Chapters Transcript Video EMG Setup and Protocol This tutorial will describe how to setup an EMG System, how to acquire a diagnostic EMG study, and how to create a report. elect your biography set up and protocols. Upon completion of this tutorial, the participant will be able to describe how to set up a M system, review the acquisition steps for diagnostic MGE, explain how to review the acquired data and create a report supporting tutorials on the Santa University website. Include pelvic floor retraining and the physician tip. When M G is the gold standard, parts one and two MGE is used to assess the electrical activity of the external anal sphincter, and the people were tallis muscle through the use of a surface electrode. The peri anal sensor will collect electrical signals from the anal sphincters. This device could be used multiple times for the same patient. The surface electrodes use surface skin patches in our place to collect the abdominal. Response. E M G testing can help to differentiate between muscle versus nerve damage and patients presenting with vehicle and continents for chronic constipation. Patients with an outlet obstruction BMG can better assess the patient's strain response and may be beneficial in retraining. Programs with the use of MGE in isthmus could be further defined by type or cause For more information on types of an isthmus or outlet obstruction. Please refer to the pelvic floor retraining position. Tip. When E. M. G is the gold standard parts one and two on this tutorial website equipment set up for Insight G three or older systems. When facing the sensor pack, the cables for the abdominal sensors will be on the left, and the peri anal sensor cable is on the far right side of the sensor pack. Connect the abdominal electrodes matching colors. Positive is black. Negative is white. Ground is green. Do not plug the Perry sensor directly into the pressure channels on the far left of the sensor pack as thes channels will not be used. This slide shows the completed MG set up note. It is not necessary to have the Perry sensor on the system during calibration. The Perry sensor will be attached to the cable on the far right side of this picture. The M G sensor pack will connect to the G three sensor pack as showing the cable connecting the sensor packs will connect in the back of the sensor path and the front of the high resolution sensor pack. Be sure that the high resolution switch is turned off when using AMG. If using the Insight Ultimate unit, follow the set up instructions on the next two slides. The E M G Dr Module has to patient connection ports. The ports are designed with quick connect ends. The connection ends on the abdominal cable and the Perry sensor cable are size two Onley fit in their proper port, so inserting them into the wrong connection port is not possible. The cable for the adapter module can be plugged into ports to three or four on the ultimate central unit. When using AMG, no other probes could be plugged into Port one of the Ultima Unit. The empty high resolution cable can be attached as long as there is no probe attached to it. To start a study, double click on the sandhill application's icon on your desktop, then double click on the Insight acquisition icon. All I am protocols, including diagnostic testing, will be found under biofeedback. Select this button to start a new procedure. Click the procedure button with the protocol highlighted. The protocol details will be a guide for the system set up. Note that with the MG, your options are diagnostic or retraining protocols. Click OK calibration of the system before each study is important. However, unlike a calibration of a motility probe, the Perry sensor and abdominal electrodes do not need to be connected to the cables. During calibration, Click on calibrate click on start E M G calibration calibrate low voltage first press and hold the L switches on the G three sensor pack or the L button on the ultimate module when the electrical count on the screen is stable for both channels. Press okay for a G three system press and hold both else switches on the front of the box, making sure each channel is lit up before pressing okay on the computer screen for the ultimate system press and hold the L button, making sure the pressed indicator light is illuminated. Next, calibrate the high voltage press and hold the H switches on the G three sensor pack or the H button on the ultimate module. When the electrical count for both channels is stable on the screen. Press Okay for the G three system, be sure both H switches on the front of the box are illuminated. Press okay on the computer screen for the ultimate system press and hold the H button, making sure the pressed indicator light is illuminated. Blue bars will extend from 0 to 200 million volts, indicating that the calibration was successful and both electrodes air working. Save the valid calibration values. Once the calibration is completed, select either start new patient or start existing patient. For most procedures, select start new patient note. Start. Existing patient is usually utilized if the patient had a previous study, as in the case of multiple retraining sessions, this will allow the studies to be saved. In the same folder. Complete the patient information Onley. The name fields are required. Either of the touch screen or standard keyboard can be used to enter the patient data. The drop menu fields can be edited to add frequently used information. Refer to the Insight User Manual for detailed instructions. A brief explanation should be performed prior to the procedure. Decrease patient anxiety by explaining that is an easily tolerated procedure and usually the only discomfort is a sensation to defecate. If this procedure follows an anal rectal motility, then you can forego the history and digital exam. If doing on lien mge procedure, do a digital exam as it will lubricate the anal canal and gives the clinician and initial evaluation of the sphincter pressures. And if the patient understands how to squeeze and push with the patient lying on their left side knees drawn up, insert the Perry sensor into the anal sphincter with the arrow pointing to the spine. Position the sensor so the best electrical signal is observed. Typically, this value will be about 10 million volts or less. Attached the black and white abdominal surface electrodes low in the groin area. Place the green, grounding electrode anywhere in the area. Avoiding bony prominence is the procedure. Protocol will guide you through the procedure for a diagnostic study. Measurements for resting, squeeze, push and cough can be created during acquisition. The constipation retraining protocol for Ultima will instruct you to zero the channels before inserting the probe. This is not necessary or advised, but if you choose to zero any channels, this must be done before connecting to the patient or inserting the Perry sensor. If using a retraining protocol for the G three system, ignore the zeroing instructions at the beginning of the protocol. Never zero the screen with the Perry sensor in the patient as this will obscure any electrical signal coming from the sphincters. Typically, during a diagnostic evaluation, you will want to measure resting this ship show stable resting pressure Squeeze, which is show an increase in sphincter activity but not abdominal activity. Cough, which should show increased abdominal and sphincter activity and push, which should show decreased sphincter activity and increased abdominal activity. This is an example of a normal diagnostic. MG study Measurements from left to right include rusting squeeze, push and cough on your completed study. The event lines that you see here in this picture indicating the type of measurement will not be automatically generated. These event lines can be added in during review. This slide illustrates normal rusting and squeeze measurements. Notice. There is no increased activity in the abdominal channel, indicating that the patient Onley squeezed. This slide represents normal push activity with increased inter abdominal pressure and sphincter. Relax ation, while I Am is the most effective method for retraining patients with chronic constipation. Detailed instruction on the use of them for retraining is beyond the scope of this tutorial. For more information on pelvic floor retraining, CR tutorial, pelvic floor retraining on the Sand Hill University website as within any retrained, step by step guidance. The steps included in the protocol can be tailored to fit the needs of the patient based on their findings. To review the study, you will need the Santel Analysis software. Double click on the sandhill application's icon on your desktop, then double click on bio view analysis or analysis. Click on the file in the left top left of the screen. The patient file is found in the following path. See Dr Sandhill patients vile. Open each measurement and evaluate for proper placement of the analysis marks. Note on the squeeze measurement. A mean value line will be placed midway between the resting marker and the squeeze peak. This is the correct placement for this marker. The push measurement will have measuring excess that indicate peak value and minimum value for push. This is the correct placement to create a report, Click on report in the toolbar. The top of the screen Select. Create a report. There are different report template options available. Select the template for a diagnostic or retraining report. Based on the procedure done, the report will open as a word document and convert edited before printing Created by
