Patent Publication Number: US-2023139116-A1

Title: System and method for pelvic floor feedback and neuromodulation

Description:
CROSS-REFERENCE TO RELATED APPLICATION 
     The present application claims the benefit of priority under 35 U.S.C. § 119(e) to U.S. Provisional Patent Application Ser. No. 62/826,548, entitled “SYSTEM AND METHOD FOR PELVIC FLOOR FEEDBACK AND NEUROMODULATION,” filed on Mar. 29, 2019, the disclosure of which is hereby incorporated by reference in its entirety for all purposes. 
    
    
     BACKGROUND 
     Electromyograph (EMG) biofeedback utilizes real time measurements of muscle contraction and relaxation via measurement of action potentials to allow a user to gain control over those muscles. EMG therapy has applications related to a large range of patient complaints, including neurologic and musculoskeletal pain, tension headaches, cerebral palsy, and urinary and fecal incontinence, in addition to many others. 
     Typically the equipment utilized to perform biofeedback has been an array of electrodes placed on the muscle group of interest, which are connected to a receiver or receiver type device that amplifies the signals from the muscles and presents it back to the patient in either an audio or visual signal. This equipment comes in a variety of forms, but the receiver is typically a multifunctional computer, which limits the application of EMG biofeedback in terms of space. In addition, the sensor electrodes must be placed by someone with training in EMG biofeedback, or the patient themselves must be taught to place them. Therefore, there is a need for EMG biofeedback equipment that overcomes these deficiencies. 
     The description provided in the background section should not be assumed to be prior art merely because it is mentioned in or associated with the background section. The background section may include information that describes one or more aspects of the subject technology. 
     SUMMARY 
     According to some implementations, a computer-implemented method provides for pelvic floor feedback. The method includes capturing a strength of action potentials via wireless sensors. The wireless sensors may be positioned proximate to a pelvic floor of a user. The method also includes transmitting the strength of the action potentials to a mobile device. The method also includes recording the strength of the action potentials on the mobile device. 
     According to some implementations, the method may also include capturing controlled contractions and relaxations of a target muscle group of the pelvic floor of the user. The method may further include comparing the controlled contractions and relaxations of the target muscle group with performance of other users. The method may further include comparing the controlled contractions and relaxations of the target muscle group with a previous performance of the user. The method may further include creating an online gaming environment via a remote server where a user may compete against other users interacting via other mobile devices connected to the remote server. 
     According to some implementations, a system provides for pelvic floor feedback. The system may include a memory storing computer-readable instructions and a processor. The processor is configured to execute the computer-readable instructions, which when executed carry out a method. The method includes capturing a strength of action potentials via wireless sensors. The wireless sensors may be positioned proximate to a pelvic floor of a user. The method also includes transmitting the strength of the action potentials to a mobile device. The method also includes recording the strength of the action potentials on the mobile device. 
     According to some implementations, the memory may also store computer-readable instructions, which when executed cause the processor to capture controlled contractions and relaxations of a target muscle group of the pelvic floor of the user. The memory may further store computer-readable instructions, which when executed cause the processor to compare the controlled contractions and relaxations of the target muscle group with performance of other users. The memory may further store computer-readable instructions, which when executed cause the processor to compare the controlled contractions and relaxations of the target muscle group with a previous performance of the user. The memory may further store computer-readable instructions, which when executed cause the processor to create an online gaming environment via a remote server where a user may compete against other users interacting via other mobile devices connected to the remote server. 
     According to some implementations, a device for pelvic floor feedback includes an adjustable housing comprising a garment or a saddle. The device also includes a plurality of sensors coupled to the housing, the plurality of sensors positioned at locations for facilitating pelvic floor neuromodulation and/or electromyograph (EMG) biofeedback with a user. The device also includes a transmitter coupled to the plurality of sensors through the housing, the transmitter comprising a Bluetooth Low Energy (BLE) device. 
     According to some implementations, the plurality of sensors are arranged in a sensor array comprising opposing pairs of sensor electrodes. The plurality of sensors may include at least one pair of elongated electrodes. Each electrode in the pair of elongated electrodes is between about 3.5″ to about 4.5″ long, and between 0.75″ and about 1.25″ wide. The plurality of sensors may be positioned in the housing, such that when the housing is mounted by a user, the sensors are positioned adjacent to a user&#39;s pudendal nerve and/or perineal nerve. The plurality of sensors may be included on a disposable flexible circuit comprising a polyethylene terephthalate (PET) substrate. 
     According to some implementations, the garment may include leg holes such that the plurality of sensors are located between the leg holes. According to some implementations, the transmitter may be coupled to a patient interface. 
     According to some implementations, the adjustable housing may include a bridge comprising at least one spring hinge. The saddle may include a pillow having a pressure to compress 25% of between 0.6 and 4.0 psi. 
     According to some implementations, the device may also include an amplifier configured to apply a neuromodulation signal to at least a subset of the plurality of sensors. The device may further include a multiplexer configured to select a set of the plurality of electrodes receiving the greatest magnitude electrical signal. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The accompanying drawings, which are included to provide further understanding and are incorporated in and constitute a part of this specification, illustrate disclosed embodiments and together with the description serve to explain the principles of the disclosed embodiments. In the drawings: 
         FIG.  1    is a back view of a garment with embedded technology for pelvic floor biofeedback, including a sensor array and spring action bridge within a sleeve, according to some implementations. 
         FIG.  2    is a lateral view of a garment with embedded technology for pelvic floor biofeedback according to some implementations. 
         FIG.  3    is a front view of a garment with embedded technology for pelvic floor biofeedback, including a sensor array and spring action bridge within a sleeve, according to some implementations. 
         FIG.  4    is a top view of saddle with locations for placement of a sensor array according to some implementations. 
         FIG.  5    is a side view of saddle with locations for placement of a sensor array according to some implementations. 
         FIG.  6    is a front view of saddle according to some implementations. 
         FIG.  7    is a schematic diagram of a sensor array with outputs connected to a multiplexer, according to some implementations. 
         FIG.  8    is a top view of an alternative configuration of a saddle with positions of a sensor array, according to some implementations. 
         FIG.  9    is an end view of an alternative configuration of a saddle according to some implementations. 
         FIG.  10    is a side view of an alternative configuration of a saddle with positions of a sensor array, according to some implementations. 
         FIG.  11    is a bottom view of a bridge spring mechanism with plates for sensors, according to some implementations. 
         FIG.  12    is an end view of a bridge spring mechanism, demonstrating movement of arms of a bridge hinging away from a spring mechanism, according to some implementations. 
         FIG.  13    is a diagram illustrating exemplary nerves, muscles, and ligaments with which aspects of the present disclosure may be implemented. 
         FIG.  14    is a diagram illustrating deployment of electrodes on exemplary nerves, muscles, and ligaments according to some implementations. 
         FIG.  15    is a schematic diagram of a sensor array with outputs connected to a multiplexer, according to some implementations. 
         FIG.  16    is a diagram of a disposable flexible circuit, according to some implementations. 
         FIG.  17    is a diagram of an exemplary generated user interface (GUI) according to some implementations. 
         FIG.  18    illustrates an example flow diagram for pelvic floor feedback and neuromodulation according to some implementations. 
         FIG.  19    is a block diagram illustrating an example computer system with which aspects of the subject technology may be implemented. 
     
    
    
     In one or more implementations, not all of the depicted components in each figure may be required, and one or more implementations may include additional components not shown in a figure. Variations in the arrangement and type of the components may be made without departing from the scope of the subject disclosure. Additional components, different components, or fewer components may be utilized within the scope of the subject disclosure. 
     DETAILED DESCRIPTION 
     The disclosed systems, methods, and devices provide for the application of EMG-based biofeedback for tracking and treatment of a variety of muscular and neurologic disorders. Specifically, an EMG-based biofeedback system is designed to be used with widely available mobile computing devices for implementing a system of gamification to allow competition amongst treatment groups. By detecting and/or stimulating nerves and/or muscles around a patient&#39;s anal region and/or pudendal nerve, the patient may be trained to overcome associated muscular and neurologic disorders of those regions. 
     The disclosed systems, methods, and devices address a problem in traditional EMG biofeedback techniques, namely, the technical problem of application of EMG biofeedback to patients. The disclosed system solves this technical problem by providing for systems, methods, and devices that measure and provide improved EMG biofeedback. The disclosed subject technology further ensures proper placement of sensors in a portable solution, without the need for professional training. 
       FIGS.  1 - 3    illustrate a garment  100  with embedded technology  102  for pelvic floor biofeedback, including a sensor array  104  with a spring action bridge  112  within a sleeve  106 , according to some implementations. The sensor array  104  may include sensors  108  arranged in pairs along a longitudinal axis of the sleeve  106 . For example, the sensor array  104  may be contained within the sleeve  106  between leg holes  110  of the garment  100 . 
     The garment  100  may be worn on the lower part of a patient&#39;s body. The garment  100  may be adjustable to fit different users. The sleeve  106  may be specifically designed to allow the sensor array  104  to be inserted or sewn into the garment  100 . For example, the sleeve  106  may be included along a central longitudinal axis of the garment  100  to allow proximate positioning of the sensor array  104  along the levator ani muscle group (e.g., urinary and fecal sphincters). 
     The garment  100  may be made of a mesh conductive material or may include conductive material inside of sensor pockets to allow for increased function of the sensors  108 . For example, the conductive material may include silver/nylon fabric. The sensors  108  may be included within pockets to allow for specific targeting of various muscle groups local to the urinary and fecal sphincters. The mesh garment  100  may also include electrically non-conductive material, such as polyester, in desired locations to reduce detection from adjacent muscle groups. 
     The sensors  108  may be directly wired to a transmitter  116  within the garment. The sensors  108  may be configured to sense and/or modulate/stimulate muscle movement/contractions. The transmitter  116  may be configured to communicate wirelessly, such as via Bluetooth, to a mobile device. For example, in users undergoing pelvic floor biofeedback, the garment  100  could include mesh underpants with sensor pockets (e.g., sleeve  106 ) sewn near a center length, such that when the user puts them on, the sensors  108  may be positioned proximate to the anal sphincter or the pudendal nerve. A bridge mechanism  112  that causes the sensors  108  to be forced into the gluteal cleft, along the longitudinal axis of the levator ani muscle, may be included to improve sensor-skin contact. For example, the bridge mechanism  112  may be included within the sleeve  106  onto which the sensor array  104  is placed. The bridge mechanism  112  may include a spring that causes the sensors  108  to be forced into the gluteal cleft to improve contact of the sensors  108  with the skin of the patient. The garment  100  may further include a ground electrode  114  against which sensed electrical activity is compared. 
     In some implementations, the transmitter  116  may include a Bluetooth Low Energy (BLE) enabled device that is embedded in the garment  100  that receives muscle action potential data from the sensors  108  of the sensor array  104 . The BLE enabled device may also receive and amplify signals from the wireless sensors  108  and interface with a mobile device via a BLE connection. For example, a downloadable software system on the mobile device may be configured to interact with the BLE device  116  within the garment to display the signals passed from the embedded sensors  108  onto the screen of the mobile device. In this way the patient may monitor results from the muscle groups of interest. A battery  120  may provide power to the electrical elements of the garment  100 . 
       FIGS.  4 - 6    illustrate a saddle  200  with positions  202  of a sensor array  206  according to some implementations. The saddle  200  may be configured to be sat upon by a patient, such that the patient&#39;s urinary and fecal sphincters are in contact with the sensors  204  of the sensor array  206 . The saddle  200  may be adjustable to fit different users. Similar to the garment  100  described above, the saddle  200  may be made of a mesh conductive material or may include conductive material inside of sensor pockets  202  to allow for increased function of the sensors  204 . For example, the conductive material may include silver/nylon fabric. The sensors  204  may target various muscle groups local to the urinary and fecal sphincters. The mesh garment  100  and saddle  200  may also include electrically non-conductive material, such as polyester, in desired locations to reduce detection from adjacent muscle groups. 
     The sensors  204  may be configured to sense and/or modulate/stimulate muscle movement/contractions. The sensors  204  may also be directly wired to a transmitter  208  coupled to the saddle  200 . As illustrated, the transmitter  208  may be located at various locations on the saddle  200 . The transmitter  208  may be configured to communicate wirelessly, such as via Bluetooth, to a mobile device. The saddle  200  may also include sensors  204  embedded within the upper surface of the saddle  200 , on which the patient sits during treatment. The saddle  200  may also include a bridge  210  that facilitates contact of the sensors with the gluteal cleft and along the longitudinal axis of the levator ani muscle A battery  220  may provide power to the sensors  204  of the saddle  200 . 
       FIG.  7    is a schematic diagram of a sensor array  300  (e.g., sensor array  104 ) with outputs connected to a multiplexer  302 , according to some implementations. For example, the multiplexer  302  may be coupled output signals of multiple sensors  304 , which may be contained within the garment  100  or saddle  200  of  FIGS.  1  and  2   . As illustrated, the garment  100  and the saddle  200  include locations for sensors  108 ,  204 . It is understood that the sensor array  300  may be located at these locations. The multiplexer  302  may also include an output signal connected to a Bluetooth enabled device (e.g., transmitter  116 ) embedded in the garment  100  or saddle  200 . 
     In some implementations of the present disclosure, the multiplexer  302  may include a 4 to 1 multiplexer having four inputs and one output. The multiplexer  302  may also include inputs for c1 and c2 inputs (e.g., control signals). In some embodiments, the multiplexer  302  may have any number other inputs, for example up to 8 or 16 inputs, with one output, or in some implementations multiple outputs. 
     In some implementations of the present disclosure, the sensor array  300  may include pairs of electrodes  306 . For example, each pair of electrodes  306  may include two sensors  304 , which may be coupled to an input of the multiplexer  302 . Each pair of electrodes  306  may be configured to sense and/or modulate/stimulate muscle movement/contractions. The pairs of electrodes  306  may be arranged in series. The multiplexer  302  is configured to select for output from the received input signals, the signal having the greatest amplitude. It is assumed that this greatest amplitude is due to the closest proximity to the desired tissue to be monitored. Each electrode may be generally circular in shape (though other regular or irregular shapes may also be used) with a diameter of between about 0.75″ and 1.25″, e.g., 1.0″. The distance between opposing electrodes across the linear axis of the sensor array may range from about 0.75″ to about 1.5″, e.g., 1.0″. 
       FIGS.  8 - 10    illustrate an alternative configuration of a saddle  400  (e.g., a pillow) with positions of a sensor array  402  (e.g., sensor array  104 ), according to some implementations. For example, the saddle  400  may be cylindrical in shape, with a circular cross-section (as shown in  FIG.  9   ). The saddle  400  may include positions for a sensor array (e.g., openings for sensing electrodes  402 , openings or modulation stimulation electrodes  408 ). The sensor array may include the above-described sensor array  104  in  FIGS.  1 - 7   . The positions  402 ,  408  may be located evenly around a circumference  404  of the saddle  400 , as illustrated in  FIGS.  8  and  10   . The sensors  406  of the sensor array may be configured to sense and/or modulate/stimulate muscle movement/contractions. 
     According to some implementations of the present disclosure, the saddle  400  may include depressions for facilitating contact between target areas of the user&#39;s anal and perineum regions and the sensors  406 . It is understood that the saddle  400  may be configured in shapes other than a cylinder. According to some implementations the saddle  400  may be integrated into a seat of an exercise bicycle, stool, or other such similar structure upon which a user can sit. 
     According to some implementations, the electrodes  406  may come in one multiple pairs to take into account, e.g., by combining sensed electrical activity, on both sides of the longitudinal axis of the sensor array. Multiple pairs can be provided as the locations of the respective sensor pairs relative to the patient&#39;s anatomy may be different each time the patient sits on the saddle  400  or when the patient shifts position while sitting on the saddle  400 . Due the imprecision of relative electrode placement over time, the multiple pairs ensures that at least one electrode pair is sufficiently close to the desired monitoring location on the patient&#39;s anatomy to detect a relevant signal. Pairing the electrodes also provides improved coverage over the patient&#39;s pelvic floor. In alternative implementations, for example, shown in  FIG.  16   , described below, a single pair of elongated electrodes can be used to detect electrical activity originating along a longer region of the user&#39;s pelvic floor, reducing the need for multiple electrode pairs and a multiplexer. According to some implementations, the electrodes may also include modulation/stimulation electrodes, and or sensing electrodes. Placement of the modulation/stimulation electrodes may be different than placement of the sensing electrodes, as illustrated in  FIGS.  1 - 10   . 
       FIGS.  11  and  12    illustrate a bridge spring mechanism  500  with plates  502  for applying distributed pressure to the inner surface of the substrate into which the electrodes are coupled, according to some implementations. For example, the bridge spring mechanism  502  may include arms  504  with hinges  506 . The plates  502  are located at the ends of the arms  504 . The arms  504  may be forced towards a substantially straight position by springs  508  at the hinges. The arms  504  may be bent towards one another by a bending force, with the spring  508  producing a force opposite to the bending force. For example, the bending force may be applied by a user&#39;s buttocks, with the spring  508  opposing the bending force (as illustrated in  FIG.  12   ), thus allowing the arms  504  and plates  502  to push the sensor array against the user&#39;s buttocks. It is understood that the illustrated bridge spring mechanism  500  is exemplary only, and other spring mechanisms may be utilized to achieve a substantially similar effect. It is further understood that sensors having the illustrated bridge spring mechanism  500  may be included with the sensor array of  FIG.  7    for inclusion in a garment  100 , for example. 
       FIG.  13    illustrates various parts of a patient&#39;s anal region, which may be stimulated and/or monitored by the above-described sensors.  FIG.  14    illustrates an exemplary placement of sensors proximate to a patient&#39;s anal region, specifically on the anal sphincter and pudendal nerve of the patient. It is understood that sensors may be placed proximate to other locations as well to provide stimulation and feedback, such as the perineal nerve. 
     According to some implementations of the present disclosure, the sensors may include sensing electrodes and modulating/stimulating electrodes. For example, the sensing electrodes may be grouped together and the modulating/stimulating electrodes may be grouped together. As illustrated in  FIG.  14   , the sensing electrodes may be positioned proximate to the anal sphincter for detection of anal sphincter contraction and relaxation. The modulating/stimulating electrodes may be positioned proximately along the pudendal nerve for modulating/stimulating the pudendal nerve. It is understood that the sensing and modulating/stimulating electrodes may be positioned according to a desired effect on a patient. For example, the modulating/stimulating electrodes may stimulate an effect to be sensed by the sensing electrodes. In this way, the sensing and modulating/stimulating electrodes may work together to achieve a desired result. 
     According to some implementations, stimulation of the pelvic floor may provide desired therapeutic effects by stimulating the nerves therein. Stimulation may also allow the patient to learn how to control the nerves better. In some implementations, the same electrodes that provide stimulation can also be used for sensing. In some implementations, sensors include dedicated stimulation electrode pairs and dedicated sensing electrode pairs. Such pairs may be in line with one another or staggered to fit more tightly together. 
       FIG.  15    is a schematic diagram of a sensor array  600  with outputs connected to a multiplexer  602 , according to some implementations. For example, the sensor array  600  may include sensing electrodes  604  coupled to inputs of the multiplexer  602 , similar to the above-described configuration of  FIG.  7   . An output of the multiplexer  602  may be coupled to an input of a Bluetooth enabled device  620 . It is understood that the sensor array  600  may be included in the marked sensor locations on the garment  100  or saddle  200 ,  400 . 
     In some implementations of the present disclosure, modulation/stimulator electrodes  604  may be coupled to outputs of the Bluetooth enabled device  620 . For example, the modulation/stimulator electrodes  604  may be arranged in pairs  606 , which are coupled in series or in parallel to one another. In a sensing mode of operation, the sensing electrodes  602  detect signals emitted by the patient. The signal with the greatest magnitude is in turn relayed by the Bluetooth enabled device  620  to a processer (e.g., a mobile device, computer, etc.). The processor processes the signals and causes the Bluetooth enabled device  620  to apply a stimulation signal to a given pair  606  of the modulation/stimulator electrodes  604  to provide a desired effect on the patient based on the received input. The pair of electrodes  606  to which the stimulation signal is applied can be selected based on detecting a pair of sensors  608  receiving a highest signal amplitude while in a detection node. Alternatively, the stimulation signal may be applied to all electrode pairs  606 ,  608 . The Bluetooth enabled device  620  may be powered by a power source  610 , such as a rechargeable battery. 
     In some implementations, the Bluetooth enabled device may be coupled to a server  630  (e.g., a remote server coupled to a user&#39;s mobile device). For example, software for controlling the array  600  may be installed on the server  630 . In an implementation, multiple devices (e.g., mobile devices) may access the server  630  and interact with the server  630  simultaneously. 
     In some implementations, the sensor array  600  may include an array of  2 N electrodes, where N equals any integer greater than 0 that are coupled to a multiplexer  602 . The multiplexer  602  may select the strongest of the signals coming from the sensor pairs  608 . The output signal of the multiplexer  602  may be coupled to a preamplifier. An analog signal from the preamplifier may be sent to an analog-to-digital converter (ADC). In an implementation, the digital signal is sent to a mobile device such as a laptop computer installed with a software program. For example, the software program captures the digital signal in real time and displays the signal on a display (e.g., a screen). For example, the sensor array  600  may have 12 total electrodes (e.g., 6 pairs). The electrodes may be equidistant from a midline of the sensor array  600 . According to some implementations, the sensor array  600  may include electrodes that are 5 mm to 10 mm in diameter and separated by 4-5 cm across the longitudinal axis of the array  600 . In some implementations, the electrode separation distance may vary based on the size of the patient the sensor array is intended for. For example, more slender users may use a sensor array with electrodes that are spaced less far apart, whereas larger framed users, may use sensor arrays with more distantly spaced electrodes to accommodate their different anatomical features. Some implementations may include different numbers of electrode pairs, for example between 3 and 10 pairs. In some implementations, the distance between the electrodes of each pair of electrodes is the same. In some implementations, the distances vary, electrode pair-to-electrode pair. 
       FIG.  16    is a diagram of a disposable flexible circuit  700 , according to some implementations. For example, the circuit  700  may be included in any of the garment  100 , saddle  200 ,  400  described above. The circuit  700  may include electrodes  702  coupled to traces  704  on a polyethylene terephthalate (PET) substrate  706 . For example, the electrodes  702  may include the sensor arrays  300 ,  600  as described above. The traces  704  may extend from the electrodes  702  down an arm  712  of the circuit  700 , such that the traces  704  couple the electrodes  702  to an edge connector  716 . For example, the edge connector  716  may be 3×1, or otherwise. 
     The circuit  700  may further include a ground cable  708  having a ground trace  710  and an ECG snap connector  714 . For example, the ground cable  708  may be configured to be bent upward to facilitate connection to a patient&#39;s device (e.g., such as a peel and stick ECG device, or other device). Additionally, the longer single electrode pair  702  may ensure proximity to a user&#39;s nerves. 
     In an implementation, the circuit  700  may be single-sided (e.g., no traces on a back side of the circuit  700 ). In a further implementation, the electrodes  702  may be coated with an adhesive gel. According to some implementations, the traces  704  may be covered with a non-conductive coating (e.g., solder resist). 
     A back side of a rectangular portion  718  of the circuit  700  may be coated with an adhesive (e.g., a double-sided peel and stick adhesive) to facilitate temporary adhesion of the circuit  700  to a patient and/or a garment/saddle/pillow (e.g., garment  100  or saddle  200 ,  400 , or otherwise). For example, the circuit  700  may be removed and disposed after use. 
     According to some implementations, dimensions of the electrodes  702  may be 1″×4″. The electrodes  702  may also be spaced 1″ apart from each other. In other implementations, the width of the electrodes may range from about 0.75″ to about 1.25″ and the lengths of the electrodes may range from about 3.5″ to about 4.5″ and they may be spaced between about 0.75″ and 1.25″ apart. According to some implementations, a dimension of the rectangular portion  718  may be 3.5″×5″. In other implementations, the width of the rectangular portion may range from about 3″ to about 4 inches and the length may range from about 4.5″ to about 5.5″. A dimension of the arm  712  may be 1″×10″. In other implementations, the width of the arm may range from about 0.75″ to about 1.25″ and the length may range from about 8″ to about 12″. The dimensions of the ground cable  708  may be 0.75″×10″. In other implementations, the length of the ground cable may be between 0.5″ and 1.0″ and the length may be between 8″ and 12″. It is understood that these dimensions are exemplary only According to some implementations, the ground cable  708  and/or the arm  712  may be shortened and/or removed. 
     According to some implementations, the electrodes  702  may include circuit interconnects comprising silver ink. The electrodes  702  may be laminar in structure. For example, a base silver ink may be selectively applied to the substrate  706 , followed by a gel of silver/silver chloride. In an implementation, the electrodes may be configured to provide a voltage range of 5V to 70V for stimulation. 
     According to some implementations, the circuit  700  may include an electrical connector for interconnecting to control electronics. In an implementation, interconnecting to the control electronics may be achieved via use of silver ink pads that engage an edge connector (e.g., edge connector  716 ). 
     According to some implementations, the circuit  700  may be coupled to a pillow. For example, the pillow may be shaped/configured similarly to the garment  100  or saddle  200 ,  400 , or otherwise (e.g., cylindrical, bike seat shape, etc.). The pillow may have a stiffness similar to that of a memory foam pillow. According to some implementations, the pillow may have a compression rate (e.g., an amount of force that compresses a cubic foot of the material by 25%) that ranges in some implementations, from about 0.5 psi to about 5 psi, in some implementations from 0.6 psi to about 4 psi, or in some implementations from about 1 to about 2 psi. A diameter range of the pillow may be about 3″-5″, for example, 4″ or 7 cm, for example. 
     The pillow may include a circuit board including a battery (e.g., battery  120 ,  220 ,  610 ), a battery charger (e.g., included with the battery), a voltage regulator, an instrumentation amplifier for EMG signals, a microprocessor (and associated memory for program storage and data storage), a pre-amplifier and analog-to-digital converter, a wireless serial data transceiver (e.g., Bluetooth), a stimulation pulse generator, and/or patient isolation circuitry. In some implementations, some or all of the additional circuitry may be included in an application specific integrated circuit (ASIC) included on the disposable circuit  700 . 
       FIG.  17    is a diagram of an exemplary generated user interface (GUI)  1700  according to some implementations. For example, the GUI  1700  may be configured to interface with a Bluetooth enabled device. In some implementations, the GUI  1700  may include a main menu page  1710  with options  1720 - 1750  that provide various functions. For example, option  1720  may include functionality for tracking a user&#39;s own individual progress (e.g., as a bar chart  1722 ), option  1730  may include functionality for gamifying the user&#39;s progress (e.g., comparing a bar chart  1732  of the user with bar charts of other users  1734 ), option  1740  may include functionality for adjusting sensor settings, and option  1750  may include miscellaneous functionality. It is understood that these options are exemplary only, and other functionality may be provided. 
     In some implementations of the present disclosure, option  1720  may be configured to track a number of contractions/relaxations of a user&#39;s sphincter muscle, for example. In an implementation option  1720  may display the results in a bar chart  1722 , with heights of each bar corresponding to magnitude or strength of set of contractions (one bar per contraction) or a number of contractions per session, day, etc. 
     In some implementations, option  1730  may be configured to track the contractions/relaxations or characteristics thereof (e.g., signal strength of the user), and compare those against other users or against a user&#39;s previous best performance, thus gamifying the performance of the user. In this way, the user may be incentivized to achieve progress towards a goal. For example, comparative charts  1732 ,  1734  may be displayed to illustrate performance differences between users. 
     In some implementations, option  1730  may be configured to show a user a pattern of contractions as a time series, and the user can be instructed to attempt to match the displayed pattern. The system can score the degree to which the user&#39;s muscle contraction pattern matches (in terms of timing and relative amplitude) that of the displayed pattern. This score, can also be compared with that of other users. Any sharing of data by a clinician or medical practice in this scenario, would be done in a HIPAA compliant manner to protect the privacy of the patient, while still providing a social and motivational experience for the user. 
     In some implementations, option  1740  can be used to control stimulation settings and stimulation protocols. In some implementations, the stimulation protocol begins with detecting which pair of electrodes detects a strongest contraction signal to determine the electrode pair that is most proximate the nerve to be stimulated. The stimulation signal is then applied to that pair of electrodes in the form of a train of low-amplitude square wave pulses. 
     According to some implementations, the miscellaneous functionality  1750  may include a summary of the user&#39;s performance  1752  (e.g., as a pie chart). The miscellaneous functionality  1750  may also identify areas for improvement  1754 . The miscellaneous functionality  1750  may also track a progress  1756  of the user (e.g., extrapolate future performance prediction based on past performance). It is understood that various other miscellaneous functionalities may be implemented in miscellaneous functionality  1750  in addition to the above-described functions. 
     The techniques described herein may be implemented as method(s) that are performed by physical computing device(s), as one or more non-transitory computer-readable storage media storing instructions which, when executed by computing device(s), cause performance of the method(s); or, as physical computing device(s) that are specially configured with a combination of hardware and software that causes performance of the method(s). 
       FIG.  18    illustrates an example flow diagram (e.g., process  1800 ) for pelvic floor feedback and neuromodulation according to some implementations. The example process  1800  may be implemented in relation to  FIGS.  1 - 17   . Further, for explanatory purposes, the blocks of the example process  1800  are described herein as occurring in series, or linearly. However, multiple blocks of the example process  1800  may occur in parallel. In addition, the blocks of the example process  1800  need not be performed in the order shown and/or one or more of the blocks of the example process  1800  need not be performed. 
     At block  1802 , a strength of action potentials via wireless sensors is captured. The wireless sensors may be positioned proximate to a pelvic floor of a user. At block  1804 , the strength of the action potentials is transmitted to a mobile device. At block  1806 , the strength of the action potentials is recorded on the mobile device. 
     In some implementations of the present disclosure, the process  1800  may involve the same software system on the mobile device and software on a remote server that interacts with the software system, allowing the information gathered on the mobile device to be shared with the software on the remote server. 
     In some implementations of the present disclosure, the process  1800  may include storing the strength of the action potentials on either the mobile device or a remote server. In some implementations of the present disclosure, the process  1800  may include creating a game environment by the software system, with which the user may interact via controlled contractions and relaxations of the target muscle group. 
     In some implementations of the present disclosure, the process  1800  may include interacting with the remote server via the software system to allow the user to play with and against other users interacting via other mobile devices at sites remote to both the server and the user to create an online gaming environment. 
     Aspects of the present disclosure are useful for various purposes, including, but not limited to: urodynamics, rehabilitation for spinal cord injuries (e.g., bowel and bladder), sports training, counting the number of action potentials as a way to score points (e.g., weightlifting, interval training, and also as a way to weight train weightlessly), game controller for a video game console (e.g., such as NINTENDO WII), fatigue tracker for job health programs (e.g., a delivery worker and the amount of stress they put on their back). 
     Aspects of the present disclosure may also improve resident training programs by teaching patients to relax muscles, identifying what muscles they shouldn&#39;t be using when performing certain tasks, etc. (e.g., may be verified first and then used as normalized values to teach future patients). Additional health benefits may be experienced in constraint induced movement therapy (CIMT) for upper extremity rehab, tension headache, temporomandibular disorder (TMJ) pain, torticollis, cerebral palsy, to reduce emotional decision making in financial traders (e.g., galvanic skin response, heart rate, muscle recruitment), pelvic floor dysfunction/chronic pelvic pain (e.g., for men and women), meditation training (e.g., wearing multiple garments simultaneously to relay what muscles groups to relax, etc.) 
     Aspects of the present disclosure may also be utilized for treating pediatric patients, men and women with urinary and fecal incontinence, pelvic pain, dyspareunia, vaginismus, constipation, and pregnant women, among others. 
       FIG.  1900    is a block diagram illustrating an exemplary computer system  1900  with which the devices and systems of the above-described Figures may be implemented. In certain aspects, the computer system  1900  may be implemented using hardware or a combination of software and hardware, either in a dedicated server, integrated into another entity, or distributed across multiple entities. 
     Computer system  1900  includes a bus  1908  or other communication mechanism for communicating information, and a processor  1902  coupled with bus  1908  for processing information. By way of example, the computer system  1900  may be implemented with one or more processors  1902 . Processor  1902  may be a general-purpose microprocessor, a microcontroller, a Digital Signal Processor (DSP), an Application Specific Integrated Circuit (ASIC), a Field Programmable Gate Array (FPGA), a Programmable Logic Device (PLD), a controller, a state machine, gated logic, discrete hardware components, or any other suitable entity that can perform calculations or other manipulations of information. 
     Computer system  1900  can include, in addition to hardware, code that creates an execution environment for the computer program in question, for example, code that constitutes processor firmware, a protocol stack, a database management system, an operating system, or a combination of one or more of them stored in an included memory  1904 , such as a Random Access Memory (RAM), a flash memory, a Read Only Memory (ROM), a Programmable Read-Only Memory (PROM), an Erasable PROM (EPROM), registers, a hard disk, a removable disk, a CD-ROM, a DVD, or any other suitable storage device, coupled to bus  1908  for storing information and instructions to be executed by processor  1902 . The processor  1902  and the memory  1904  can be supplemented by, or incorporated in, special purpose logic circuitry. 
     The instructions may be stored in the memory  1904  and implemented in one or more computer program products, i.e., one or more modules of computer program instructions encoded on a computer-readable medium for execution by, or to control the operation of, the computer system  1900 , and according to any method well known to those of skill in the art, including, but not limited to, computer languages such as data-oriented languages (e.g., SQL, dBase), system languages (e.g., C, Objective-C, C++, Assembly), architectural languages (e.g., Java, .NET), and application languages (e.g., PHP, Ruby, Perl, Python). Instructions may also be implemented in computer languages such as array languages, aspect-oriented languages, assembly languages, authoring languages, command line interface languages, compiled languages, concurrent languages, curly-bracket languages, dataflow languages, data-structured languages, declarative languages, esoteric languages, extension languages, fourth-generation languages, functional languages, interactive mode languages, interpreted languages, iterative languages, list-based languages, little languages, logic-based languages, machine languages, macro languages, metaprogramming languages, multi-paradigm languages, numerical analysis, non-English-based languages, object-oriented class-based languages, object-oriented prototype-based languages, off-side rule languages, procedural languages, reflective languages, rule-based languages, scripting languages, stack-based languages, synchronous languages, syntax handling languages, visual languages, wirth languages, and xml-based languages. Memory  1904  may also be used for storing temporary variable or other intermediate information during execution of instructions to be executed by processor  1902 . 
     A computer program as discussed herein does not necessarily correspond to a file in a file system. A program can be stored in a portion of a file that holds other programs or data (e.g., one or more scripts stored in a markup language document), in a single file dedicated to the program in question, or in multiple coordinated files (e.g., files that store one or more modules, subprograms, or portions of code). A computer program can be deployed to be executed on one computer or on multiple computers that are located at one site or distributed across multiple sites and interconnected by a communication network. The processes and logic flows described in this specification can be performed by one or more programmable processors executing one or more computer programs to perform functions by operating on input data and generating output. 
     Computer system  1900  further includes a data storage device  1906  such as a magnetic disk or optical disk, coupled to bus  1908  for storing information and instructions. Computer system  1900  may be coupled via input/output module  1910  to various devices. The input/output module  1910  can be any input/output module. Exemplary input/output modules  1910  include data ports such as USB ports. The input/output module  1910  is configured to connect to a communications module  1912 . Exemplary communications modules  1912  include networking interface cards, such as Ethernet cards and modems. In certain aspects, the input/output module  1910  is configured to connect to a plurality of devices, such as an input device  1914  and/or an output device  1916 . Exemplary input devices  1914  include a keyboard and a pointing device, e.g., a mouse or a trackball, by which a user can provide input to the computer system  1900 . Other kinds of input devices  1914  can be used to provide for interaction with a user as well, such as a tactile input device, visual input device, audio input device, or brain-computer interface device. For example, feedback provided to the user can be any form of sensory feedback, e.g., visual feedback, auditory feedback, or tactile feedback, and input from the user can be received in any form, including acoustic, speech, tactile, or brain wave input. Exemplary output devices  1916  include display devices such as an LCD (liquid crystal display) monitor, for displaying information to the user. 
     According to one aspect of the present disclosure, the devices and systems can be implemented using a computer system  1900  in response to processor  1902  executing one or more sequences of one or more instructions contained in memory  1904 . Such instructions may be read into memory  1904  from another machine-readable medium, such as data storage device  1906 . Execution of the sequences of instructions contained in the main memory  1904  causes processor  1902  to perform the process steps described herein. One or more processors in a multi-processing arrangement may also be employed to execute the sequences of instructions contained in memory  1904 . In alternative aspects, hard-wired circuitry may be used in place of or in combination with software instructions to implement various aspects of the present disclosure. Thus, aspects of the present disclosure are not limited to any specific combination of hardware circuitry and software. 
     Various aspects of the subject matter described in this specification can be implemented in a computing system that includes a back-end component, e.g., such as a data server, or that includes a middleware component, e.g., an application server, or that includes a front-end component, e.g., a client computer having a graphical user interface or a Web browser through which a user can interact with an implementation of the subject matter described in this specification, or any combination of one or more such back-end, middleware, or front-end components. The components of the system can be interconnected by any form or medium of digital data communication, e.g., a communication network. The communication network can include, for example, any one or more of a LAN, a WAN, the Internet, and the like. Further, the communication network can include, but is not limited to, for example, any one or more of the following network topologies, including a bus network, a star network, a ring network, a mesh network, a star-bus network, tree or hierarchical network, or the like. The communications modules can be, for example, modems or Ethernet cards. 
     Computer system  1900  can include clients and servers. A client and server are generally remote from each other and typically interact through a communication network. The relationship of client and server arises by virtue of computer programs running on the respective computers and having a client-server relationship to each other. Computer system  1900  can be, for example, and without limitation, a desktop computer, laptop computer, or tablet computer. Computer system  1900  can also be embedded in another device, for example, and without limitation, a mobile telephone, a PDA, a mobile audio player, a Global Positioning System (GPS) receiver, a video game console, and/or a television set top box. 
     The term “machine-readable storage medium” or “computer-readable medium” as used herein refers to any medium or media that participates in providing instructions to processor  1902  for execution. Such a medium may take many forms, including, but not limited to, non-volatile media, volatile media, and transmission media. Non-volatile media include, for example, optical or magnetic disks, such as data storage device  1906 . Volatile media include dynamic memory, such as memory  1904 . Transmission media include coaxial cables, copper wire, and fiber optics, including the wires that comprise bus  1908 . Common forms of machine-readable media include, for example, floppy disk, a flexible disk, hard disk, magnetic tape, any other magnetic medium, a CD-ROM, DVD, any other optical medium, a RAM, a PROM, an EPROM, a FLASH EPROM, any other memory chip or cartridge, or any other medium from which a computer can read. The machine-readable storage medium can be a machine-readable storage device, a machine-readable storage substrate, a memory device, a composition of matter effecting a machine-readable propagated signal, or a combination of one or more of them. 
     As used herein, the phrase “at least one of” preceding a series of items, with the terms “and” or “or” to separate any of the items, modifies the list as a whole, rather than each member of the list (i.e., each item). The phrase “at least one of” does not require selection of at least one item; rather, the phrase allows a meaning that includes at least one of any one of the items, and/or at least one of any combination of the items, and/or at least one of each of the items. By way of example, the phrases “at least one of A, B, and C” or “at least one of A, B, or C” each refer to only A, only B, or only C; any combination of A, B, and C; and/or at least one of each of A, B, and C. 
     To the extent that the terms “include,” “have,” or the like is used in the description or the claims, such term is intended to be inclusive in a manner similar to the term “comprise” as “comprise” is interpreted when employed as a transitional word in a claim. The word “exemplary” is used herein to mean “serving as an example, instance, or illustration.” Any embodiment described herein as “exemplary” is not necessarily to be construed as preferred or advantageous over other embodiments.