Figure 12-1.1. Surface EMG electrodes.

measurements invalidates changes in the PFM measurements and can inadvertently reinforce maladaptive abdominal contractions. The recommended surface electrode placement for monitoring abdominal muscle activity

Figure 12-1.3. The multiple electrode probe (MEP) internal sensor. (Courtesy of SRS Medical, Redmond,WA.)

is along the lower quadrants of the abdominal wall. Intravaginal, intrarectal, or perianal placement of surface electrodes may be used to monitor the PFMs. To obtain an evaluation, patients are instructed to simply relax, and then perform an isolated pelvic muscle contraction over a 10-second period, followed by performing a Valsalva maneuver; this sequence is repeated 2 to 4 times for accuracy. During contraction, the abdominal muscle activity should remain relatively low and stable indicating the patient's ability to isolate PFM contraction from abdominal contraction (Figure 12-1.4). During the Valsalva maneuver,

Figure 12-1.2. The Orion Platinum Multi-Modality Biofeedback System shows a typical display during a PFM contraction.(Courtesy of SRS Medical,Redmond,WA.)

Figure 12-1.4. Channel 1 - PFM sEMG tracing during a contraction. Channel 2 -Abdominal sEMG muscle activity.

mr*- '-' - *f-'îi *

•*.r - ^ . .v ■ V ■> i i < — . •• * ' :

Jy^K' 's&OfV K jnt* t Jlri T"-^-' I rw v.^ .•..] Gift r V

Figure 12-1.5. Channel 1 - sEMG tracing of the PFM during a Valsalva maneuver. Channel 2 - Abdominal sEMG muscle activity.

PFM muscle activity should decrease below the resting baseline (to <2 ||V), while the abdominal sEMG activity increases with elevated intraabdominal pressure (Figure 12-1.5). These objective measurements are documented and reviewed with the patient. This also provides the clinician with initial objective measurements to gauge training and recommended at-home practice according to individual capabilities.

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