PATHWAY™ CTS 2000 CONTINENCE EVALUATION and TRAINING SYSTEM OPERATOR’S GUIDE
Copyright © 2002 The Prometheus Group One Washington Street, Suite 303 Dover, New Hampshire 03820
FOR ASSISTANCE, CALL YOUR LOCAL SALES REPRESENTATIVE, DISTRIBUTOR, OR THE PROMETHEUS GROUP AT 800.442.2325 IN THE U.S. AND CANADA OR 603.749.0733 INTERNATIONAL. FOR TELEPHONE TECHNICAL SUPPORT CALL 800.272.8492 IN THE U.S. AND CANADA OR 603.742.6053 INTERNATIONAL. WEBSITE: www.theprogrp.com E-MAIL: [email protected]
CONTENTS Pathway™ CTS 2000 Continence Evaluation and Training System Equipment and Accessories Include: One Pathway™ CTS 2000 Module consisting of one channel of vaginal or rectal intracavity EMG or external pelvic muscle EMG, one channel of accessory muscle EMG, one channel of vaginal or rectal intracavity Electrical Stimulation and two channels of vaginal or rectal intracavity Pressure Manometry; One Active Matrix Color Notebook or SVGA Color Desktop Computer System with Color Inkjet Printer; One #2583 Pathway™ Preamplifier; Four packets of #6750 Pathway™ Electrodes; Four packets of #6801 Easytrode™ Pregelled Electrodes; One #5338 6’ Electrode Lead Wire Set; Four #6330 Pathway™ Vaginal EMG/Stimulation Sensors; Two #6340 Pathway™ Rectal EMG/Stimulation Sensors; Two #6420 Pathway™ Vaginal Silicon Pressure Sensors; Two #6425 Pathway™Rectal Silicon Pressure Sensors; One #8402 Computer Serial Interface Cable, One Synergy™ 3-Dimensional Software Program; Ten #4102 Patient Information Handouts; Ten #4632 3-Day Bladder Control Diaries; Operator’s Guides.
Pathway™ and Synergy™ are trademarks of The Prometheus Group. The Pathway™ CTS 2000, Synergy™ 3-Dimensional Software and this manual are Copyright © 2002, The Prometheus Group.
INDICATIONS FOR USE: * Urinary Incontinence : Stress, Urge and Mixed Incontinence * Neuromuscular Reeducation CONTRA-INDICATIONS * Active Infection or Genital Disease * Severe Pelvic Pain * Pregnancy * Postpartum or Post Surgical (6 weeks) * Atrophic Vaginitis * Dyspareunia * Menstrual Period * Pacemaker or Cardiac Arrhythmia * Presence of Any Known Malignancy * History of Severe Urine Retention * Prolapse * Diminished sensory perception Caution: Federal law (USA) restricts this device to sale by or on the order of a licensed medical practitioner, licensed by law in the state in which they practice. Caution: Federal law (USA) restricts this device to sale by or on the order of a physician when used for the treatment of incontinence. Caution: Use only electrodes from The Prometheus Group with your Pathway™ EMG device. Any other electrode may not be compatible with the Pathway™ device. Warnings: • Be sure to read this operator's guide before using this device. • Do not put this device underwater or get device wet. It could damage the device. • Do not connect any preamp, lead wire, or electrode to a wall outlet. • Do not leave electrodes attached when device is not in use. • Do not use while sleeping. • Do not use during intercourse. • Do not use with any other object in vagina or rectum. • Do not keep electrode in vagina or rectum for extended periods. • Never operate machinery including automobiles during stimulation. • Discontinue use if bleeding develops. Precautions: • The Pathway™ CTS-2000 should only be used with Pathway™ perineometer sensors. • Be sure stimulation is off while inserting or removing electrodes. Adverse effects • Skin irritation beneath or around electrode sites may develop. 3
TABLE OF CONTENTS PHYSICAL
Front Panel Back Panel
Intracavity #6330 Pathway™ Vaginal EMG/Stimulation Sensor and #6340 Pathway™ Rectal EMG/Stimulation Sensor External pelvic EMG or accessory muscle EMG #5338 6’ Electrode Lead Wire Set Accessory EMG channel. Input for the #2583 Pathway™ Preamplifier Intracavity #6420 Pathway™ Vaginal Silicon Pressure Sensor and #6425 Pathway™ Rectal Silicon Pressure Sensor
8 8 9 10
Start-up Windows Icon Opening Screen EXIT to Windows Icon UTILITIES Button COM Ports RealTime Mode START HERE Button EXIT TO MAIN MENU EDIT PATIENT ADD PATIENT Patient Demographic Information INTAKE QUESTIONNAIRE BLADDER CONTROL DIARY Application Protocols PAUSE RESET MODIFY PROTOCOL Screens Channels Display Type Templates Animations Timing 3D Goals On-Line Statistics Ranges Colors Names Stim Menu
11 11 12 12 13 13 13 14 14 15 16 16 17 18 19-22 23 23 23 24 25-26 26-27 27 27-28 28-29 29 29-31 31 31-32 32 32 33-34
CLICK HERE WHEN FINISHED MODIFYING PROTOCOL Save Protocol Patient Protocol Show Patient Protocols Delete Protocol File Create Link Protocol START COLLECTING DATA EXIT TO MAIN MENU REPORTS/REPLAY Button Choose a PATIENT Delete Highlighted Patient Patient Saved Sessions Delete Session Compare Sessions REPORTS Graph Types Summary Session Statistics Detailed Session Statistics Insertions and Attachments Insertions Page Header Demographic Information Notes, Interpretations, Rx Attachments Intake Questionnaire Bladder Diary Home Program HIDE MENU Command Line Print Print Preview MR and TR Series Download View the MR and TR Series Downloaded Data Delete the MR and TR Series Downloaded Data Filename View the Reports Menu Exit and Return to Opening Screen ZOOM Undo Zooming Expand Vertically and Compress Vertically Add a Marker Delete a Marker MARKER Adjust Mode REPLAY TECHNICAL SPECIFICATIONS
34-36 35 35-36 36 36 36-38 38-39 39 40-41 42 43 43 43 43-44 45 46 46-47 47 47-48 48 48-49 49 49-50 50 50 50-51 51 51 51 51 52 52 52 52 52 52 52-53 53 53 53 53 53 53 54
PHYSICAL The Front Panel
EMG A/STIM Primary EMG channel and Stimulation channel. Input for the intracavity #6330 Pathway™ Vaginal EMG/Stimulation Sensor, the intracavity #6340 Pathway™ Rectal EMG/Stimulation Sensor or the external pelvic muscle EMG and accessory muscle EMG #5338 6’ Electrode Lead Wire Set. EMG B Accessory muscle EMG channel. Input for #2583 Pathway™ Preamplifier. PRESSURE C Primary Pressure Manometry channel. Input for the intracavity #6420 Pathway™ Vaginal Silicon Pressure Sensor or the intracavity #6425 Pathway™ Rectal Silicon Pressure Sensor. PRESSURE D Secondary Pressure Manometry channel. Input for the intracavity #6420 Pathway™ Vaginal Silicon Pressure Sensor or the intracavity #6425 Pathway™ Rectal Silicon Pressure Sensor. L.E.D. POWER INDICATOR Indicates whether the Pathway™ CTS 2000 power is on or off. Power must be on (L.E.D. illuminated) to operate the Pathway™ CTS 2000. 6
The Back Panel
COMPUTER INTERFACE Interfaces the Pathway™ CTS 2000 to the laptop or desktop computer using the #8402 Computer Serial Interface Cable. The male end of the cable is connected to the Pathway™ CTS 2000 and the female end to the computer. Connect the female end to the 9 pin male output in the back of the computer. This output is labeled Serial, Com or 10101 on the computer. POWER OUTPUT Connects the Pathway™ CTS 2000 to a standard 110V power wall outlet. CAUTION: USE ONLY THE PATHWAYTM POWER TRANSFORMER SUPPLIED WITH THIS UNIT. POWER ON/OFF SWITCH Turns the power on and off to the Pathway™ CTS 2000. Power on is represented by the top portion of the switch depressed with the L.E.D. illuminated on the front panel.
MECHANICAL Intracavity #6330 Pathway™ Vaginal EMG/Stimulation Sensor and #6340 Pathway™ Rectal EMG/Stimulation Sensor.
Refer to the instructions for use enclosed with each sealed sensor bag. Make certain the jack is pushed fully into the EMG A/STIM channel. External pelvic EMG or accessory EMG #5338 6’ Electrode Lead Wire Set.
Snap the two white and one green lead wires onto the #6801 Easytrode™ Pregelled Electrodes. Remove the #6801 Easytrode™ Pregelled Electrodes individually. For external pelvic muscle, place the two white (active) lead wires at the 3 and 9 o’clock positions around the anus. Place the green (reference) lead wire over the ischial tuperosity or buttocks muscle. For accessory muscles such as abdominals, adductors and gluteals, prepare the skin with an alcohol pad to avoid high impedance artifact and wipe dry with a tissue or cloth. Place the two white lead
wires side-by-side over the bulk of the muscle. Place the green lead wire above or below the two white wires. Make certain the jack is pushed fully into the EMG A/STIM channel. Accessory EMG channel. Input for the #2583 Pathway™ Preamplifier.
Accessory muscles such as abdominals, leg adductors and gluteals are commonly monitored by placing the active electrodes over the bulk of the muscle. The #2583 Pathway™ Preamplifier has three female snaps; two labeled ACT (active) and one labeled GND (ground). Prepare the skin with an alcohol pad to avoid high impedance artifact. Wipe dry with a tissue or cloth. Snap the #2583 Pathway™ Preamplifier onto one of the #6750 Pathway™ Electrodes taking care to orient the snaps correctly. Make sure all three snaps are secure. Carefully remove the backing of the #6750 Pathway™ Electrode and place the two labeled ACT over the bulk of the muscle with the length of the electrode parallel with the muscle fibers. Make sure the plug is seated fully into EMG B.
Intracavity #6420 Pathway™ Vaginal Silicon Pressure Sensor and #6425 Pathway™ Rectal Silicon Pressure Sensor.
Refer to the instructions for use enclosed with each sealed sensor bag. After insertion, inflate the sensor by using the pressure syringe provided. Open the syringe valve fully and then twist the syringe clockwise onto the end of the sensor tube. Depress the syringe valve until the #6420 Pathway™ Vaginal Silicon Pressure Sensor is filled with 5ml of air or the #6425 Pathway™ Rectal Silicon Pressure Sensor is filled with 3ml of air. Rotate the syringe counterclockwise to unseat and rotate the end of the sensor tube clockwise into PRESSURE C or PRESSURE D. Make sure the fitting is secure so that there is an air-tight seal.
OPERATING THE PATHWAY™ CTS 2000 CONTINENCE EVALUATION and TRAINING SYSTEM Interface the Pathway™ CTS 2000 and computer as described in the PHYSICAL section. For tutorial purposes, plug the #5338 6’ Electrode Lead Wire Set into EMG A/STIM, the #2583 Pathway™ Preamplifier into EMG B, and a properly inflated #6420 Pathway™ Vaginal Silicon Pressure Sensor or #6425 Pathway™ Rectal Silicon Pressure Sensor into PRESSURE C. Prepare the skin of the left and right forearm flexor area and, using the #6801 Easytrode™ Pregelled Electrodes and the #6750 Pathway™ Electrodes, place EMG A/STIM on the left forearm and EMG B on the right. Power the Pathway™ CTS 2000 and the computer (if a laptop, wall power is preferred over battery power for longer time usage). Once the computer has completed its start-up procedures and the Windows Icon screen appears use the mouse or mouse keypad to position the mouse arrow on the Synergy 3-D Icon and double click the left mouse button.
The Boot-Up or Opening screen consists of the Synergy™ 3-Dimensional Software and The Prometheus Group™ logos with four Main Menu buttons in the lower left portion of the screen (EXIT, UTILITIES, START HERE, REPORTS/REPLAY). The computer specifications and recommendations, software version, Technical Support phone number, company website and e-mail, are located in the lower right portion of the screen. Every thirty days the Pathway™ CTS 2000 performs an automatic system check and calibration. Any malfunction will be documented in the lower right portion of the screen. Call the Technical Assistance number on the screen.
The EXIT button allows you to leave the Synergy™ 3-Dimensional Software program and return to the Windows Icon screen by positioning the mouse arrow on the EXIT button and clicking once on the left mouse button.
Position the mouse arrow on the UTILITIES button and single click the left mouse button.
The Pathway™ CTS 2000 is preset to the correct COM Port (usually COM 1) for each computer configuration and the RealTime Mode is preset to Live Data. Live Data means that you are acquiring and displaying the patient’s EMG, Pressure or Stimulation signals. The RealTime Mode also has a Demo option. Demo means that the Synergy™ 3-Dimensional Software automatically displays a preprogrammed or “dummy” signal. The Demo option is quite useful as an aid to learn the software without patient involvement. Stimulation menus and stimulation protocols (single or linked) cannot be accessed or run in the Demo mode. To change from Live Data to Demo simply place the mouse arrow inside the circle next to Demo and single click the left mouse button. To accept this change place the mouse arrow inside the OK button and single click the left mouse button. To NOT accept use the Cancel button in the same manner. The Transfer Patient Files button allows patient data files to be transferred from another file directory to this program. Access this option by placing the mouse arrow inside the Transfer Patient Files button and single click the left mouse button. A prompt will then appear asking for the drive location and filename of the patient data files. The Manual Calibration button performs the system check and calibration at any time. For purposes of this tutorial and to make full use of system capabilities, the Live Data option will be used. Select Live Data and click on OK. 13
Position the mouse arrow on the START HERE button and single click the left mouse button.
The RealTime screen is used to acquire and display patient signals or “dummy” signals using embedded or modified protocols and to add or edit patient information. Note that most buttons and headers on this screen are currently “grayed out” (not active) while the EXIT TO MAIN MENU button, Patients: header with the pull-down list, ADD PATIENT button and EDIT PATIENT button are bold (active). This is to establish a hierarchy and guide to the menu structure by only activating certain headers and buttons when access is required.
If you place the mouse arrow in the EXIT TO MAIN MENU button and single click the left mouse button you will return to the Boot-Up or Opening screen.
Place the mouse arrow on the down arrow button under the Patients: header and single click the left mouse button. Notice this activates a pull-down list with a fictitious patient named Jane Doe. Place the mouse arrow on Jane Doe (Doe; Jane) and single click the left mouse button. This is the method by which you would select an existing patient from the Patients: pull-down list to either EDIT PATIENT information or acquire and display patient signals. Note that selecting an existing patient activates the Application Protocols: header with pull-down list and the Show Patient Protocols button to select a Protocol for signal acquisition and display.
To add a new patient to the Patients: pull-down list, place the mouse arrow on the ADD PATIENT button and single click the left mouse button. This will activate the Patient Demographic Information page.
The first and last name of the new patient are the only required entries for addition to the pull-down list. Use the tab key on the keyboard to advance the cursor to a new field. For purposes of this tutorial add the minimum of a real or fictitious patient name.
Note two additional patient information options on this page: INTAKE QUESTIONNAIRE and BLADDER CONTROL DIARY. Place the mouse arrow on the INTAKE QUESTIONNAIRE button and single click the left mouse button.
The INTAKE QUESTIONNARIE consists of five pages of multiple choice and fill-in questions. This questionnaire is an excellent tool for profiling the patient’s incontinence history. To make a multiple choice selection place the mouse arrow inside the circle next to your choice and single click the left mouse button. To correct an incorrect choice simply click on the correct choice. For check-off boxes place the mouse arrow inside the box and single click the left mouse button on the appropriate box or boxes. To correct an incorrect choice click on the incorrect choice. For fill-in questions place the mouse arrow inside the fill-in area and single click the left mouse button. This will activate a cursor and allow you to type in the entry. Use the Backspace button on the keyboard to erase the entry in case of error. To activate the next page place the mouse arrow inside the NEXT button and single click the left mouse button. To activate previous pages use the BACK button. Once complete click on the SAVE AND EXIT button. The INTAKE QUESTIONNAIRE will be saved under the patient’s name and can be viewed and printed as a single document or as part of an integrated report by accessing the REPLAY/REPORTS button on the Boot-Up or Opening screen.
From the Patient Demographic Information page position the mouse arrow on the BLADDER CONTROL DIARY button and single click the left mouse button.
Fill in or correct the choices in the same manner as the Intake Questionnaire. The BLADDER CONTROL DIARY is based on the results of The Prometheus Group’s 3 Day Bladder Control Diary patient handout. Once completed, click on the SAVE AND EXIT button. Multiple BLADDER CONTROL DIARIES can be stored under the patient’s name and can be viewed, compared (up to three) and printed as a single document or as part of an integrated report by accessing the REPLAY/REPORTS button on the Boot-Up or Opening screen. From the Patient Demographic Information page click on OK. This will return you to the RealTime screen with the newly added patient’s name in the pull-down list box. Now clicking on the down arrow under the Patients: header reveals Doe; Jane and the newly added patient. NOTES: 1) No more than one patient can appear in the pull-down list box after you have selected a patient. This protects patient privacy. 2) If you acquire an extensive patient list, type in the first letter of the patient’s last name in the box, click the down arrow under the Patients: header and last names beginning with the letter typed will appear.
To add or change patient information, select a patient and then click EDIT PATIENT. This will activate the Patient Demographic Information page. NOTES: While the Edit Patient Information section can be changed, the saved INTAKE QUESTIONNAIRE or BLADDER CONTROL DIARY cannot. You can add subsequent BLADDER CONTROL DIARIES but there is only one INTAKE QUESTIONNAIRE per patient. When a patient’s name appears in the pull-down list box, the Application Protocols: header, the down arrow under this header and the Show Patient Protocols button become active. This part of the menu structure is used to acquire and display the the patient’s EMG, Pressure or Stimulation signals (Live Data only) or present Demo signals. Place the mouse arrow on the down arrow under the Application Protocols: header and click.
This will display five of the eighteen embedded Application Protocols. Placing the mouse arrow on the down arrow button of the protocol file and continuously clicking moves you down the protocol list. Similarly, the up arrow button moves you up the protocol list. An Application Protocol is defined as an evaluation or training display that would be utilized with many patients. The embedded Application Protocols are: dual, area, 10W20R10T, 2EMGs.pro dual, area, 10W20R10T, EMGA, PressureC.pro dual, area, 2W4R10T, 2EMGs.pro dual, area, 2W4R10T, EMGA, PressureC.pro dual, area, resting, 2EMGs.pro dual, area, resting, EMGA, PressureC.pro resting, 2W4R10T, 10W20R10T, 2EMGs.prl resting, 2W4R10T, 10W20R10T, EMGA, PressureC.prl resting, 2W4R10T, 10W20R10T, PressureC.prl single, area, 10W20R10T, PressureC.pro single, area, 2W4R10T, PressureC.pro single, area, resting, PressureC.pro single, stim, 100Hz, 5on10ff, 15min.pro single, stim, 100Hz, 5on5off, 15min.pro single, stim, 12.5Hz, 5on10off, 15min.pro single, stim, 12.5Hz, 5on5off, 15min.pro single, stim, 200Hz, 5on10ff, 15min.pro single, stim, 200Hz, 5on5off, 15min.pro single, stim, 50Hz, 5on10off, 15min.pro single, stim, 50Hz, 5on5off, 15min.pro Definitions: dual—split screen display, two graphical displays. single—single screen display, one graphical display. area—scrolling graph with area beneath the scroll filled-in. 10W20R10T or 2W4R10T—describes the work (contract), rest (relax) and number of trials (repetitions) to the patient’s evaluation or training program. For example, 10W20R10T means 10 seconds of work, 20 seconds of rest for 10 trials. resting—describes a continuous (non work/rest) display of patient activity. 2EMGs—EMG A and EMG B are the active channels. EMGA, PressureC—EMG A and PRESSURE C are the active channels. PressureC—PRESSURE C is the active channel.
stim—STIM channel is the active channel. 12.5HZ, 50Hz, 100Hz, 200Hz—the frequency setting of the STIM channel. 5on10off or 5on5off—describes the on and off time of the stimulation. For example, 5on10off means that the stimulation will last for 5 seconds with 10 seconds of no stimulation. 15min---denotes total stimulation treatment time. .pro—designates a protocol file. .prl—designates a LINKED protocol file. Locate the protocol dual, area, resting, 2EMGs.pro and place the mouse arrow on this protocol and click. The dual display should now be active with the EMG A area graph on the top screen and the EMG B area graph on the bottom screen. Notice the increase and decrease in EMG activity by contracting and relaxing the muscles of the left and right forearm. Now, place the mouse arrow on the down arrow under the Application Protocols: header and click. Choose the dual, area, 2W4R10T, 2EMGs.pro. The dual display is divided into Work and Rest intervals with a Trial number and Work and Rest countdown in the lower left of the screen as well as audio Work/Rest cues. These are used to prompt the patient when to contract and when to relax. Choose dual, area, resting, EMGA, PressureC.pro. Note that accessing a protocol with a pressure channel activates a Zero Pressure button at the bottom of the menu structure. Click on this button to baseline the pressure display. Contract the left forearm (EMG A/STIM) and squeeze the pressure sensor. Return to dual, area, resting, 2EMGs.pro for tutorial purposes. Choosing a protocol is done in precisely the same manner as choosing a patient.
Note that after selecting an Application Protocol the remainder of the menu structure is now active. Beginning from the top of the menu structure: START COLLECTING DATA, PAUSE, RESET, MODIFY PROTOCOL, Event Markers and buttons 1-5, Delete Protocol File and Create Link Protocol are now active.
The PAUSE button freezes the real-time display with no loss of data collection. When activated, the PAUSE button changes to CONTINUE. To start the display again click on CONTINUE. The display and any data collection will resume.
The RESET button restarts the display. Any data collected prior to activating RESET will be discarded.
The MODIFY PROTOCOL button represents the portal from which all embedded protocols can be changed to accommodate any EMG, Stimulation and Pressure evaluation and training parameters. The protocol to be modified is the protocol that currently resides in the Application Protocol box. For example the dual, area, resting, 2EMGs.pro in the Application Protocol box will be modified. Click on MODIFY PROTOCOL and the following drop-down menu appears:
Note that accessing MODIFY PROTOCOL deactivates the menu structure beneath it (Patients, Application Protocols etc.).
Click on Screens.
EMG, Stimulation or Pressure can be presented on a Single Screen, Dual Screen (as it is now), or a Quad Screen by clicking in the appropriate circle and then the OK button. Dual Screen will be used for tutorial purposes.
Click on Channels.
Choose whether and where EMG, Stimulation or Pressure is displayed. Limit of two Channels per screen. If two Channels are to appear on one screen, these Channels must be the same modality. For example, EMG A/STIM and EMG B can appear on the same screen. PRESSURE C and PRESSURE D can appear on the same screen. EMG A/STIM and PRESSURE C cannot appear on the same screen. To choose a Channel or Channels click on the box beside the Channels. To deselect a Channel, click on the checked box. Deselecting a Channel or Channels will be required to change a screen from representing EMG A/STIM or EMG A/STIM and EMG B to PRESSURE C or PRESSURE D or PRESSURE C and PRESSURE D. Click the OK button when complete. **IMPORTANT APPLICATION NOTES: 1. Choosing EMG A/STIM for a Stimulation Protocol and EMG B to monitor accessory muscles is allowed but has limitations. During the Stim On cycle EMG 25
B will exhibit an increase in activity level because of the enormity (in comparison to EMG microvolts) of the Stimulation signal. During the Stim Off cycle EMG B will exhibit activity correctly. Additionally during the Stim Off cycle the primary channel, EMG A/STIM, will exhibit the EMG activity of the pelvic floor muscles. This unique feature will be discussed in the Stimulation Menu section. 2. Always use the primary channel, EMG A/STIM, for accessory muscle activity if PRESSURE C and/or PRESSURE D are used for the pelvic floor muscles.
Click on Display Type.
Choose what type of Display will represent the Channel(s) on the Screen(s). Place the mouse arrow inside the appropriate circle and click. The Ribbon Scroll on a two Channel Screen is not allowed and, if chosen, will display the Wide Scroll. Click on Templates/Upper Screen as a Screen Display Type
This will bring-up a series of exercise Templates to choose from. Click on the circle beside the desired Template and then click OK. This will return you to the Display Types menu. Click OK. The Template will now appear on the Upper Screen. The patient will now attempt to duplicate the Template outline with pelvic floor muscle exercises. The Template always uses the Area Scroll Screen Display type to Display activity. Once you have viewed a Template, change the Display back to Area Scroll. Only the Circle display or Animations display utilize the Invert box. This box allows control of the success of these displays for both muscle contraction and muscle relaxation techniques. The Animations section consists of a series of actual high resolution video clips designed to motivate patients. The Settings control the successful completion of the display criteria. The successful completion can be either the full display Range (Full Range) or a goal (Use Goal). Selecting Use Goal places a 10.0 EMG or pressure goal in the Goal box below the active display. Click on the Up or Down arrow continuously to increase or decrease the goal until the desired goal is attained. Click the Up or Down arrow under Range beneath and to the left of the active display to either increase or decrease the Full Range or adjust the Range for the goal (Use Goal).
Click on the Rose display. This will activate the Animation Channel Selection. The Primary Channel controls the animation. If selected, the Secondary Channel will be displayed as statistics below the active display. Choose EMG A as the Primary Channel and EMG B as the Secondary Channel and click OK. Keep the Settings on Full Range and click OK.
Use the Up and Down arrows beneath Range to change sensitivity. Always choosing EMG A as the Primary Channel and EMG B as the Secondary Channel, experiment with different Animations, Settings, Invert, Goal and Range. Notice that successfully completing the Animation task initiates unique audio reinforcement. When done, click on Display Type and revert to Area Scroll, Click on Screens for Dual Screen and then Channels eliminating EMG B on the Upper Screen by clicking on its box.
To modify Timing the protocol currently residing in the Application Protocol box must be a Work/Rest Protocol. The Application Protocols: header is “grayed out” (not active) when modifying a protocol. Because a Resting Protocol is currently
active, a Work/Rest Protocol cannot be accessed. Choose a Work/Rest Protocol as the Application Protocol the next time to modify Timing.
When a Work/Rest Protocol is selected all Timing features are activated as the above screen exhibits. Type in the new Work Time, use the tab key to proceed to the # of Trials and type in new # of Trials, then tab to Rest Time and type in new Rest Time. Chose whether the Screen Reset should be the full length of the Display or 1 Work/Rest Trial. The Work/Rest Prompts can be either audio Pings or Voice. Keep the Smoothing function at 7. Click the OK button. Notice that activating a Work/Rest Protocol divides the active Display into Work and Rest segments (the solid line begins a Work interval, the dotted line begins a Rest interval), initiates audio Work/Rest cues and begins a Trial counter and Work/Rest countdown at the bottom of the menu structure.
This button toggles between 3-dimensional and 2-dimensional displays when clicked.
Goals assist the patient in training performance by placing a line on the Display and initiating an audio tone if the Goal criteria is attained. Click on the Goal button.
An Above Tone Goal is used to motivate the patient to contract the muscle above a level and, if successful, an audio tone sounds. This is most commonly used on the pelvic floor muscle channel. A Below Tone Goal rewards the patient for not contracting (inhibiting) a muscle above a level and, if successful, an audio tone sounds. This is most commonly used on the accessory muscle. An Above Tone or Below Tone Goal could be activated for each displayed channel. Also, if Goals are activated for a Work/Rest Protocol, each Channel could have an Above Tone or Below Tone Goal for the Work Period and an Above Tone or Below Tone Goal for the Rest Period. The best use of Goals is to set an Above Tone Goal for the pelvic muscle and a Below Tone Goal for the accessory muscle and, for a Work/Rest Protocol, set these Goals for the Work Period only. The audio tone will sound only if both the Above Tone Goal and Below Tone Goal criteria are met simultaneously. These Goals are used for active, voluntary muscle activity and are of no value for the involuntary muscle activity produced by Stimulation. Choose an Above Tone for A WORK Goal and a Below Tone for B WORK Goal and click on the OK button. A Goal line now appears on the active Display for each Channel with Goal line adjustments below the active Display. Adjust by clicking on the Up and Down Arrow buttons under the word Goal and next to the Goal type (Abv Tn = Above Tone, Blw Tn = Below Tone).
*APPLICATION NOTE: The Goals button does not function for the Animations displays. Animations display goals are controlled as previously described.
On-Line Statistics Note that on the same line as the Goal arrows the NAME of the active Channel is displayed along with statistics which are both displayed and updated. The statistics include CurVal which is the Current Value of activity, Avg for Average level of activity, Max for Maximum level of activity and %S for Percentage Success of the patient attaining the Goal performance criteria. If the active Display has Work/Rest intervals, then individual statistics will be displayed for the WORK and REST. The displayed statistics are calibrated to the modality displayed. For example EMG is calibrated in microvolts (µV) and Pressure is calibrated in millimeters of Mercury (mmHG) with an optional calibration button of cm H2O to the left of the Zero Pressure button. Ranges
Note that to the left of the active Channel Name a Range box is displayed. Ranges (the vertical scale of the active Display) can be adjusted to the patient’s level of activity by placing the mouse arrow inside the Up or Down Arrow button and clicking. The Up Arrow increases the Range and the Down Arrow decreases the 31
Range. This allows you to display the optimum Range for each individual patient’s activity level. To the right of these arrows are the words Log (Logarithmic) and Lin (Linear) with circle buttons. Placing the mouse arrow inside the Lin circle and clicking changes the Range from Logarithmic to Linear.
Use this option to select and change the color of a Channel or Channel Background. Click on the Colors button, click on a circle beside a displayed Channel or Background, then click the OK button. This will produce a Color Palette. Click on the new color desired and click the OK button.
Click on the Names button.
Use this option to identify the electrode or sensor placement for each displayed channel as well as assign specific names to each of the Event Markers. Type and tab then click on the OK button. Note that the Channel names above the active Display now change to the names assigned.
This option is active only if one of the displayed channels is EMG A/STIM. Click on the Stimulation Menu button.
To activate the Stimulation Menu click the TURN STIM ON button. Then place the mouse arrow inside the Treatment Time box and click. Type in the total session Treatment Time in minutes. Place the mouse arrow inside the Stim timing On time: box and click. Then type in the desired time for Stimulation. Follow the same procedure for the Stim OFF time and the Treatment Time. Next choose the Hz frequency by clicking on the appropriate button. Finally, increase the Stimulation amplitude carefully by placing the mouse arrow on the Increase button and clicking slowly until the desired involuntary contraction is attained. This button Increases the amplitude in increments of 1mA (milliamp). Notice that there is also an option to Increase in 5mA increments. Once attained, click on EXIT with Stim ON and the active display will begin the Stimulation treatment. Notice at the bottom of the menu structure that activating a Stimulation treatment also activates a STOP STIM button. Clicking on this button will Stop Stimulation. Selecting another Protocol