PROMETHEUS MR-20 Manual

PATHWAY®
MR-20 Dual Channel
EMG System with
Alpha/Numeric LCD Display
(Part #9710)
OPERATOR’S GUIDE

PATHWAY®MR-20 OPERATOR’S GUIDE 1
Made in the U.S.A.

PATHWAY®MR-20 OPERATOR’S GUIDE 2
One Washington Street, Suite 3171
Dover, New Hampshire 03820 U.S.A.
Tel: [phone]
Fax: [phone]
theprogrp.com | [email protected]

PATHWAY®MR-20 OPERATOR’S GUIDE 3
CONTACT INFORMATION
The Prometheus Group®
One Washington Street, Suite 3171
Dover, New Hampshire 03820 U.S.A.
Tel: [phone]
Toll Free: 1-800-442-2325
Fax: [phone]
theprogrp.com | [email protected]
FOR ASSISTANCE, CALL YOUR LOCAL SALES REPRESENTATIVE,
DISTRIBUTOR, OR THE PROMETHEUS GROUP®AT 800.442.2325 IN THE
U.S. AND CANADA
OR [phone] INTERNATIONAL.
FOR TELEPHONE TECHNICAL SUPPORT CALL 800.272.8492
IN THE U.S. AND CANADA
OR [phone] INTERNATIONAL.
Copyright © 2013 The Prometheus Group®. All rights reserved.
This document contains condential and proprietary information that is the
property of The Prometheus Group®, Inc. and is protected by the copyright
laws of the United States, international copyright treaties, and all other
applicable national laws. Any unauthorized use, reproduction or transfer of
any information in this document is strictly prohibited. This document
contains information regarding technology that is protected under one or
more United States patents and other pending United States and foreign
patents. The Prometheus Group®logo and combinations thereof,
Pathway®and Telesis®are registered trademarks of The Prometheus Group®,
Inc., One Washington Street, Suite 3171, Dover, NH 03820. Easytrode™is a
trademark of Multi Bio Sensors Inc. All other brand and product names are
used for identication only and are the property of their respective holders.
Specications are subject to change without notice.
Printed in the U.S.A.
52_075bEN

PATHWAY®MR-20 OPERATOR’S GUIDE 4
One Washington Street, Suite 3171, Dover, NH 03820
[e-mail] | theprogrp.com | Phone: [phone] | Fax: [phone]
Dear Valued Customer,
On behalf of The Prometheus Group®, we would like to personally thank
you for your recent purchase.
The Prometheus Group® is recognized for providing exceponal
products, outstanding customer service, and unparalleled technical
support.
Because our goal is to build a long-term partnership with your company,
our dedicated team is here to make sure you get the most from your
investment.
Feel free to contact our technical support team to answer any
quesons that you may have concerning the installaon or operaon of
your equipment. Our products are user friendly, and most training and
quesons can be handled eecvely over the phone.
The technical support line may be used as an invaluable tool at your
convenience.
We value our relaonship and look forward to working with you and
your company for years to come.
Respecully,
The Prometheus Group® Technical Support Team
Celebrating
1989
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Est.
Technical Support:
Tech Support Phone:
1-800-272-8492
Tech Support Email:
[email protected]
Fax: [phone]
Our support team is
available Monday - Friday,
between 8:30 AM - 5:00 PM EST.
There is never a charge for
Telephone Technical
Support.

PATHWAY®MR-20 OPERATOR’S GUIDE 5
TABLE OF CONTENTS
NOMENCLATURE..........................................................................................7
SERVICE INFORMATION..............................................................................7
INDICATIONS FOR USE................................................................................8
CONTRAINDICATIONS..................................................................................8
CHAPTER 1: PHYSICAL/MECHANICAL OVERVIEW..................................13
Front and Bottom Panels............................................................................13
Top Panel....................................................................................................14
Rear Panel..................................................................................................15
Installing & Replacing the Battery...............................................................16
Pathway®Electrodes (Part #6750).............................................................17
Pathway®Adapter (Part #3660)..................................................................19
Pathway®Intracavity Sensors.....................................................................20
Pathway®Vaginal EMG/Stimulation Sensor (Part #6330)..........................20
Pathway®Vaginal/Rectal EMG Sensor (Part #6320)..................................20
Pathway®Rectal EMG/Stimulation Sensor (Part #6340)............................22
24” Electrode Lead Wire Set (Part #5328)..................................................23
Disposable Lead Wire Electrodes (Part #7400)..........................................25
Display Modes.............................................................................................27
Start-up Display...........................................................................................27
Standard Modes..........................................................................................29
Goals...........................................................................................................29
STIM............................................................................................................32
CHAPTER 2: OPERATION...........................................................................27
CONNECTING THE PATHWAY®PREAMPLIFIER CABLES
(PART #2583) TO:
Cautions.......................................................................................................8
Warnings and Prohibitions...........................................................................9
Contents of Kit............................................................................................12
APPLICATIONS..............................................................................................8

PATHWAY®MR-20 OPERATOR’S GUIDE 6
Max Display................................................................................................32
Ratio Display Mode....................................................................................34
Special Functions Chart.............................................................................35
Selecting WORK/REST MODE..................................................................36
Display Data...............................................................................................38
Clear Data..................................................................................................40
Response Time..........................................................................................41
Obsolete Functions....................................................................................35
Lock Mode.................................................................................................42
CONNECTING THE PATHWAY®MR-20 TO A COMPUTER....................45
Software Available.....................................................................................43
Telesis®Software for the Pathway®MR Series (Sold Separately).............43
Recall Mode..............................................................................................45
CHAPTER 3: TROUBLESHOOTING...........................................................46
Erratic Readings........................................................................................46
High Baseline Readings............................................................................48
Battery Check............................................................................................49
Lock Mode.................................................................................................49
Pathway®MR-20 Care and Maintenance..................................................50
Storage.......................................................................................................50
Cleaning....................................................................................................51
CHAPTER 4: PATHWAY®MR-20 TECHNICAL SPECIFICATIONS.............52
To Order Accessories.................................................................................53
Quick Reference Guide..............................................................................54
STANDARD WARRANTY SERVICE AGREEMENT..................................55

PATHWAY®MR-20 OPERATOR’S GUIDE 7
NOMENCLATURE
SERVICE INFORMATION
In this Operator’s Guide, NOTES, CAUTIONS, and WARNINGS are included,
which have the following implications.
CAUTION: There are no serviceable parts within this device.
The user should not attempt to service the instrument beyond that
described in the Pathway®MR-20 Operator’s Guide. Refer all other
servicing to The Prometheus Group® qualied Technical Support
personnel. Please call 1-800-272-8492 in the U.S.A. and Canada, or
[phone] international, or e-mail
[email protected].
The device should be serviced by The Prometheus Group®
qualied Technical Support personnel when:
• Any cable, cord, or plug has been damaged.
• The device does not appear to operate normally or exhibits a
marked change in performance.
• The instrument has been dropped, or the casing is damaged.
• Fluid has been spilled on the device, or it has been immersed,
and it appears that uid has entered the housing.
CAUTION: A hazard to a piece of equipment or property –
for example, potential for an electrical short, water damage, or some
other danger to the equipment but not the operator or patient. Can
also be a reference to HIPAA or another medical legal requirement.
WARNING: A hazard to a person - a potential danger to the operator
or patient such as electrical shock or some other potential danger.
GENERAL PROHIBITION: To signify a prohibited action.
NOTE: A procedural emphasis - usually something regarding preparation for
a process or a reminder that some bit of information recorded here will be
used later for another purpose.

PATHWAY®MR-20 OPERATOR’S GUIDE 8
INDICATIONS FOR USE
CONTRAINDICATIONS
APPLICATIONS
CAUTIONS
Surface electromyography is a safe and effective technique for relaxation
training and muscle re-education.
When using internal sensors such as the Pathway®Vaginal EMG Sensor:
EMG biofeedback is a safe and effective technique for the assessment and
treatment of pelvic oor dysfunction and monitoring the performance of Kegel
exercises. The pelvic oor muscles include the levator ani group as well as
the pubococcygeus (PC), iliococcygeus, and coccygeus. These are skeletal
muscles which respond to re-education, strengthening, endurance training,
and relaxation. Conditions that can be assessed or treated using this
technique include stress incontinence, mixed incontinence,
and urge incontinence.
Do not use this device for treatment of incontinence in the presence of:
bladder infection, vaginal infection, or during pregnancy.
For Pelvic Floor and Orthopedic rehabilitation.
Prior to using this device, be sure to read the Pathway®MR-20 Dual
Channel EMG System with Alpha/Numeric LCD Display Operator’s
Guide for installation, maintenance, cleaning, technical data,
service, and warranty information.
Federal law (USA) restricts this device for sale by or on the order of
a licensed medical practitioner, licensed by law in the state in which
they practice.

PATHWAY®MR-20 OPERATOR’S GUIDE 9
CAUTIONS (CONTINUED)
WARNINGS & PROHIBITIONS
When using the Pathway®MR-20 device with Telesis®software, be
sure that the USB Serial Interface Cable is no longer than 3 meters,
as it may affect EMG readings and data transmission.
Skin irritation may develop beneath or around electrode sites.
This device is NOT intended for use with anesthetic gases mixed
with air, oxygen or nitrous oxide. Danger of electrical ignition.
Be sure to read this operator’s manual before using this device.
Use by improperly trained personnel or non-licensed healthcare
professionals may cause damage to the equipment or harm to the
patient.
Use only electrodes and accessories from The Prometheus Group®
with the Pathway® MR-20 device. Any other electrodes or
accessories may not be compatible with the Pathway®MR-20 device
and will void the device warranty.

PATHWAY®MR-20 OPERATOR’S GUIDE 10
WARNINGS & PROHIBITIONS (CONTINUED)
DO NOT immerse any part of this device in any uid.
To reduce the risk of electrical shock, DO NOT connect any
preamplier, lead wire, electrode, or any other component to a wall
outlet.
DO NOT leave electrodes attached when device is not in use.
To reduce the risk of electrical shock, DO NOT open the
device housing. Refer all servicing to The Prometheus Group®
qualied Technical Support personnel.
DO NOT prematurely unpack electrodes as prolonged exposure to
air may cause the electrode adhesive to dry out.
DO NOT use electrodes or other consumables with an expired
shelf-life.
DO NOT clean and re-use single use consumables such as
electrodes.
DO NOT clean and re-use single patient use sensors on multiple
patients. Please refer to the instructions included with each sensor.
Disassembly of equipment by anyone other than The Prometheus
Group® qualied Technical Support personnel will void the device
warranty.

PATHWAY®MR-20 OPERATOR’S GUIDE 11
Use only heavy-duty 9V alkaline batteries with this device, DO NOT use
any type of line-powered adapter.
For the treatment of relaxation training and muscle re-education.
DO NOT attempt to use this device simultaneously with stimulation being
supplied from an electrical muscle stimulator.
WARNINGS & PROHIBITIONS (CONTINUED)

PATHWAY®MR-20 OPERATOR’S GUIDE 12
CONTENTS OF KIT
Before using the Pathway® MR-20 for the rst time, carefully open the box and
conrm that all equipment and accessories listed below are included and agree with the
packing list or invoice. If there are questions about the contents,or you wish to
order additional supplies, please call Customer Service, Toll-Free: 1-800-442-2325 in
the U.S.A. and Canada, [phone] international, or Fax: [phone].
Customer Service Representatives are available between 8:30 AM and 5:00 PM EST.
The Pathway®MR-20 kit contains the following items:
(1) Pathway®MR-20 Dual Channel EMG System with Alpha/Numeric LCD
Display Module providing Two Channels of EMG
(1) Operator’s Guide
(1) Carry Pouch
(1) Heavy-Duty 9V Alkaline Battery
Starter Accessory Package:
(2) – Pathway® Preamplier, Available in White or Gray, 5’ (Part #2583)
(1) – Pathway®Electrodes Sample Packet, (Rectangular, 3 Snaps in a Row Style)
(Part #6750)

PATHWAY®MR-20 OPERATOR’S GUIDE 13
Front and Bottom Panels
CHAPTER 1: PHYSICAL/MECHANICAL OVERVIEW
The device pictured above is the Pathway®MR-20 Dual Channel EMG System with
Alpha/Numeric LCD Display. Note EMG input Channels A & B.
EMG A: Is the primary EMG Channel and the input for the Pathway® Preamplier
(Part #2583).
EMG B: Is the secondary or accessory EMG Channel and the input for the Pathway®
Preamplier (Part #2583).
Dual Channel LCD Display (Bar Graph): Displays Channel options, moving bar
graphics, goal level, goal direction, and microvolt levels.
Four LED Indicator Lights: To signal goal success.
Up and Down Arrow Keys: Two sets of Up and Down Arrow Keys to position the goal
arrow on the LCD display for each Channel.
Channel “A” and Channel “B” Keys: Dene display type, direction, and control
special functions.
EMG A
EMG B
Four LED Indicator Lights
Up and Down Arrow Keys
for Channel A
Up and Down Arrow Keys
for Channel B
Dual Channel LCD Display
(Bar Graph)
Channel “A” Key
Channel “B” Key

PATHWAY®MR-20 OPERATOR’S GUIDE 14
Top Panel
CHAPTER 1: PHYSICAL/MECHANICAL OVERVIEW
ON/VOL OFF: This thumbwheel switch turns the power on and off and adjusts the
volume. Looking directly at the front panel of the Pathway®MR-20, power the device
on by rotating the thumbwheel switch clockwise and power off by rotating the switch
counterclockwise.
PHONE: This output allows the user to connect an optional headset with a mono mini
plug and will allow the audio feedback to be heard only by the person wearing the
headset.
STIM OUT: This output requires a stimulation interface cable (not included), and will
accept any functional stimulator that has an accessory or manual input jack for
activating EMG controlled stimulation. A FUNCTIONAL STIMULATOR IS A
SEPARATE DEVICE FOR STIMULATION AND IS NOT AVAILABLE FROM THE
PROMETHEUS GROUP®.
NOTE: The Pathway®MR-20 DOES NOT produce electrical stimulation.
SERIAL (Computer Interface): Interfaces the Pathway®MR-series device to the
laptop or desktop computer using the provided USB cable, (if purchased with
software).
Red LED Indicator Light: Indicates that a serial connection has been established
via the USB cable. It does not indicate power to the device.
Red LED Indicator Light
PHONE
STIM OUT
ON/VOL OFF
Thumbwheel
Switch
SERIAL
(Computer Interface)

PATHWAY®MR-20 OPERATOR’S GUIDE 15
Rear Panel
CHAPTER 1: PHYSICAL/MECHANICAL OVERVIEW
The serial number of the device is located inside the battery compartment. See above
diagram for exact location.
Durable clip for a secure hold
The above image is a close up view of the battery compartment with the serial
number location highlighted.
Serial Number Locaon

PATHWAY®MR-20 OPERATOR’S GUIDE 16
Installing and Replacing the Battery
CHAPTER 1: PHYSICAL/MECHANICAL OVERVIEW
To install or change the battery, remove cover by pressing down on the designated
area of the compartment cover and slide it in the direction indicated. Place the new
battery in compartment, noting orientation of battery terminals. Replace the cover,
snapping rmly into place. Each heavy-duty 9V alkaline battery should last 20-25
hours.

PATHWAY®MR-20 OPERATOR’S GUIDE 17
CHAPTER 1: PHYSICAL/MECHANICAL OVERVIEW
Cable Connections for Orthopedic: Connecting the Pathway®
Preamplier(s) (Part #2583) to Pathway®Electrodes (Part #6750)
Pathway® Preamplier, Available in White
or Gray, 5’ (Part #2583)
Pathway®Electrode (Rectangular, 3 Snaps
in a Row Style) (Part #6750)
To obtain best EMG results, the following steps should be taken:
Connecting the Pathway® Preamplier(s) to the Pathway®MR-20: First, plug the
Pathway® Preamplier(s) connector ends into the corresponding inputs for EMG A and
EMG B on the Pathway®MR-20.
NOTE: The Pathway® Preampliers (Part #2583) are color coded white
and gray. Either preamplier can be used for EMG A or EMG B.
EMG A: To monitor primary muscle
EMG B: To monitor secondary muscle

PATHWAY®MR-20 OPERATOR’S GUIDE 18
CHAPTER 1: PHYSICAL/MECHANICAL OVERVIEW
Connecting Pathway®Electrode(s) to Pathway® Preamplier(s): The Pathway®
Preampliers (Part #2583) have three female snap on electrode positions: two labeled
(ACT) for active electrodes and one (GND) for the ground electrode. Verify the male
tabs of the Pathway®Electrodes (Part #6750) are snapped into the corresponding
female snaps of the Pathway® Preamplier (Part #2583).
Skin Preparation: Prepare the skin with an alcohol pad to avoid high impedance
artifact. Wipe dry with a tissue or cloth.
Pathway®Electrode Preparation: With the Pathway®Electrode (Part #6750)
attached to the Pathway® Preamplier (Part #2583), use the white tab on the Pathway®
Electrode (Part #6750), to carefully remove the mylar backing being cautious to keep
the hydrogel adhesive strips intact on the surface of the electrode.
Pathway®Electrode Placement: Place the two active (ACT) electrodes over the bulk
of the muscle. Make sure the length of the Pathway®Electrode (Part #6750) is placed
parallel with the muscle bers as shown in Figure 1 below.
Figure 3. Figure 4.
Cable Connections for Orthopedic: Connecting the Pathway®
Preamplier(s) (Part #2583) to Pathway®Electrodes (Part #6750)
Example: Electrode Placements for VMO / VL Deciency
Back of Electrode
Hydrogel Strips
Figure 1. The preferred electrode location is between the
motor point (or innervation zone) and the tendinous insertion,
with the detection surfaces arranged so that they intersect as
many muscle bers as possible.
Tendinous insertion
Electrode
Muscle Fibers
GND ACT ACT
Sensing Surfaces of Pathway®
Electrode (Part #6750)
Figure 2. Back of Pathway®
Electrode (Part #6750) showing
placement of sensing surfaces
and adhesive gel strips.
EMG A Placement
The electrode for EMG A is placed
over the bulk of the VMO
(Vastus Medialis Oblique)
and runs parallel to
the muscle bers.
Leg - Head on view
(Primary Muscle)
EMG B Placement
The electrode for
EMG B is placed over the bulk
of the VL (Vastus Lateralis)
and runs parallel to the
muscle bers.
(Secondary Muscle)
Leg - Side prole view

PATHWAY®MR-20 OPERATOR’S GUIDE 19
CHAPTER 1: PHYSICAL/MECHANICAL OVERVIEW
Cable Connections for Internal Pelvic Floor: Connecting the Pathway®
Adapter (Part #3660) to the Pathway®Intracavity Sensors (Part #6330,
Part #6320, and Part #6340)
Pathway®Adapter (Part #3660)
When connected with the Pathway® Preamplier, (Part #2583), the Pathway®Adapter
(Part #3660) allows the EMG device to accept the intracavity sensors or an electrode
lead wire set.
To obtain best EMG results, the following steps should be taken:
EMG A: To monitor primary muscle
EMG B: Accessory muscle placement:
Commonly monitored accessory muscles
include abdominals, leg adductors, & gluteals
Pathway®Adapter
(Part #3660)