(646) 355-8777
  • Home
    Home This is where you can find all the blog posts throughout the site.
  • Categories
    Categories Displays a list of categories from this blog.
  • Tags
    Tags Displays a list of tags that have been used in the blog.
  • Bloggers
    Bloggers Search for your favorite blogger from this site.
Blog posts tagged in Biofeedback

Sexual dysfunction is a common negative consequence of Multiple Sclerosis, and may be influenced by neurologic and physical changes, or by psychological changes associated with the disease progression. Because pelvic floor muscle health can contribute to sexual health, the relationship between the two has been the subject of research studies for patients with and without neurologic disease. Researchers in Brazil assessed the effects of treating sexual dysfunction with pelvic floor muscle training with or without electrical stimulation in women diagnosed with multiple sclerosis (MS.) Thirty women were allocated randomly into 3 treatment groups; 20 women completed the study. All participants were evaluated before and after treatment for pelvic floor muscle (PFM) function, PFM tone, flexibility of the vaginal opening, ability to relax the PFM’s, and with the Female Sexual Function Index (FSFI). Rehabilitation interventions included pelvic floor muscle training (PFMT) using surface electromyographic (EMG) biofeedback, neuromuscular electrostimulation (NMES), sham NMES, or transcutaneous tibial nerve stimulation (TTNS). The treatments offered to each group are shown below.

  sEMG biofeedback Sham NMES Intravaginal NMES TTNS
Group 1 (n=6) X X    
Group 2 (n=7) X   X  
Group 3 (n=7) X     X


The following factors made up the inclusion criteria for the study: age at least 18 years, diagnosis of relapsing-remitting MS, and a 4 month history of stable symptoms. All of the participants were sexually active and were found to be able to contract pelvic floor muscles correctly. Group 1 patients were treated with “sham” electrical stimulation using surface electrodes placed over the sacrum at a pulse width of 50 ms and a frequency of 2 Hz. Patients in Group 2 used an internal (vaginal) electrode at 200 ms at 10 Hz. Group 3 were given transcutaneous tibial nerve stimulation at 200 ms and 10 Hz. All groups followed these treatments with pelvic floor muscle exercises using a vaginal sensor and biofeedback.

Therapists are increasingly learning about and treating pediatric patients who have pelvic floor dysfunction, yet there are still not enough of them to meet the demand. Many therapists I have spoken to are understandably concerned about how to transfer what they have done for adult patients to a younger population. Here are some of the more common concerns therapists express or questions they ask in relation to the pediatric population:

  • Can we use biofeedback with children?
  • Do we complete internal assessments on kids?
  • How do we change the way we talk to the children?
  • How much do we have to teach the parents to get the information across?
  • Why do we teach strengthening even if some of the kids mostly need relaxation or coordination?

Although each question deserves a longer answer, we can start with biofeedback, and the answer is a resounding “yes”. There is abundant research affirming the potential benefit of biofeedback training for children with pelvic floor dysfunction. And no, we do not typically complete an internal pelvic muscle assessment on children, as that would not be appropriate. Considering that pediatrics can refer to young adults up to age 18-21, there may be a reasonable clinical goal in mind for utilizing internal assessment or treatment. The words we use when we speak to children become very important. Herman & Wallace faculty member Dawn Sandalcidi (known as “Miss Dawn” to her younger patients) gives ample strategies for adapting our language in her continuing education course Pediatric Incontinence and Pelvic Floor Dysfunction. For example, Dawn emphasizes the importance of describing an episode of incontinence as a “bladder leak” and of pointing out to a child that his or her bladder leaked, rather than the child leaking. She also likes to encourage parents and school personnel to drop the term “accident” from vocabulary. In her 2-day course, Dawn also teaches therapists how to train children to become a “Bladder Boss”, and how to teach young patients about relevant anatomy.

What are you saying when giving directions to men during pelvic floor muscle training, and how do those instructions affect the effectiveness of a contraction? These questions are tackled in a study that is very interesting to therapists working in pelvic dysfunction. 15 healthy men ages 28-44 (with no prior training in pelvic floor training) were instructed to complete a submaximal effort pelvic muscle contraction. Tools utilized to acquire data in the study include those below:

Assessment tool Measuring
Transperineal ultrasound displacement of pelvic floor landmarks
Surface EMG (electromyography) abdominal, anal sphincter muscle activation
Nasogastric transducer intra-abdominal pressure (IAP)
Fine wire electromyography (3 participants only) puborectalis, bulbocavernosus muscles

Participants sat upright on a plinth (backrest reclined at ~20 degrees with their knees extended). Directions for the submaximal efforts were given by telling the men to produce a level 3/10 effort with 10 being a maximal contraction. The men were instructed to hold the contraction for 3 seconds, and they were given 10 seconds rest between each of the 4 contractions using different verbal cues. (This series of 4 contractions was repeated with randomization for verbal cues, with a 2 minute rest in-between.) Verbal instructions were intended to target specific contractile tissues as described below- some of this theory could be validated via the fine wire EMG.

Upcoming Continuing Education Courses

Dec 4, 2015 - Dec 6, 2015
Location: Washington University School of Medicine

Dec 6, 2015 - Dec 8, 2015
Location: Kettering Health

Dec 11, 2015 - Dec 13, 2015
Location: Scripps Memorial Hospital La Jolla

Dec 11, 2015 - Dec 13, 2015
Location: Marathon Physical Therapy

Jan 16, 2016 - Jan 17, 2016
Location: Florida Hospital - Wesley Chapel

Jan 16, 2016 - Jan 17, 2016
Location: Harrison Medical Center-Silverdale Rehabilitation

Jan 29, 2016 - Jan 31, 2016
Location: South University

Jan 30, 2016 - Jan 31, 2016
Location: Cherry Creek Wellness Center

Feb 5, 2016 - Feb 7, 2016
Location: Florida Hospital - Wesley Chapel

Feb 26, 2016 - Feb 28, 2016
Location: Evergreen Hospital Medical Center

Mar 4, 2016 - Mar 6, 2016
Location: Comprehensive Therapy Services

Mar 5, 2016 - Mar 6, 2016
Location: St. Luke’s Hospital Rehab Services

Mar 6, 2016 - Mar 8, 2016
Location: Touro College: Bayshore

Mar 11, 2016 - Mar 13, 2016
Location: Cottage Rehabilitation Hospital

Mar 12, 2016 - Mar 13, 2016
Location: Pacific Medical Center

Mar 12, 2016 - Mar 13, 2016
Location: Texas Children’s Hospital

Mar 18, 2016 - Mar 20, 2016
Location: The George Washington University

Mar 19, 2016 - Mar 20, 2016
Location: One on One Physical Therapy

Mar 19, 2016 - Mar 20, 2016
Location: Mercy Hospital

Apr 1, 2016 - Apr 3, 2016
Location: Marathon Physical Therapy

Apr 1, 2016 - Apr 3, 2016
Location: Mercy Hospital

Apr 2, 2016 - Apr 3, 2016
Location: Anne Arundel Medical Center

Apr 2, 2016 - Apr 3, 2016
Location: Florida Hospital - Wesley Chapel

Apr 8, 2016 - Apr 10, 2016
Location: CentraState Medical Center

Apr 8, 2016 - Apr 10, 2016
Location: Meriter Hospital

Apr 15, 2016 - Apr 17, 2016
Location: Loyola University Stritch School of Medicine

Apr 16, 2016 - Apr 17, 2016
Location: Kima - Center for Physiotherapy & Wellness

Apr 22, 2016 - Apr 24, 2016
Location: Providence St. Josephs Medical Center

Apr 23, 2016 - Apr 24, 2016
Location: The George Washington University

Apr 23, 2016 - Apr 24, 2016
Location: Mizzou Physical Therapy-Rangeline