12 Bio feedback.ppt

1、Pelvic Muscle Retraining,Biofeedback,Pelvic Muscle Biofeedback,The word Biofeedback comes from 2 words. Biological (pertaining to the body) Feedback (giving back information) It is an instrument assisted process that feeds back actions of the pelvic muscles. EMG feedback Pressure feedback,Pelvic Mus

2、cle Retraining Goal,Correct defect seen on manometry or EMG study,Pelvic Muscle Retraining,Three types of pelvic muscle training Strengthening Exercises Rectal Sensory Training Straining (Valsalva) Training,BiofeedbackPatient Selection,Prerequisites: Motivation Ability to process instructions Abilit

3、y to contract sphincter Adequate sensation(detect40 cc) Motivated healthcare provider,BiofeedbackPatient Selection,Poor candidates Sphincter defect ? severe neurogenic incontinence Non-compliant patients,Procedure OverviewIdentify Defect,Manometry EMG,Low Resting Pressure,Low Voluntary Squeeze Press

4、ures,Diminished Rectal Sensation,Paradoxical Response to Straining,Procedural OverviewBaseline Assessment,Diet diary fluid intake fiber intake milk products,Procedural OverviewBaseline Assessment,Stool diary,Procedural OverviewBaseline Assessment,Quality of Life,Procedural OverviewBaseline Assessmen

5、t,Patient Education Anatomy/Pathophysiology,Anatomy Anus/Rectum,Anorectal Angle,Dynamics of the Anorectal Angle,Anorectal Angle in Action,Procedural OverviewPatient Education,Pelvic muscle response show patient example of normal vs abnormal (pts),Procedural OverviewPatient Education,Protocol learn e

6、xercises 3-6 sessions perform exercises at home Expectations perform exercises daily return on scheduled visits,Pelvic Muscle Retraining ProtocolStrengthening Exercises,GOAL Strengthen pelvic muscles Improve resting and squeeze pressure Improve the ability to recruit muscles more quickly Increase aw

7、areness of pelvic muscles,Pelvic Muscle Retraining ProtocolStrengthening Exercises,Identify defect Baseline Assessment Patient Education Guide patient to identify pelvic muscle contract, squeeze, tighten, draw up pressure/activity waveform will go up,Pelvic Muscle Retraining ProtocolStrengthening Ex

8、ercises,Guide/coach pt. to contract pelvic muscle correctly do not use abd. muscles attempt to reach threshold hold for designated amt. of time rest for a count of 10 between,Pelvic Muscle Retraining ProtocolStrengthening Exercises,Instruct how to perform at home written instructions 5 sets of 20 sq

9、ueezes/day sitting, recumbant, standing Return in 3-7 days Stool diary Tapes Home trainer,Pelvic Muscle Retraining ProtocolStrengthening Exercises,Repeat Sessions Review diary Assess compliance with exercises Assess improvement in squeeze EMG or pressure strength and duration Assess performing corre

10、ctly Reinforce exercise technique increasing threshold and duration,Baseline EMG,EMG after 1 bfdb session,After 4 sessions,EMG after 6 Sessions,Pelvic Muscle Retraining ProtocolRectal Sensory Training,GOAL To decrease the patients sensory threshold by resensitizing patient to smaller volumes of rect

11、al distension Improve pelvic muscle awareness, recruitment and strength with strengthening exercises,Pelvic Muscle Retraining ProtocolRectal Sensory Training,Strengthening Exercises Identify pelvic muscles To contract pelvic muscles when senses rectal distension To strengthen squeeze,Pelvic Muscle R

12、etraining ProtocolRectal Sensory Training,Inflate balloon in rectum with a volume pt. can sense Repeat several times to reinforce sensation Decrease volumes in increments of 5 ml Repeat each volume until quick response of sensation,Pelvic Muscle Retraining ProtocolRectal Sensory Training,Home Instru

13、ctions Pelvic strengthening exercises Aware of rectal filling squeeze when feels sensation Stool diary Return 3-7 days,Pelvic Muscle Retraining ProtocolRectal Sensory Training,Repeat Sessions Assessment of symptoms Compliance with exercises Rectal inflations with decreasing increments to lower sensa

14、tion threshold assess if contracting EAS with each inflation,Pelvic Muscle Retraining ProtocolValsalva Training,GOAL To decrease pelvic muscle activity or pressure when patient attempts to strain (valsalva), thereby eliminating the inappropriate response of contracting the pelvic muscles. Improve aw

15、areness of pelvic muscles with strengthening exercises,Pelvic Muscle Retraining ProtocolValsalva Training,Identify inappropriate muscle response Baseline information stool diary diet diary Patient education,Pelvic Muscle Retraining ProtocolValsalva Training,Pelvic strengthening exercises Improve awa

16、reness of pelvic muscles Strengthen muscle Pushing to decrease activity/pressure of EAS and puborectalis coach pt. to try different techniques to decrease activity/pressure blow out squeeze then relax and push,Pelvic Muscle Retraining ProtocolValsalva Training,Exercise technique rest/squeeze/push pr

17、ogress to rest/push feet flat on floor lean forward,Pelvic Muscle Retraining ProtocolValsalva Training,Home Instructions Bowel habit training Proper sitting position Home trainers Diet diary x3 days Stool diary Return in 3-7 days,Pelvic Muscle Retraining ProtocolValsalva Training,Repeat Sessions Ass

18、ess diaries Assess compliance Perform straining maneuvar to determine progress Continue coaching exercises,Baseline EMG,EMG after 1 bfdb session,Bowel Training,GOAL To train the bowel to pass stool every day by taking advantage of the gastric colic reflex and getting the patient and bowel into a rou

19、tine to promote defecation.,INCONTINENCE,Poor EAS contraction,in response to rectal,distension,Weak Pelvic Muscles,Weak Voluntary,Squeeze,Diminished Rectal,Sensation,Loose,Stool,Pelvic Muscle,Strengthening,Training,Pelvic Muscle,Strengthening,Training,Rectal Sensory,Training,EAS Coordination,Training,Pelvic Muscle,Strengthening,Training,Correct with,Medicati