Product in the Spotlight - MAPLe, THE SMARTEST AMONG THE EMGs
Author: Nynke Feenstra
The new EMG device MAPLe has a probe to record in the vagina or anus the activity of the pelvic floor muscles at 24 points. This allows the therapist to diagnose more accurately and treat more goal-oriented, according to the manufacturer Novuqare. One of the first pelvic floor therapists to work with the MAPLe, is Judith Jesterhoudt. She works at the Expertise Centre for Pelvic Floor Disorders PelvicMotion in Naarden. What are the experiences with MAPLe so far?
You are working with the MAPLe since November 2014. How many patients did you treat with it since?
“My colleague and I used it in about 40 patients. We already stopped using the standard EMG equipment as it only measures an average muscle activity of the whole pelvic floor and that’s no use to us. We had switched to echography. The MAPLe is a huge improvement. I can now see exactly which muscle layer is overactive and which piece of muscle hardly does anything.”
Have you observed yet that you achieve better results with the MAPLe?
“Not for all types of pelvic dysfunctions, but I did in patients with tail bone pain for instance. After childbirth such a complaint can arise sometimes and the general practitioner or the company doctor cannot find anything upon examination. For tail bone pain we insert the probe anally. I had a patient with tail bone pain in whom I couldn’t see anything abnormal as long as she was laying on the treatment table. But as soon as she stood up or sat down on a chair, the pain came on. On the iPad we saw the innermost ring in the lower quadrant (see Figure 2) blacken. This means that the levator ani and coccygeus muscles pulled at the tail bone tremendously. On the screen I showed the patient what happened in her pelvic floor, which provides insight. What’s more, with electrostimulation I could show her the location of the piece of muscle she had to release. Thus, the patient discovered how she could release that muscle. For support she received relaxing electrostimulation with the MAPLe which reduced the pain.”
According to the supplier ‒ Novuqare ‒ the MAPLe improved the treatment of an overactive bladder significantly. Is that your experience, too?
“Up to now, we used the MAPLe for treating five patients with an overactive bladder. You can turn the probe in such a way that the urethra will come to lie exactly between two electrodes. If you stimulate the area around the urethra with only those two electrodes, it has a soothing effect on the nerve structures that convey to the brain the stimulus ‘I have to pee’. After just three or four treatments these five patients felt much less urge. The uncomfortable feeling had gone.”
Do you have such good results in the treatment of incontinence as well?
“Incontinence is more complicated. For instance, in a patient who was incontinent of faeces we saw on the MAPLe that the deeper muscle layers worked too hard and the internal anal sphincter did hardly anything. What exactly was the problem? Did those deeper muscle layers push the stool out? Or was the weak sphincter the cause of the problem? Then you are faced with the question, what is better: first strengthen the internal sphincter and then work on relaxing the deeper muscle layers? Or the other way round? That is new. The MAPLe makes you as a therapist think: what am I doing? The patient also needs to be able to handle the information given to him or her through the MAPLe. So, with regard to incontinence we are still figuring out what we can do with the new information. I see the MAPLe as a tremendous improvement of our profession.”
MAPLe-probe
The MAPLE probe is shaped like a long tampon. During the therapy session, the probe is inserted in the vagina or the anus. In the MAPLe probe the electrodes recording muscle activity are located in the front, at the back, on the left and on the right. The measurement is not only all around but also from bottom to top. The muscle activity will be therefore measured at 24 spots in total.
Reading the measurement results
The measurement results are being visualized on an iPad in two ways. With a line and with circles.
The four quadrants represent the front, the back, the left and the right of the lower part of the body. You look as if through a funnel. Which parts of the pelvic floor muscles are active or inactive? Black is very active. For the grayscales applies: the lighter, the less active.
