note: Note: Some screen descriptions mention animation cycles : this is the length of time it takes for the animation to play from start to finish. The times indicated are only approximates as they vary across computer systems. They also vary when the frame rate is changed. Counter displays are not chronometrically accurate: they can be used to count or be used as points when conditions are met and/or sustained. Assessment/ Review The purpose of these screens is to analyze the state of the patient s muscles at each step of their recovery and training. The various signal displays like linegraphs, 3-D spectra, histogram, and the accompanying statistics and median frequency give a level of awareness of the muscle performance. By comparing the values from the previous session with the current one you can see what needs to be improved in the next session. In addition, you can see which technique to use to improve muscle activity. MyoTrac 3 Continence Suite 32

33 M3 UFI - 1Ch Linegraph for Review A simple screen displaying the signal from channel A. Numerical displays show the current value, some statistics and the median frequency. This sample screen was provided by the Biofeedback Foundation of Europe; designed by Nancy Schully(p.9) M3 UFI - 2Ch 2 linegraphs The top linegraph connects to channel A, and the one below it to channel B. The numerical displays are the current values of each channel as seen at the top right, and the statistics are found near the bottom. M3 UFI - 2Ch bargraphs-no sound The purpose of this screen is to see whether the signal of A can be maintained above or below threshold for a specified duration. In the meantime B should remain below threshold. This display can also be used for training (p.41). Opening the screen in Screen Editor Lite (p.28) you can enter the value for the duration. by double-clicking beside Seconds. M3 UFI - 2Ch Multi-linegraph l-r scale Both channels A and B are shown on a mulit-linegraph to easily compare the shape of the signals. The numerical displays are the current values, statistics and median frequencies. Note: to measure the height of channel A s signal use the left vertical scale, and for B s use the right vertical scale. Open Display: M3 od UFI - 2Ch Multi-linegraph l-r scale This sample screen was provided by the Biofeedback Foundation of Europe; designed by Nancy Schully(p.9) MyoTrac 3 Continence Suite 33

34 M3 UFI - 2Ch single-multi-linegraphs The signals from channel A and B can be compared or analyzed separately. The numerical displays are the current values found on the top right, and the statistics and median frequencies found at the bottom. Note: to measure the height of channel A s signal use the left vertical scale, and for B s use the right vertical scale. This sample screen was provided by the Biofeedback Foundation of Europe; designed by Nancy Schully(p.9) Relaxation The relaxation screens are designed to reinforce lowering levels of EMG activity. The rewards are typically set to encourage EMG activity to fall below its threshold. As the patient releases muscle tension/activity they are rewarded through audio and visual feedback usually linked to an animation or signal display. M3 UFI - 1Ch bargraph A simple bargraph display ideal for individuals that need help focusing on relaxation. When the threshold is set above the patient s resting level soft music is heard as long as the signal stays below its threshold. The objective is to assist relaxation through soothing audio feedback. M3 UFI - 1Ch Earth Puzzle A more actively challenging display for relaxation when you set the animation threshold below the patient s resting level. As the EMG activity relaxes, the patient is rewarded by puzzle pieces filling in fast and a constant low pitch tone is heard. A single tone alarm is heard whenever the EMG activity returns to a level above the animation s threshold. MyoTrac 3 Continence Suite 34

35 M3 UFI - 1Ch filled line-bar graphs A simple filled linegraph display. As the EMG activity falls below the linegraph s threshold, hearing music will reward the patient. M3 UFI - 1Ch Growing Fractal 02 This display assists a patient to differentiate between contracting and relaxing their muscles. Set the animation scale to a maximum value that is appropriate for a low sub-maximal contraction. Set the animation threshold in the middle of this scale. As the patient sustains a sub-maximal contraction and the EMG activity goes above the threshold, the fractal will fill in. As the patient releases the contraction and the EMG activity falls below its threshold the fractal will slowly open and a relaxing song is heard. The complete animation cycle takes approximately 20 seconds, 10 on each side of the threshold. This sample screen was provided by the Biofeedback Foundation of Europe; designed by Nancy Schully(p.9) M3 UFI - 1Ch Parrot Puzzle A simple display screen consisting of an animation and a linegraph. A sustained contraction of about 20 seconds above threshold removes the puzzle pieces. A release of the muscle activity of about the same duration below threshold fills in the puzzle and plays a relaxing song. This sample screen was provided by the Biofeedback Foundation of Europe; designed by Nancy Schully(p.9) M3 UFI - 1Ch Parrot Puzzle bargraph This screen consists of an animation and a bargraph. The animation cycle is approximately 40 seconds. A sustained contraction of about 20 seconds above threshold removes all the puzzle pieces. A sustained release/relaxation of about 20 seconds below threshold completes the puzzle, and rewards the patient with soft music. As soon as the signal goes below the threshold, soft music plays, but the pieces only start filling in after 3 seconds. This display can also be used for strengthening. MyoTrac 3 Continence Suite 35

36 M3 UFI - 1Ch Smiley A sustained contraction of about 3-4 seconds above threshold turns the smiley face into a frowning one and eliminates the music. Relaxing the muscle activity for about 3-4 seconds below threshold returns to a smiley face and plays a joyful song. M3 UFI - 2Ch line-filled graphs Channel A is the filled linegraph and channel B the single linegraph. Both signals change color when crossing the threshold. Soft music is heard when both channels are below threshold. If either channel moves above threshold the music stops. M3 UFI - 2Ch Relaxation Green light As channel A goes below the threshold notice the signal s colour changing, music playing, and the green light brightening. A counter linked to the blue linegraph represents the length of time channel A activity is staying below its threshold. If A crosses above the threshold the counter resets to 0 and the music stops This sample screen was provided by the Biofeedback Foundation of Europe; designed by Nancy Schully(p.9) M3 UFI - 2Ch Relaxation with DVD The DVD will play as long as both channels are below their threshold. If either goes above threshold the DVD pauses. This sample screen was provided by the Biofeedback Foundation of Europe; designed by Nancy Schully(p.9) MyoTrac 3 Continence Suite 36

37 Strengthening The strengthening screens described here are primarily used for reinforcing muscle contractions of channel A. Feedback is initiated when the signal crosses the threshold of the graph or scale displaying that signal. In order for the reward to be effective, the contraction must be sustained above the threshold for a period of time. Therefore, the threshold setting is not a goal in and of itself; the sustained contraction is the goal. Set the threshold such that it is attainable by the patient. For instance, 40% of the average of a 10 second contraction would be achievable. Most clinicians make a judgement call for each patient depending on how the person performed during their assessment from that session. In order for the muscle to improve its ability to sustain a contraction it must have time to rest and recover between contractions. However, open display screens do not have built-in cycles of work and rest; therefore, you must remember to cue the patient during a rest. Several of the strengthening screens have conditional requirements for both channels A and B. Typically, channel A must stay above its threshold and channel B must stay below for the reward to kick in. If one of the conditions is not met, then the reward is not provided or the animation is reset to the beginning of its cycle. (Note that some of the animation cycles are short and some of them are as long as 45 seconds). Even though both conditions must be maintained for the reward, a beginning patient with extremely poor muscle tone can utilize all of these open display screens. The variable in using these screens for well-conditioned muscle tone vs. extremely poor muscle tone is the scale of the animation and/or the threshold setting. M3 UFI - 1Ch Dolphin Puzzle A song will be heard immediately when the signal goes above the threshold setting on the bargraph. But, a sustained contraction of at least 3 seconds above threshold is required before pieces start to fill in the Dolphin puzzle. When the signal goes below threshold, the song stops as well as the animation. Both resume as soon as the signal goes above the threshold. Changing the scales on the bargraph will not impact the display; the threshold setting controls the display. MyoTrac 3 Continence Suite 37

38 M3 UFI - 1Ch Fractal 06 The fractal partially closes when the signal is above the threshold, and opens up and disappears when the signal is below. The complete animation cycle is about 40 seconds. Audio feedback is available both above and below the threshold. Above is a song, and below are birds. This sample screen was provided by the Biofeedback Foundation of Europe; designed by Nancy Schully(p.9) M3 UFI - 1Ch Jumping Car The car morphs to upbeat music when the signal is above the threshold. The music softens as the signal nears the orange line from above, and gets louder as the signal moves away. The car stops moving and a constant tone can be heard when the signal is below the threshold. This sample screen was provided by the Biofeedback Foundation of Europe; designed by Nancy Schully(p.9) M3 UFI - 1Ch Jumping Puppet The puppet s posture is dependent on the scale of the animation; therefore, the puppet is completely extended when the EMG is above the maximum scale setting. Try changing the upper scale of the animation as if it was a threshold. There is no audio feedback. This sample screen was provided by the Biofeedback Foundation of Europe; designed by Nancy Schully(p.9) M3 UFI - 2Ch Butterflies Butterflies and flowers appear to the sound of chirping birds when the signal goes above the threshold. But the butterflies and flowers disappear as a relaxing song plays when the signal goes below the threshold. The animation cycle is very short: about 3-4 seconds. This display can also be used for relaxing. MyoTrac 3 Continence Suite 38

39 M3 UFI - 2Ch Conditional DVD The DVD stays on when the Channel A signal is above its threshold and Channel B signal stays below. If either condition is not met the DVD stops playing. M3 UFI - 2Ch Drying Lake The water recedes and seagulls can be heard as channel A stays above the threshold and the channel B stays below. Both animation and sound stop when the Channel A falls below the threshold. The animation resets once the Channel B goes above the threshold. The animation can be reset manually and its cycle is about 20 seconds. M3 UFI - 2Ch Fading Mouse As Channel A stays above its threshold on the bargraph and Channel B stays below, the picture will focus. The counter will display the length of time this condition is being met. If Channel B exceeds its threshold the animation and the counter reset. This animation can be reset manually. There is no audio feedback on this display, and the animation cycle is about 47 seconds. M3 UFI - 2Ch Filled linegraph The audio feedback is conditional to both channels of EMG. Music will play when Channel A is above its threshold and Channel B is below. If B exceeds its threshold the music stops. Also notice the color changes on the graphs as the signal crosses threshold. Open display: M3 od UFI - 2Ch Filled linegraph MyoTrac 3 Continence Suite 39

40 M3 UFI - 2Ch filled linegraphs The audio feedback is a midi splitter musical piece. Each channel represents different parts of the musical piece. When Channel A is above its threshold and Channel B is below its threshold both parts are heard. When both channels are out of condition the song stops playing. If either condition is not met only one part is heard. M3 UFI - 2Ch Flower Explosion The animation is conditional to both channels. As Channel A stays above its threshold and Channel B stays below the flower explodes. A counter represents the length of time A is above and B is below. If Channel A falls below its threshold the cycle is suspended. If Channel B exceeds its threshold the flower and the counter reset to the beginning. The complete animation cycle is about 30 seconds. M3 UFI - 2Ch Hero Morph-fast The animation represents Channel A and is dependent on the scale on the left. The boy morphs into a superman when Channel A s signal is toward the upper range of the scale. As the signal comes down the scale, the superman returns to a boy. No audio feedback. M3 UFI - 2Ch Hero Morph-slow The animation is connected to Channel A and is threshold dependent. Once the signal goes above its threshold the boy slowly morphs into a superman. The complete animation cycle is about14 seconds. There is an audio tone heard when the signal is above threshold. If Channel B exceeds its threshold the animation resets to the beginning. The animation can also be reset manually. MyoTrac 3 Continence Suite 40

41 M3 UFI - 2Ch Turtle The picture of a turtle will slowly zoom in when Channel A is above its threshold and B is below. The picture will freeze if A falls below its threshold. Both picture and counter will reset if Channel B exceeds its threshold. The counter maintains the length of time these conditions are met. The complete animation cycle takes about 24 seconds. Training After the patient has gained some muscle control they can test their newly developed skill with more difficult screens. The first few displays provide different exercises involving contractions and releases using various animations. A couple of screens deal with sustaining release below resting levels. The remaining screens have simple templates that the patient can follow. The templates shown are for one cycle and only go up as high as 10µV. Also, in an open display recording these guides will go on continuously until the session is stopped. When the patient reaches the lowest level of the template allow them to go lower if they can. For more complicated templates and suggestions on how to train with them see Templates and Template Training below, p.55. M3 UFI - 2Ch Animal game An exercise to control muscle contraction by lining up the cartoon man with the animal as shown in the blue square while the line-up of animals constantly changes. Channel A is connected to the animation. The stronger the contraction the further the man moves to the right, and to keep the man moving the signal from channel B should remain below its threshold. Adjusting the maximum scale setting on the animation can make the game easier or more difficult. The higher the scale setting the stronger the contraction must be to move the man to the far right. See Adjusting Scales and Thresholds, p.27. MyoTrac 3 Continence Suite 41

42 M3 UFI - 2Ch Car race The aim is to make the blue car of channel A pass the finish line (the white bar on the far right of each track) before the yellow car of channel B. To meet this goal, A must stay above its threshold while B stays below. The points for A increment when both channels are in condition, and the points for B increment when B is above threshold. M3 UFI - 2Ch Green light This display focuses on training the muscle of channel A to go below its resting level so as to reinforce the notion of release. With practice, the patient learns how to reverse a muscle spasm towards a sustained release of a relaxed muscle. As channel A goes below threshold, the green light turns on. The points represent the length of time the signal stays below the threshold (assuming resting levels are about 2µV). Channel B linegraph does not influence the animation, but simply to monitor accessory muscles. M3 UFI - 2Ch Growing Sphere Channel A controls the ball. Relaxing the muscle enlarges the ball and contracting it shrinks the ball. Like the screen M3 UFI 2Ch Green light, this one can also be used to maintain release below resting levels. Channel B changes colour when it passes the threshold. Adjusting the maximum scale setting on the animation can make the task easier or more difficult. See Adjusting Scales and Thresholds, p.27. This sample screen was provided by the Biofeedback Foundation of Europe; designed by Nancy Schully(p.9) M3 UFI - 2Ch Maze To complete the maze the muscle of channel A must be contracted enough for the dot to reach the center. The animation stops when channel B goes above threshold. Adjusting the maximum scale setting on the animation can make the task easier or more difficult. The higher the scale setting the stronger the contraction must be to complete the maze. See Adjusting Scales and Thresholds, p.27. MyoTrac 3 Continence Suite 42

43 M3 UFI - 2Ch template03 Open display: M3 od UFI - 2Ch template03 This sample screen was provided by the Biofeedback Foundation of Europe; designed by Nancy Schully(p.9) M3 UFI - 2Ch template04 Open display: M3 od UFI - 2Ch template04 This sample screen was provided by the Biofeedback Foundation of Europe; designed by Nancy Schully(p.9) M3 UFI - 2Ch template05 Open display: M3 od UFI - 2Ch template05 This sample screen was provided by the Biofeedback Foundation of Europe; designed by Nancy Schully(p.9) M3 UFI - 2Ch template06 Open display: M3 od UFI - 2Ch template06 This sample screen was provided by the Biofeedback Foundation of Europe; designed by Nancy Schully(p.9) MyoTrac 3 Continence Suite 43

44 M3 UFI - 2Ch template07 Open display: M3 od UFI - 2Ch template07 This sample screen was provided by the Biofeedback Foundation of Europe; designed by Nancy Schully(p.9) M3 UFI - 2Ch template08 Open display: M3 od UFI - 2Ch template08 This sample screen was provided by the Biofeedback Foundation of Europe; designed by Nancy Schully(p.9) M3 UFI - 2Ch template09 Open display: M3 od UFI - 2Ch template09 This sample screen was provided by the Biofeedback Foundation of Europe; designed by Nancy Schully(p.9) M3 UFI - 2Ch template10 Open display: M3 od UFI - 2Ch template10 This sample screen was provided by the Biofeedback Foundation of Europe; designed by Nancy Schully(p.9) MyoTrac 3 Continence Suite 44

45 M3 UFI - 2Ch template11 Open display: M3 od UFI - 2Ch template11 This sample screen was provided by the Biofeedback Foundation of Europe; designed by Nancy Schully(p.9) M3 UFI - 2Ch template12 Open display: M3 od UFI - 2Ch template12 This sample screen was provided by the Biofeedback Foundation of Europe; designed by Nancy Schully(p.9) M3 UFI - 2Ch template13 Open display: M3 od UFI - 2Ch template13 This sample screen was provided by the Biofeedback Foundation of Europe; designed by Nancy Schully(p.9) M3 UFI - 2Ch template14 The exercise to be performed is start with 4 seconds of rest. then 4 to 5 seconds of work followed by 3 seconds of rest repeat the work and rest 2 more times then end with 10 to 20 seconds of rest. This template is set to cycle only once during an open display recording as well as during replay. Open display: M3 od UFI - 2Ch template14 This sample screen was provided by the Biofeedback Foundation of Europe; designed by Nancy Schully(p.9) MyoTrac 3 Continence Suite 45

46 SCRIPTS Scripts allow the development of predefined protocols that provide clinicians the ability to group together varied types of activities with specific display screens. The results are a set statistics that can be trended across sessions reflecting patient progress and can help determine the type of exercise and/or practice that is needed by that patient. The first two are general scripts for pelvic muscle dysfunction: one is an assessment and the other a work-rest exercise. The next set is a series of work-rest and training scripts focusing on perineal reeducation. These work-rest scripts provide short exercise sessions with simple templates. The training scripts are longer sessions with complex templates and they can be used in the design of a treatment program. Although the screens featured in this section are used for scripts, they can also be used in open display sessions. For simplicity, only the screen that characterizes the script will be shown. In the case of the perineal training scripts, only the screen for its Level 1 is shown (see Templates and Template Training, p.55). Pelvic Muscle Dysfunction Assessment Script There are many types of biofeedback assessments for the pelvic muscles and are typically dependent upon the type of incontinence and or muscle dysfunction the patient presents. One of the scripts included within the Continence Suite is M3 PMD Assessment 5 Activities. This is a basic assessment protocol that allows the clinician an objective measurement of pelvic muscle function and progress. The 5-activity assessment looks at the Resting Level of the Pelvic Muscles before and after a series of exercises. The purpose is to see the statistical mean of the resting levels of both channels A and B. The assessment also includes exercises for Quick Contractions, Contract & Hold and Endurance. Each type of exercise results in a different outcome that is then utilized to determine what type of exercise is needed for that day s session and how to best individualize the various open display screens for that patient. For instance, the resting level mean obviously is used as a guide for establishing the threshold value for relaxation type open display screen exercises. During the Quick Contraction exercise, the maximum value is representing a value that would be appropriate to set the y-axis maximum scales on either the animation or graph displays. Contract & Hold s result in a mean value for both the work cycle and rest cycle that can then help to calculate the 40% upper threshold setting on strengthening open display screens. And finally the mean value on channel A from the endurance can provide you with a sub-maximal threshold value. As mentioned the script is divided into 5 activities: 1. Pre-baseline; divided into 3 steps: a. Verify signal: take the time to make sure the sensor and cables are connected properly. No data is recorded. Pressing any key on your keyboard allows you to advance to the next step. b. Read instructions: gives you an overview of what to expect; no data is recorded; press any key when you are done. c. Pre-baseline: relax muscles to determine initial resting level. Duration is 60 seconds. Statistics calculated: mean and median frequency for both channels 2. Quick contractions; divided into 2 steps and repeats 3 times: MyoTrac 3 Continence Suite 46

47 a. Relax: duration is 4 seconds. Statistics calculated: mean and median frequency for both channels. b. Quick contractions: contract quickly 1 to 3 times during 6 seconds. Statistics calculated: maximum for both channels and median frequency for A. 3. Contract and hold; divided into 2 steps and repeats 3 times: a. Relax: duration is 10 seconds. b. Contract and hold: maintain contraction for 10 seconds. Statistics calculated: mean for both channels, and maximum and median frequency for A. 4. Endurance; divided into 2 steps: a. Relax: duration is 5 seconds b. Contract and hold: maintain contraction for 20 seconds. Statistics calculated: mean for both channels, and median frequency for A. 5. Post Baseline: relax muscles to determine new resting levels; duration is 60 seconds. Statistics calculated: the same as activity 4. 1a. Verify signal 1b. Instructions 1c. Pre-baseline 2a,b. Relax, Quick contractions 3a,b. Relax, Contrac and hold 4a,b. Relax, Sustain contraction 5. Post baseline MyoTrac 3 Continence Suite 47

48 This sample script was provided by the Biofeedback Foundation of Europe; designed by Nancy Schully(p.9). Pelvic Muscle Dysfunction Work-Rest Script The script is divided into 3 activities: 1. Pre-baseline; divided into 3 steps: a. Verify signal: take the time to make sure the sensor and cables are connected properly. No data is recorded. Pressing any key on your keyboard allows you to advance to the next activity. b. Read instructions: gives you an overview of what to expect; no data is recorded; press any key when you are done. c. Pre-baseline: relax muscles to determine initial resting level. Duration is 60 seconds. 2. Rest-work cyle: divided into 2 steps and repeated 10 times: a. Rest: relax muscles for 10 seconds. b. Work: contract and hold for 10 seconds. 3. Post baseline: relax muscles to determine new resting levels; duration is 60 seconds. Statistics calculated for parts 1c, 2a, 2b and 3: mean and median frequency for both channels. 1a. Verify signal 1b. Instructions 1c. Pre-baseline 2. Rest-Work 3. Post basline This sample script was provided by the Biofeedback Foundation of Europe; designed by Nancy Schully(p.9). MyoTrac 3 Continence Suite 48

49 Perineal Work-Rest Scripts Each script is made up of 3 activities: 1. Pre-baseline; divided into 2 steps: a. Verify signal: take the time to make sure the sensor and cables are connected properly. No data is recorded. Pressing any key on your keyboard allows you to advance to the next activity. b. Pre-Baseline: relax muscles to determine initial resting level. Duration is 15 seconds. 2. Work-Rest: template exercise starting with a contraction then a relaxation cycling 5 times. Duration depends on the work and rest parts. 3. Post-Baseline: relax muscles to determine new resting level. Duration is 15 seconds. Statistics calculated by default for parts 1b, 2 and 3: maximum, minimum, mean, standard deviation, and variability for both channels. 1a. Verify Signal 1b. Pre-Baseline 2. Work-Rest 3. Post Baseline The displays shown below are under the category of Perineal Reeducation. As well, listed beside them are theirs names, the scripts that use them, the duration of each work and rest part, their Open Display screen names, and the maximum height of their templates. Also, their templates have 5 cycles of work and rest. MyoTrac 3 Continence Suite 49