Howard I. Glazer, Ph.D, is a clinical psychologist in New York City with a professional practice limited to the use of surface electromyographic biofeedback in the treatment of pelvic floor muscle dysfunctions and vulvovaginal pain syndromes. He is a clinical associate professor in Obstetrics and Gynecology at Cornell Medical College/New York Hospital, and a member of the International Society for the Study of Vulvovaginal Disease (ISSVD). His background combines neurophysiology/neurochemistry, learning therapy, sex therapy, behavioral medicine and electromyography. He provides individual clinical services, training workshops, in-office specialty training, and he is actively involved in several multidisciplinary and multinational research projects.
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Incontinence is a major healthcare problem costing a conservative estimate of $15 billion, annually, in the USA. This reality is mirrored in countries worldwide. Patients with this problem often lead lives of quiet desperation and social isolation.
Incontinence is among the leading causes of nursing home admission, with approximately 50% of all residents being incontinent. While it is estimated that the number of incontinent geriatric patients can be as high as 80%11, it is more difficult to estimate the incidence in younger populations, though studies by Nygaard show incontinence to be common in young nulliparous women, particularly during physical activities. One Danish study5, conducted with a group of 45-year-old women, found that 22% experienced stress incontinence. It was also noted that only three percent of these women sought medical attention for their problem.
Can you describe your biofeedback protocol?
While working with lower urogenital tract pain patients I had an increasing awareness that previous protocols used for urological and gastrointestinal disorders were not applicable to this patient population. These protocols relied on analysis of muscle amplitude, partly related to the limits of the technology in which relatively slow signal processing limited the output or feedback to amplitude related information. Within the field of biofeedback, surface electromyography still did not fully utilize the range of electro-physiological information available in the electromyographic signal. This simple approach limited our focus to disorders of resting tone and contractile amplitudes as the only dysfunctions. This is a fairly unsophisticated way of working with the muscle, as muscles are in fact much more complex than revealed by simply looking at the overall electrical amplitude generated by an area of muscle under the sensor. Read more...