Surface Electromyography Evaluation

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The abdominal and pelvic floor,the two channels of sEMG muscle activity, should be monitored simultaneously during the sEMG evaluation and the sEMG biofeedback-assisted pelvic muscle exercise training. Interpretative problems arise when monitoring only pelvic floor muscles without controlling changes in the intraabdominal pressure. The transmission of abdominal artifact to perennial measurements invalidates changes in the pelvic floor muscle measurements and can inadvertently reinforce maladaptive abdominal contractions.9 The recommended surface electrode placement for monitoring abdominal muscle activity is along the long axis on the lower right quadrant of the abdominal oblique muscles. Perianal placement of surface electrodes may be used to monitor the pelvic floor muscles when internal sensors are inappropriate as in young pediatric patients.

Semg Biofeedback For Pelvic Floor

Figure 13.6. Surface perianal placement (From Vickers D, Davila GW. Kegels and biofeedback. In: Davila GW, Ghoniem, GM,Wexner SD, eds. Pelvic Floor Dysfunction: A Multidisciplinary Approach. Springer-Verlag London Ltd, 2006:303-310.)

Table 13.4. Abdominal and pelvic floor muscle surface electromyography (sEMG) evaluation sEMG resting baseline sEMG peak amplitude the contraction sEMG mean amplitude of the contraction during a 10-second period

Duration of the contraction: 0 if <5sec, 1 if 5sec, 2 if >5 sec and

<10 sec, 3 if >10 sec sEMG muscle recruitment scale: 0, slow; 10, fast Pelvic muscle isolation during contraction: 0, none; 10, good Valsalva maneuver

Progress this week: 0, worse, to 10, excellent

Figure 13.6. Surface perianal placement (From Vickers D, Davila GW. Kegels and biofeedback. In: Davila GW, Ghoniem, GM,Wexner SD, eds. Pelvic Floor Dysfunction: A Multidisciplinary Approach. Springer-Verlag London Ltd, 2006:303-310.)

Placing the active electrodes in the left and right anterolateral positions around the anal orifice and placing the reference electrode on the gluteus maximus or coccyx reduces artifact (Fig. 13.6). To obtain an evaluation, instruct the patient to simply relax, then to perform an isolated pelvic muscle contraction over a 10-second period, followed by performing a Valsalva maneuver; this sequence is repeated two to four times for accuracy (Table 13.4).During contraction, the abdominal muscle activity should remain relatively low and stable, indicating the patient's ability to isolate PFM contraction from abdominal contraction (Fig. 13.7). During the Valsalva maneuver, PFM muscle activity should decrease below the resting baseline to <2 |V,while the abdominal sEMG activity increases with elevated intraabdominal pressure (Fig. 13.8). These objective measurements are documented and reviewed with the patient. This also provides the clinician with initial objective measurements to gauge training and recommended home practice according to individual capabilities.

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