Practical Guidelines Myomed 632
Contents
1. to the pressure p channel of the unit ENRAF NONIUS p pressure channel Connect the Anal pressure sensor CD art nr 3444043 to connecting cable By the way an alternative set with the Connecting hose for vaginal pressure sensor art nr 3444044 and the pressure Anal pressure sensor CD 3444043 sensor art nr 3444042 is of course also J possible In the main menu of the unit select Myomed 632 E Feedback Therapy with the central Home controller Therapy Wizard Electrotherapy Feedback Therapy system Settings Confirm with the confirmation button Select Pressure with the central controller Feedback Therapy Confirm with the confirmation button Myofeedback Myofeedback Stimulation Pressure Pressure Myofeedback stored Sessions EOR i NONIUS 5 14 Feedback Therapy Pressure Continuous Exercise Rest Template E1810 00 Pressure Continuous Settings Treatment Time Sensitivity P 120 hPa Zero Threshold P 0 0 hPa Graph LE sound Record Pressure Continuous Settings Treatment Time Sensitivity P Zero Threshold P 0 0 hPa Graph i sound Record 120 hPa Pressure Continuous Settings Treatment Time Sensitivity P Zero Threshold P 120 hPa 0 0 hPa Graph Sound Record PN0 00 PH 0 00 Select Continuous with the central controller Confirm with the confirmation button Since we attached a new2. This area was defined in the Stimulation above Threshold Settings as Stimulation Time EOR l NONIUS 5 12 Wyofeedback Stimualtion As the EMG signal goes above treshold than the stimulation starts Feedback Therapy Myofeedback Stimulation Alternating Stimulation above Threshold Stimulation below Threshold Alternating 1 2 Stimulation above Threshold 1 2 Stimulation below Threshold 1 2 E18 10 00 5 Pressure feedback Pressure feedback is for demonstration purposes not very different from EMG feedback Where the electrical activity of a muscle is the measured and displayed signal in EMG in pressure feedback we look at the pressure Pressure is the mechanical outcome of muscle activity Pressure feedback is very common in incontinence training but it also can be used in hand rehabilitation for example Pressure feedback is easy to show in exhibitions as no electrodes sticking is required just with a simple balloon you can show the functionality of the unit Connecting cable for anal pressure probe 3444043 Well with the description above of Stimulation above threshold you should be able to figure out how to set a Stimulation below Threshold The only difference is of course that stimulation will be triggered as soon as the EMG signal goes below the threshold value Go ahead and try it out Connect the Connecting cable for the anal pressure probe art nr 3444045
3. Practical Guidelines For the Enraf Nonius Commercia ial Training Myomed 632 EOR E NONIUS 5 Copyright amp Exclusive Sales and Service FENRAR I BNONIUS g Enraf Nonius B V P O Box 12080 3004 GB ROTTERDAM The Netherlands Tel 31 0 10 20 30 600 Fax 31 0 10 20 30 699 info enraf nonius nl www enraf nonius com E N NRAF ONIUS Content 1 PR CAMMD IG qe t TES 1 2 Namn CONVENIO ER 1 24 Genta controle MEER RET T 1 2 2 Onion DUNO rena i stats N AE d EM debe ee ad heads 1 29 JASSISUDUIODS 6 docs a A A A A Adr A a CM A CLIE 1 ZA BUONA O Da hice cet Matai t eh crete le Ota sone t health Macau ae NS tcl 1 3 The firSt EMG demoristraltlon ioi toni coute ed nse ste celta ests sched east crees ce ais 2 SUME da tanta tliat Salant cs dsletiralaadenn Sask Malle a Gissloah cedlaleuess 5 S MEN Roe T 6 On MEI dM r T 7 SA ROCO nonae th sete cers amet ake ane a a a ence cena wrens cana sees ct eee cen Aa 8 Myofeedback and stimulation 21leeeeeeeeeeeeeieeee ee eeee eene enne nnne nnn nnn nnn nnn nnn 9 4 1 Stimulation above TreShold cc cccccceccccseecceseececeseceseeeeceeeeeseucesseueesseecessecesseeeeseeeesaeees 10 4 2 Stimulation below Threshold cc cccccccccceecceeeececesececeeeeseeeeseuceeseeeesseecesseeesegeeeseeeessaees 13 Pressure feedback ecsccscocccssspesnteusacesesatenwcagececssavacstaeseanto
4. cuescecseueascesaucseacecestwatenmnccetecseecceduatoceatees 13 Additional Myomed demonstration items eeeeeeeeeeeeeeeeeeeeeee eene 16 6 1 Graphic representations ite tite Bee ees 16 622 The uuseor templates eor Did ee weist eee eee cdd ru CRI 17 6 3 After the treatment Analyze 3 ino oio caute a qti leta ee eae 18 7 Generic 6 series demonstration items 1leeeeeeeeeeeeeesieee nein enhn nnn n nnn ahhh nnn nns 19 7 1 The tiltable screen amp viewing angle sseeeesseseeeseeeeeeeennnnn mnn 19 7 2 The one hand ODS ANON sss uota cams ct tu metes icai summ M weak MEI pu TAE 19 7 3 The use of the electrotherapy wizard ccccssececcseseeeceesececeeseecaeeeeceegeeessenseesseeeeeeas 20 EAE a NONIUS 1 Preamble In the following pages we will present a step by step practical guidelines for demonstration of the Myomed 632 All steps are documented and displayed in this guideline but don t hesitate to ask in case of any queries This guideline is not an instruction or user manual In case you need to know in depth the possibilities of the unit you need to consult the User s Manual of the unit you are using User manuals can be downloaded from the Enraf Nonius partnersite http www partnersite enraf nonius org 2 Naming convention In this manual we will use the following names and terminology EMG Pressure Feedback SEMG Confirma
5. e right side Ask the patient for some contraction to set de correct sensitivity ENRAF NONIUS Upscaling bya factor 10 y scale of O to 200 Myofeedback Continuous Senings Treatment Time Sensitivity 200 pV Shift 0 pv Graph Sound E1m 10 00 Myofeedback Conti Threshold value What is sensitivity e Sensitivity changes the y scale in other words the amplification of the EMG signal Example o Acertain signal strength will be well visible at a scale of 1 tot 200 the left graph That same signal will hardly be visible on a 0 to 2000 scale 10 times less sensitive the right graph So for feedback purposes we would set the sensitivity to 200 in this case The signal is then good visible for the patient By means of the back button go back to the Settings of the Continuous program Select Threshold from the menu with the central controller Confirm with the confirmation button Ask the patient to contract again Change the Threshold with the central controller to a value at the top of that contraction Push the confirmation button to return ENRAF NONIUS CE er ters NM Weight lifter reacts when the Threshold is achieved Myofeedback Continuous Settings Treatment Time Sensitivity shift Threshold Graph sound E1m 10 00 What is threshold e Threshold is a value that the patient should accomplish during his exercise session the goal that t
6. eatment or demonstration you are doing you will always have the choice of graphical representation of the signal Somewhere during the setting of the feedback parameters you will see the menu item Graph Select Graph from the menu with the central controller Confirm with the confirmation button You can then choose from a bar graph or continuous graph The bar graph is less impressive but more easy to understand Worthwhile showing both options to your customer ENRAF NONIUS Feedback Therapy Myofeedback Continuous Exercise Rest template Continuous 1 2 Exercise Rest 1 2 Template 1 2 Myofeedback Template Settings Template Template Time Rest Time Cycles Sensitivity Shift Template Height a hyo ptm 4t ia Template Time 200 160 Template Height Myofeedback Template Reco Patient tries to follow the template For training purposes one can use templates to simulate movement patterns A template is simply a shaped Threshold Where the normal threshold is a single value the dotted line in the graph that the patient is asked to achieve with templates one introduces changes over time of the Threshold value To start training with templates select Template from the Myofeedback menu with the central controller and confirm with the confirmation button Select Template from the Template Settings menu with the centra
7. ecific value where a noticeable sensation is generated that itchy feeling Note For this EMG demonstration we refrain from the contraction as described in the electrotherapy guide a noticeable NEUE sensation will do NONIUS Assist E o 12 45 15 00 ma Myofeedback Stimualtion Alternatimn Grey area rest phase Myofeedback Stimualtion Alternating i Myofeedback Stimualtion Alfarestina E on om eel If this point is found we start the EMG stimulation treatment via the assist button Select Start in the upcoming screen and confirm You are now getting a combination of all the parameters you entered in different phases Grey area rest phase In the grey area you see the rest phase that part where no activity should be seen This area was defined in the Stimulation above Threshold Settings as Rest Time White area active EMG In the white area the patient should activate the muscle of interest The EMG signal of that activity is shown in this white area This area was defined in the Stimulation above Threshold Settings as Exercise Time The pink area 7 stimulation phase As soon as the activity of the patient is above the threshold the stimulation will start remember we are doing a demonstration of Stimulation above Threshold Here the EMG display will vanish and the electro stimulation exactly according to the protocol as we set it will start
8. electrodes Myomed 632 Home Therapy Wizard Electrotherapy Feedback Therapy system Settings Place the two EMG stimulation electrodes 3444 222 on the belly of that muscle Place the reference electrode on a bony structure somewhere else on the body for example on the elbow of the other arm Note the bony structure is required because placing the reference electrode on an other muscle could cause disturbance of the EMG signal of the muscle of interest In the main menu of the unit select Feedback Therapy with the central controller Confirm with the confirmation button tm j NONIUS 5 Myomed 632 li Myofeedback Myofeedback Stimulation Pressure Pressure Myofeedback Stimulation E1m 0 00 Feedback Therapy Myofeedback Continuous Exercise Rest Template Continuous 1 2 Exercise Rest 1 2 Template 1 2 3 1 Sensitivity Myofeedback Continuous Settings Treatment Time Sensitivity 200 yv Shift Threshold Graph E1m 10 00 Myofeedback Continuous Settings Select Myofeedback from the menu with the central controller Confirm with the confirmation button Select Continuous from the menu with the central controller Confirm with the confirmation button Select Sensitivity from the menu with the central controller Confirm with the confirmation button Set the sensitivity to 200 uV The muscle activity will be displayed from th
9. firmation button to return One now can adjust sensitivity again to maximize the view on the screen With proper sensitivity threshold and shift set one can start recording Select Record from the menu with the central controller Confirm with the confirmation button The treatment time now starts A small green triangle in the right tab indicates it is running EOR l NONIUS 5 During the recording we can always adjust Myoteedback the sensitivity threshold and shift without Contin Re oe a oe i i i 0 ries p Change Sensitivity interrupting the treatment Use the central controller to select one of the three buttons on the screen left side in order to change these settings Change Treshold Change Shift currently active and therefor orange Congratulations you just completed your first demonstration on a Myomed 632 If you understood the above part you basically understand the functionality and use of this unit 4 Myofeedback and stimulation Besides basic EMG feedback that is measuring and displaying the electric activity of the muscles the Myomed also allows for a combination of myofeedback and stimulation This combination of feedback and electrotherapy can be used for numerous reasons for example in order to combine relaxation with muscle strengthening or to re educate proper movements like lifting techniques Hereunder a simple demonstration of myofeedback and stimulati
10. he therapist can set In the normal graph it is represented by a triangle and a dotted line In the bar graph it is represented by an orange line The weight lifter will react in case this dotted line the threshold is achieved Shift is a special tool only available in the Myomed 6 series With shift one shift the 0 value of the EMG signal on the y axis Why is shift used Especially in treatment of hypertonic muscles increased muscle tension there always is a basic tension in other words a basic EMG signal A large part of the graph would therefore be occupied by this basic tension By shifting the whole graph we can only get the relevant part in the screen we exclude the basic tension How to set the shift Note For a correct use connect the patient is first Step 1 Ask the patient to contract Set the sensitivity to the maximum bandwidth that is the value where the entire signal is within the range of the screen Step 2 Select Shift with the central controller Push the confirmation button to accept tm j NONIUS 5 Myofeedback Continuous Settings Treatment Time Sensitivity Shift Threshold Graph Sound E1m 10 00 Myofeedback Continuous Record Indicates recording D 1 fT tet Scroll with the central controller until only the relevant part of the signal is displayed in the graphic The relevant part is the entire signal minus the basic tension Push the con
11. interface we need to reset the zero pressure for that interface Select Zero with the central controller Be sure no pressure is applied to the interface Confirm with the confirmation button The pressure zero calibration of the machine is now reset Set the different parameters of the pressure feedback demonstration Treatment Time 4 minutes Sensitivity P 120 hPa Threshold P 50 hPa The function of Sensitivity and Threshold are exactly the same as in EMG feedback Shift is not relevant here There is no basic pressure you just put the basic pressure to O with the zero setting You can however change the shift during treatment if necessary Select Record with the central controller Confirm with the confirmation button to start the demonstration COR NONIUS 5 Change Sensitivity Treshold or Shift during treatment This concludes the demonstration of the pressure feedback It s simple isn t it 6 Additional Myomed demonstration items Now you know how easy it is to demonstrate a Myomed just a few additional items 6 1 Graphic representations Myofeedback Continuous Settings 10 00 Sensitivity 200 pV Shift 0 uV Threshold 0 pv Sound Record E1 mio00 Just like during the EMG treatment you can change the Sensitivity Threshold or Shift The green triangle in the lower right Tab indicates that the treatment is running Whatever feedback tr
12. k one step Pressure and select Report from the menu with the Continuous R central controller dh shold P Confirm with the confirmation button Graph Sound Record Analyze You will now get a simple overview of the Pressure values of that specific training Continuous Report Minimum 0 0 hPa Maximum 122 6 hPa Average Total execution time 0 30 5 COR BNONIUS g Generic 6 series demonstration items The following items are imperative in order to convince a potential customer of the ease of use of the Enraf Nonius 6 Series all units not just the Myomed Items that has been proven in practice and although sometimes very simple and basic extremely valuable in the real life daily situation of the therapist 7 1 The tiltable screen amp viewing angle Tiltable good view from all angles But due to the highres tft also visible from the sides it has a very wide angle view One hand on the patient and one hand on NR the treatment unit that is how a physiotherapist should work and wants to he index finger f wor Not many units allow this but the Enraf Nonius 6 series does Full control of the unit with just one hand select the item from the menu with your index finger and confirm with the thumb couldn t be easier bd E f Ear NONIUS Confirm with the thumb 7 3 The use of the electrotherapy wizard Always quick
13. l controller Confirm with the confirmation button One can now choose from rectangular shapes triangular shapes etc Choose the rectangular shape For this shape you can set a number of parameters For easy demonstration set e Time to 5 sec e Rest Time to 7 seconds e Template Height to 70 Now start recording During this session the template will appear as set The patient tries to follow the template by means of contracting the muscles at the proper height and time as indicated by the dotted lines of the template Of course you can change Sensitivity Threshold and Shift during recording when necessary 17 6 3 After the treatment Analyze BEES With the Myomed it is easy to show results Pressure i directly after the treatment as well Continuous Settings graphically as in numbers sensitivity P 120 hPa Zero Threshold P 0 0 hPa Graph A Confirm with the confirmation button Sound Record Analyze At the end of the treatment select Analyze from the menu with the central controller The graph of the recording will be shown In Pressure case you want to zoom in on a particular Continuous Analysis part of the graph click on the cursor button and move the cursor with the central controller tot the part of interest and press the confirmation button O Click the magnifying glass to zoom In AA 8 P B00 00 For the numerical results go bac
14. ly show the therapy guide for electrotherapy it is clear easy to Pain Mananement in Manan n understand and unique Therapy information Arthritis Arthrosis High actuality local treatment Intensity just perceptible sensory level Localization Shoulder electrodes rar i NONIUS 5
15. on nT Turn on the unit and connect the patient P E exactly the same way as described in the first demonstration The reference electrode Note we are combining EMG and stimulation Do not use normal stimulation electrodes they are not suited for EMG purposes Only electrodes 3444 222 are applicable The EMG stimulation electrodes Itm j NONIUS 5 Select Myofeedback and stimulation from Feedback Therapy the menu with the central controller Myofeedback Confirm with the confirmation button Myofeedback Stimulation Pressure Pressure Myofeedback Stored Sessions Select Stimulation above Threshold from Feedback Therapy the menu with the central controller Myofeedback Stimulation Alternating Confirm with the confirmation button stimulation above Threshold Stimulation below Threshold With Stimulation above Threshold the electrotherapy currents will become active Alternating 1 2 when the EMG signal supersedes the Stimulation above Threshold 1 2 threshold value Stimulation below Threshold 1 2 Select Russian Stimulation from the menu Feedback Therapy with the central controller Myofeedback Stimulation ll Premodulated Confirm with the confirmation button Russian Stimulation Biphasic Pulsed Current TENS O gt Faradic Current O Diadynamic Current X High Voltage rar a i NONIUS 5 Practical Guidelines F
16. or tek Erra Hori ua Corvavebnci ad Trairar of ire Electrotherapy Myofeedback Stimulation Stimulation above Threshold Settings Rest Time Exercise Time Stimulation Time Cycles Sensitivity Shift Threshold ETWOT 15 Cona 7 Left Tab J We now will set the parameter of the Russian Stimulation exactly the same as in the Practical Guidelines For the Enraf Nonius Commercial Training Electrotherapy Application Select Treatment Time with the central controller Confirm with the confirmation button Use the central controller to set the time on 4 minutes Select Surge Program with the central controller Confirm with the confirmation button In the Surge Program set the following parameters 2 seconds 6 seconds 2 seconds 10 seconds Ramp up Time Hold Time Ramp down Time Interval Time If all surge parameters are set we complete the Stimulation above Threshold Settings Enter the following settings Rest Time 5 seconds Exercise Time 5 seconds Stimulation time 5 seconds Be sure you also set a threshold We are doing a demonstration of Stimulation above Threshold so without threshold it will not stimulate either Set a value of 100 mV for threshold With the above setting we are now going to search for the proper intensity level of the stimulation This means we press button A and are slowly going to increase the currents shown in the left tab and look for that sp
17. tion button Stimulation Electrical stimulation of tissue wy Bn Wi Electro Myo Graphy biofeedback of electric activities of muscles muscle groups biofeedback of the mechanical output the compression relaxation of muscles muscle groups Surface EMG 2 1 Central controller The big round button that scrolls trough the menus 2 2 Confirmation button The long mouse button for confirmation of the selected item with the central controller 2 3 Assist button The small orange button just above the confirmation button that allows for a quick jump to Home Stop etc 2 4 Buttons A toD The 4 small buttons just below the screen Functionality of these buttons is defined by the current tabs in the menu screen KO NONIUS 3 The first EMG demonstration Turn on the unit Connect the EMG cable 3444 673 in the channel 1 connector E1 M EMG cable 3444 673 Channel 1 Channel 2 It NONIUS Connect the reference cable 3444 674 to the REF Connector of the unit Reference Palpate just below the elbow in order to find the muscle belly of the extensor muscles of the forearm EMG stimulation electrodes 3444 222 placed on the muscle belly of the The electrodes are placed at th of the extensor muscles muscle belly Rinse and clean that area of the arm ENRAF NONIUS EMG stimultation electrodes 3444 222 The reference electrode The EMG stimulation
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