Dr. Glazer’s sEMG assessment protocol offers insight into lower urogenital and gastro-intestinal disorders where pelvic floor musculature is involved. The Glazer assessment protocol consists of voluntary muscle contractions, with intervening rest periods. The entire muscle evaluation process takes approximately seven minutes and the procedure is painless.
Howard I. Glazer, Ph.D, was 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 was a clinical associate professor in Obstetrics and Gynecology at Cornell Medical College/New York Hospital, and was a member of the International Society for the Study of Vulvovaginal Disease (ISSVD). His background combined neurophysiology/neurochemistry, learning therapy, sex therapy, behavioral medicine and electromyography. He provided individual clinical services, training workshops, in-office specialty training, and he was actively involved in several multidisciplinary and multinational research projects.
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Prostate cancer is one of the most prevalent cancers in western countries and is the third leading cause of death in men. Radical Prostatectomy (RP) is the gold-standard treat-ment for prostate cancer. One of the biggest concerns regarding RP is urinary incontinence (UI). Depending on the definition, UI occurs in 8% to 87% of patients who undergo RP.
Vulvodynia is a descriptive, not a diagnostic, term covering a wide range of disorders which have, as one component, pain in the vulvar area. Vulvar pain can arise from many sources. In no other area of biofeedback practice, is it more important to rule out all medical reasons for the symptoms prior to commencing treatment, and to treat patients only under prescription from a specialty physician, not on self-referral. While there are many acute problems that may initiate or prolong introital dyspareunia (pain on vaginal penetration) or vulvar burning sensations, you will probably be referred only the chronic cases. If there are still acute problems present, these must be remedied prior to further treatment. Gynecological sources of vulvovaginal discomfort include vaginal infections, fungal (a wide range of yeast overgrowth includes hundreds of identified species) or bacterial (Bacterial Vaginiosis). These infections cause changes in the vaginal ecosystem such that vaginal discharge is highly irritative to the vulvar tissue. Another major source of vulvar discomfort is hormone related and occurs perimenopausally and post menopausally. Estrogen deficiency frequently leads to a thinning of vulvar tissue with consequent irritation. Dermatological sources of vulvar discomfort include a variety of conditions involving vulvar tissue changes such as lichen simplex chronicus, lichen planus and lichen sclerosis.
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...
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