Biofeedback therapy in pelvic floor disorders

1. Biofeedback therapy in pelvic floor disorders Roxana Bazaz Behbahani MsC.Physiotherapy

2. What is Pelvic Floor Biofeedback Therapy? • Pelvic floor biofeedback therapy is a type of physical therapy that can help men and women to learn how to contract and relax the pelvic floor muscles. • It can be useful for patients who have bladder or bowel incontinence, slow urination caused by abnormal pelvic muscle contraction,and pelvic floor dysfunction. • Patients usually spend 3 sessions a week for 1-2 months with a therapist who is specially trained in pelvic floor therapy.

3. How does pelvic floor biofeedback therapy work? • Pelvic floor biofeedback therapy works by training the brain and pelvic muscles to work together to tighten and relax the pelvic floor muscles. • Sensors in the vagina or rectum measure the contraction and relaxation of the muscles and patients get visual cues on a computer monitor so that they can learn to better use these muscles. • In many cases women have tried “Kegel” exercises to strengthen the pelvic muscles without success, but they have not been contracting the proper muscles or they have been contracting them in an improper manner. Many of these women will have more improvement following pelvic floor biofeedback therapy.

4. Biofeedback tools in pelvic floor muscle training • Sensory biofeedback • Pressure biofeedback • Cyctometric and urodynamic • Ultrasonic • Electromyographic

5. Sensory biofeedback • Digital palpation • Vaginal cones

6. Pressure biofeedback • Perineometry

7. Ultrasonic biofeedback • Trans abdominal ultrasonography

8. Electromyographic biofeedback

9. Electromyographic biofeedback • Biofeedback units generally provide either visual or auditory feedback relative to the quantity of electrical activity • Visual feedback uses lights, bars, or analogue or digital meters • Auditory feedback uses increasing or decreasing tones, buzzing, beeping or clicking

10. SEMG artifacts Line interference (50/60Hz noise) EKG Artifacts Movement artifacts

11. SEMG signal analysis • Baseline or resting level: the level of SEMG when the muscle is totally relaxed. It is generally accepted that the SEMG of a muscle at rest should be below 5μV. • Averaged contraction (mean of SEMG during contraction): this is a good indicator of the level of muscle strength and endurance (while performing an isometric contraction). • Peak or maximum: this is the maximum SEMG amplitude the muscle can generate. • Variability: is a good indicator of the neuromuscular stability.

12. SEMG signal analysis

13. SEMG recording of a healthy muscle. Resting level is low onset and release are quick and the contraction is high

14. SEMG unhealthy muscle The resting level is too high The level of contraction is very low The muscle shows instability