Pathway NMR 400 Operators Manual Guide

CONTENTS NMR 400

PathwayTM NMR 400 Quad Channel EMG System with SynergyTM 3-Dimensional Software Equipment & Accessories Include: One PathwayTM NMR 400 Module consisting of four channels of EMG; Four #2583 PathwayTM Preamplifiers; One packet of #6750 PathwayTM Electrodes; One #8402 Computer Serial Interface Cable; One SynergyTM 3-DimensionalSoftware Program on CD-ROM; One Operator’s Guide. Minimum Computer Requirements: Windows 95, 98, 2000, NT 4.0 or XP operating system; Celeron or higher CPU; 64MB RAM; 4MB 3-D Video RAM; CD-ROM; 56K Baud Modem; 25MB available Hard Drive space; available 9 pin Serial Port.

PathwayTM and SynergyTM are trademarks of The Prometheus Group. The PathwayTM NMR 400, SynergyTM 3-Dimensional Software and this manual are Copyright © 2002, The Prometheus Group.

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INDICATIONS FOR USE: Surface electromyography is a safe and effective technique for relaxation training and muscle re-education. 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: Use only electrodes from The Prometheus Group with your PathwayTM EMG device. Any other electrode may not be compatible with the PathwayTM 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. • Use only batteries with this device, do not use any type of line-powered adapter. • Do not connect any preamp, lead wire, or any other component to a wall outlet. Do not leave electrodes attached when device is not in use.

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TABLE OF CONTENTS PHYSICAL

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Front Panel Back Panel Top Panel

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MECHANICAL

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Primary EMG channel. Input for the #2583 PathwayTM Preamplifier Secondary EMG channels. Input for the #2583 PathwayTM Preamplifiers

OPERATION

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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 Application Protocols PAUSE RESET MODIFY PROTOCOL Screens Channels Display Type Templates Animations Timing 3D Goals On-Line Statistics Ranges Colors Names CLICK HERE WHEN FINISHED MODIFYING PROTOCOL Save Protocol Patient Protocol

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10 10 11 11 12 12 12 13 13 14 15 15 16-18 19 19 19` 20 20-21 21-24 23 23-24 24-25 25 25-27 27 27-28 28 28 29-30 29-30 30

Show Patient Protocols Delete Protocol File Create Link Protocol Event Markers 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 Home Program HIDE MENU Command Line Print Print Preview MR and TR Series Download View the MR and TR Series Downloaded Data Delete an MR and TR Series Downloaded Data Filename View the Reports Menu Exit and Return to Opening Screen ZOOMING Undo ZOOMING Expand Vertically and Compress Vertically Add a Marker Delete a Marker MARKER Adjust Mode REPLAY

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30 30 30-32 32 32-33 33 34-47 36-37 37 37 37 37-38 39 40 40 41 41-45 42-44 42-43 43 43-44 44-45 44 45 45 45 45 45 46 46 46 46 46 46 46 47 47 47 47

PHYSICAL The Front Panel

EMG A Primary EMG channel. Input for #2583 PathwayTM Preamplifier. EMG B, C, D Secondary EMG channels. Input for #2583 PathwayTM Preamplifiers. L.E.D. POWER INDICATOR Indicates whether the PathwayTM NMR 400 power is on or off. Power must be on (L.E.D. illuminated) to operate the PathwayTM NMR 400.

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The Back Panel

9 Volt Battery Compartment. Caution statement. The Top Panel

COMPUTER INTERFACE Interfaces the PathwayTM NMR 400 to the laptop or desktop computer using the #8402 Computer Serial Interface Cable. The male end of the cable is connected to the PathwayTM NMR 400 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 ON/OFF BUTTON Turns the power off and on to the PathwayTM NMR 400. Power on by depressing the button which illuminates the L.E.D. on the front panel.

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MECHANICAL Primary EMG channel. Input for #2583 PathwayTM Preamplifier.

Make certain the plug is seated fully into EMG A. Note: The four #2583 PathwayTM Preamplifiers supplied are color coded with two white and two gray wires to assist in distinguishing between EMG channels. Any preamplifier can be used for any EMG channel. The #2583 PathwayTM 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 PathwayTM Preamplifier onto one of the #6750 PathwayTM Electrodes taking care to orient the snaps correctly. Make sure all three snaps are secure. Carefully remove the backing of the #6750 PathwayTM Electrode and place the two labeled ACT over the bulk of the muscle with the length of the electrode parallel with the muscle fibers. Secondary EMG channels. Input for the #2583 PathwayTM Preamplifiers.

Accessory muscles are commonly monitored by placing the active electrodes over the bulk of the muscle. The #2583 PathwayTM 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 PathwayTM Preamplifier onto one of the #6750 PathwayTM Electrodes 8

taking care to orient the snaps correctly. Make sure all three snaps are secure. Carefully remove the backing of the #6750 PathwayTM 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 certain the plug is seated fully into EMG B, C and D.

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OPERATING THE PATHWAYTM NMR 400 QUAD CHANNEL EMG SYSTEM Interface the PathwayTM NMR 400 and computer as described in the PHYSICAL section. For tutorial purposes, plug a #2583 PathwayTM Preamplifier into EMG A, EMG B, EMG C and EMG D. Prepare the skin of the left and right forearm flexor and extensor area and, using the #6750 PathwayTM Electrodes, place EMG A and EMG B on the left extensor and flexor and EMG C and EMG D on the right extensor and flexor. Power the PathwayTM NMR 400 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.

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BOOT-UP SCREEN

The Boot-Up or Opening screen consists of the SynergyTM 3-Dimensional Software and The Prometheus GroupTM 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 hand portion of the screen.

The EXIT button allows you to leave the SynergyTM 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.

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Position the mouse arrow on the UTILITIES button and single click the left mouse button.

The PathwayTM NMR 400 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 signals. The RealTime Mode also has a Demo option. Demo means that the SynergyTM 3Dimensional Software automatically displays a preprogrammed or “dummy” signal. The Demo option is quite useful as an aid to learn the software without patient involvement. 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. For purposes of this tutorial, the Live Data option will be used. Select Live Data and click on OK.

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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.

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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.

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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.

**NEW PIC NEEDED 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. 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. 15

To add or change patient information, select a patient and then click EDIT PATIENT. This will activate the Patient Demographic Information page. 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 signals (Live Data) or present Demo signals. Place the mouse arrow on the down arrow under the Application Protocols: header and click.

This will display the five embedded Application Protocols. As Application Protocols are added, 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:

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dual, line, 10W20R10T, 4EMGs.pro dual, line, 2W4R10T, 4EMGs.pro dual, line, resting, 2W4R10T, 10W20R10T, 4EMGs.prl dual, line, resting, 4EMGs.pro quad, area, ribbon, resting, 4EMGs.pro Definitions: dual—split screen display, two graphical displays. line—scrolling graph. area—scrolling graph with area beneath the scroll filled-in. ribbon—scrolling graph with 3-D appearance. 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. 4EMGs—EMG A, EMG B, EMG C and EMG D are the active channels. .pro—designates a protocol file. .prl—designates a LINKED protocol file. Locate the protocol dual, line, resting, 4EMGs.pro and place the mouse arrow on this protocol and click. The dual display should now be active with the EMG A and EMG B line graph on the top screen and EMG C and EMG D line graph on the bottom screen. Notice the increase and decrease in EMG activity by contracting and inhibiting the flexor and extensor muscles of the left and right forearm. Activate the dual, line, 2W4R10T, 4EMGs.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. Return to dual, line, resting, 4EMGs.pro for tutorial purposes. Choosing a protocol is done in precisely the same manner as choosing a patient.

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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.

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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 evaluation and training parameters. The protocol to be modified is the protocol that currently resides in the Application Protocol box. For example the dual, line, resting, 4EMGs.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.).

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Click on Screens.

EMG 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.

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Choose whether and where EMG A, EMG B, EMG C and EMG D are displayed. To choose a Channel or Channels click on the box beside the Channels. To deselect a Channel, click on the checked box. Click the OK button when complete. **IMPORTANT APPLICATION NOTES If a Dual Screen display is activated, EMG A and EMG B are defaulted to the same screen as are EMG C and EMG D. Activating a Single Screen will limit the Channel choices to two of the four EMG Channels.

Click on Display Type.

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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.

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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 muscle activity. The Template always uses the Area Scroll Screen Display type to Display activity. Once you have viewed a Template, change the Display back to Wide 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 microvolt goal in the Goal box below the active display. Click on the Up or Down arrow next to the 10.0 microvolt goal 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 active display to either increase or decrease the Full Range or adjust the Range for the goal (Use Goal).

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Click on the Rose display. This will activate the Animation Channel Selection. The Primary Channel controls the animation. If selected, the Secondary Channel(s) 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 finished, click on Display Type and revert to Line Scroll, click on Screens for Dual Screen and then Channels putting EMG A and EMG B in the Upper Screen and EMG C and EMG D in the Lower Screen by clicking on the appropriate boxes.

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

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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.

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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 primary 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 secondary muscles. 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 primary muscle and a Below Tone Goal for the secondary muscles 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 Goals are met simultaneously. Choose an Above Tone for EMG A WORK Goal and a Below Tone for EMGs B, C and D 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.

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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 in EMG microvolts (Uv). 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 Range. This allows you to display the optimum Range for each individual patient’s activity level.

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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.

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Once any changes to the Protocol are complete, this large button at the top of the menu structure must be accessed in order to return to the active menu structure. Click on this button.

To store the modified Protocol as an Application Protocol and place on the Application Protocol list, click on the box. This will activate the Save As… window which displays the name of the Protocol that was modified. If a name change is desired, place and properly position the mouse arrow inside this window and type the new Protocol name. Note that the modified Protocol can also be stored as a Patient Protocol and placed on the Patient Protocol list. To activate, click on the appropriate box. This will reveal the Patient that was selected in the Patients: window and activate the Save As… window. The modified Protocol can be stored as both an Application and Patient Protocol or as only an Application or Patient Protocol. In either case, if the Protocol name is 29

not changed and the OK box is clicked, a prompt will appear asking you if you want to overwrite the existing file. Clicking on the Yes button means that the same Protocol name will be used for the new, modified Protocol. **IMPORTANT APPLICATION NOTE A Patient Protocol is defined as a Protocol that has been uniquely modified to accommodate a particular Patient’s training. In other words, this Protocol will not be used in the generic fashion of an Application Protocol but will be used only for this Patient. This is an excellent method for progressing the Patient’s training from one session to the next.

This button appears directly below the Application Protocols: window. Click to reveal what Patient Protocols have been stored for the Patient highlighted in the Patients: window. Notice by activating the Show Patient Protocols button, the Application Protocols: changes to Patient Protocols: and the Show Patient Protocols button changes to Show Application Protocols. This acts as a toggle between utilizing Application or Patient Protocols. If activated, Patient Protocols have precisely the same function and flexibility as the Application Protocols previously described ( modifying etc.).

Directly below Show Patient or Application Protocols. The Protocol that appears in the protocol window can be deleted by clicking on the Delete Protocol File. This will bring-up an “Are you sure” message with a Yes and No button.

Directly below Delete Protocol File. With Application Protocols: in the Protocol window, click on Create Link Protocol.

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Note that the Applications Protocol list now appears in triplicate with up and down and left and right arrows available so that the entire list can be accessed and the complete listing can be read. Linking Protocols provides the flexibility to seamlessly move from one Protocol to a second and finally a third on the active Display without the need to access the Protocol list. This feature is most efficiently used where there are different Patient evaluation phases. Select the first Protocol to be shown on the active Display from Protocol List 1:, the second from Protocol List 2: and the third from Protocol List 3:. A total of three Protocols MUST be selected and only individual Protocols (.pro files) not linked Protocols (.prl files) can be linked. If an error is made in Protocol selection a Deselect List button at the bottom of each Protocol list will eliminate the incorrect choice and allow the correct selection. Note that the Protocols selected appear in the Selected Files: windows and after three files are selected the Save Link Protocol file as… window is activated. Typing in the Link Protocol name and clicking the OK button creates the linked Protocol and stores the linked Protocol in the Application Protocol list as a .prl file.

**IMPORTANT APPLICATION NOTE

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Notice that activating a Linked Protocol also creates a JUMP>> button directly below the Create Link Protocol button. The JUMP>> button is used to move the protocol from the first to the second or the second to the third link without completing the sweep time or number of work/rest trials. This is used to facilitate a rapid link change where necessary or indicated. Linked Protocols (.prl files) cannot be modified. Event Markers

Directly below the MODIFY PROTOCOL button are the Event Markers with buttons 1, 2, 3, 4, and 5. These are used to mark an Event or anomaly on the active Display such as a Patient cough or movement or other artifact. A vertical line will appear on the active Display with the button number clicked (or the name of the button if typed in under Marker Names in the Modify Protocol menu). Any Markers clicked on during data collection will be stored in REPLAY/REPORTS and will appear on the REPLAY graphic and will appear and can be manipulated on the REPORTS graphic.

Click on this button to initiate the data collection process. This MUST be done in order to save the statistical and graphic information on any evaluation or training session for the REPLAY/REPORTS section. Once activated, the button will read STOP COLLECTING DATA. Click STOP COLLECTING DATA only if sufficient information has been collected on a continuous (non-timed) session or if the decision is made to stop a timed session before completion. Timed session example: Stopping a Work/Rest Protocol prior to the completion of all the trials (repetitions). Whether terminated manually or by the completion of a timed session a Saving Session prompt will appear with the patient’s file name and the option to save (OK) or not save (Cancel). For this tutorial, click on Cancel. Either choice will reset the RealTime screen so that a new patient and new protocol can be selected.

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IMPORTANT NOTE: If STOP COLLECTING DATA is activated on a Linked Protocol (.prl file) prior to the third and final protocol in the link NO DATA WILL BE SAVED.

**IMPORTANT APPLICATION NOTE If a Work/Rest Protocol, either as a .pro or .prl file, is selected and START COLLECTING DATA is initated, a 5 second countdown will appear on the screen before the patient’s first work (contract) interval. This allows the patient to prepare for the first work interval and helps maintain the accuracy of the data collected.

Click on the EXIT TO MAIN MENU button.

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