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I am pleased to report that the world's first "public" demonstration
of a remote evaluation of "private" pelvic floor muscles was a smashing,
resounding success! It worked flawlessly.
On Sunday morning, in front of a large audience at the AAPB Convention
in Raleigh, NC, I conducted a live "evaluation" of the pelvic muscles of
a female “patient” who was sitting in front of her computer in San Jose,
California on the other side of the continent.
Microsoft’s standard “Netmeeting” program provided live two-way audio
and video (“web-cam”) connection, and the TeleVital’s Internet software
provided the biofeedback program – all at the same time. The simultaneous
video and audio were extremely valuable for observing patient postural shifts
and other artifacts that would appear in the EMG graphs. For demonstration
purposes, we used a “wireless” T-1 internet device at the convention hotel,
but the same set up has been used with a 56K dial-up modem with good results.
The pelvic evaluation was conducted using a new “Glazer-Perry Protocol”
designed for evaluating pelvic muscle dysfunctions, such as incontinence
and vulvodynia. In addition, Naras Bhat demonstrated a Cardiac biofeedback
program and Yair Lurie demonstrated an EEG session using the same subject.
The entire demonstration was LCD-projected on a screen for everyone to see.
Some years ago a European Psychlogist commented on a virtue of my then-new
inserted vaginal EMG sensor. Referring to our ability to assess this private
part of the body without invading the patient’s privacy, he said, “It’s
amazing. You can actually ‘be there’ without ‘being there’.” Now it appears
that we can even ‘be there’ from a very safe distance of 3,000 miles.
The system still has some technological “rough edges.” For instance,
there was often a nearly 1-second delay in video updates, and the audio
speakerphone, set up for benefit of the live audience, produced an echo.
But the biofeedback itself functioned flawlessly and the audience was quite
impressed. It should be obvious that modalities that do not require rapid
refresh rates (such as EMG, temp, etc.) easily fit within the available
Internet bandwidth, whereas multi-site EEG is still somewhat constrained.
The TeleVital system presently works with biofeedback hardware from J&J,
Thought Technology, and East3, with more to come. One of these devices is
connected to the patient’s computer’s serial or USB port, and everything
else is handled by JAVA-based software residing on the TeleVital website.
All session data is processed and stored on the TeleVital site as well,
and is available at any time for review by the clinician.
In addition to clinician-to-patient connections, it is also possible
to have a three-way supervisor-clinician-patient set up for therapist training
or supervision purposes. The same set up can also be used by a single patient
for “at home” practice. In that case, the therapist can later log in to
review all the practice graphs and statistics.
In the current programs, the therapist (or the supervisor) can control
the gain and speed (x and y axes) of the display on the fly, and the changes
are immediately reflected on both patient and therapist screens.
Although the technology is ready for prime time, TeleVital is still finalizing
their business plans. Current talk is a credit card, per session fee, or
a “prepaid phone card” model, and this issue should be resolved by the time
you read this.
This technology is especially useful for conditions like vulvodynia,
where trained and experienced clinicians are few and far between. It also
allows collaboration with national experts when a local clinician wants
help with a difficult case.
Another application made-to-order for internet biofeedback is in a university
counselling service setting, where all student dorm rooms are already connected
by fiber optic networks, and all students are required to have computers.
The therapist can “drop in” on each student’s scheduled home practice session
to observe and guide daily training.
Reference: For a demonstration, visit http://www.televital.com
Volume 29, Number 2, page 6 Biofeedback News
Magazine Summer 2001
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