Enraf-Nonius CT-7 User manual

Brand: Enraf-Nonius

Model: CT-7

Type: User manual

DBe sure to read this manual before use.

Keep this manual in a safe place for future reference.

Combination Therapy Equipment

PHYSISYSTEM

Model

CT-7

Instruction manual

For Professional Use

About This Manual

zKeep this manual in a safe place where it can be referred to whenever necessary.

zIf this manual becomes lost or damaged, contact your OG Wellness Technologies

distributor immediately.

zFollow the instructions and procedures specied in this manual.

zDo not operate, care for or provide maintenance for the product except as specied in

this manual.

zThe contents of this manual and caution labeling on the product may not cover all

potential dangers associated with the product.

OG Wellness is unable to foresee dangers arising from any use of the product other than its intended use.

zKeep safety considerations in mind when using, cleaning or inspecting the product,

including, but not limited to the contents of this manual and caution labeling on the

product.

zThe product you have purchased may dier in some details from the illustrations in

this manual. Parts of the illustrations in this manual may be omitted or simplied to aid

explanation.

zThe specication and design of the product, as well as the contents of this manual are

subject to improvement and change without notice.

zFor inquiries or further information, contact your OG Wellness Technologies distributor.

zGreat care has been taken in the preparation of this manual. In the event of any error or

omission, or if any of the contents are unclear, please contact your OG Wellness

Technologies distributor.

zOG Wellness Technologies holds the copyright of this manual.

zIt is prohibited to copy, edit or translate all or any part of this manual without the prior

written consent of OG Wellness Technologies.

zDo not copy the contents of this manual via any electronic reading or scanning device

including, but not limited to, image scanners.

zCompany names and product names described in this manual are trademarks or

registered trademarks of their respective companies in Japan and other countries.

Table of Contents

1. Foreword ------------------------------------------------------------------------------------------------------ 4

1. 1 IntendedUser/Operator ------------------------------------------------------------------------------------ 4

1. 2 ProductLiability ------------------------------------------------------------------------------------------------ 4

2. Product Description --------------------------------------------------------------------------------------- 4

3. Precautionary Instructions ------------------------------------------------------------------------------ 5

4. Intended Use ------------------------------------------------------------------------------------------------- 6

4. 1 Electrotherapy -------------------------------------------------------------------------------------------------- 6

4.1.1 Painmanagement --------------------------------------------------------------------------------------------6

4.1.2 Musclestimulation --------------------------------------------------------------------------------------------7

4.1.3 Description of current waveforms ------------------------------------------------------------------------- 8

4.1.4 Illustrationsofcurrentwaveforms ----------------------------------------------------------------------- 16

4. 2 UltrasoundTherapy ------------------------------------------------------------------------------------------21

4.2.1 Indications - Ultrasoundtherapy ------------------------------------------------------------------------ 21

4.2.2 Contra-indications - Ultrasoundtherapy -------------------------------------------------------------- 21

4.2.3 Precautionsandwarnings - Ultrasoundtherapy --------------------------------------------------- 21

4.2.4 Relevanthazards - Ultrasoundtherapy--------------------------------------------------------------- 21

4.2.5 Potentialadverseeects - Ultrasoundtherapy ----------------------------------------------------- 21

4.2.6 Parameters - Ultrasoundtherapy ---------------------------------------------------------------------- 22

4. 3 CombinationTherapy ---------------------------------------------------------------------------------------22

5. Package Contents ---------------------------------------------------------------------------------------- 22

6. Installation -------------------------------------------------------------------------------------------------- 24

6. 1 SystemswithoutaVacuumUnit --------------------------------------------------------------------------24

6. 2 SystemswithaVacuumUnit ------------------------------------------------------------------------------24

6. 3 ConnectiontoMainsSupply ------------------------------------------------------------------------------- 24

6. 4 DisconnectionfromMainsSupply -----------------------------------------------------------------------24

6. 5 PlacingtheBattery -------------------------------------------------------------------------------------------25

6. 6 OperationfromBattery -------------------------------------------------------------------------------------- 25

7. Application Information -------------------------------------------------------------------------------- 26

7. 1 Electrotherapy -------------------------------------------------------------------------------------------------26

7.1.1 Beforetreatment -------------------------------------------------------------------------------------------- 26

7.1.2 Duringtreatment -------------------------------------------------------------------------------------------- 26

7.1.3 Endingtreatment -------------------------------------------------------------------------------------------- 26

7.1.4 After treatment ----------------------------------------------------------------------------------------------- 26

7.1.5 Rubberelectrodes ------------------------------------------------------------------------------------------ 27

7.1.6 Vacuumelectrodes ----------------------------------------------------------------------------------------- 27

7.1.7 Self-adhesiveelectrodes ---------------------------------------------------------------------------------- 27

7.1.8 Electrolyticeects ------------------------------------------------------------------------------------------- 28

7.1.9 Current density ---------------------------------------------------------------------------------------------- 28

7.1.10 Connection and disconnection reactions ------------------------------------------------------------- 28

7. 2 Ultrasound ------------------------------------------------------------------------------------------------------28

7.2.1 Contactcontrol ----------------------------------------------------------------------------------------------- 28

7.2.2 Thecontactmedium ---------------------------------------------------------------------------------------- 29

7.2.3 Beforetreatment -------------------------------------------------------------------------------------------- 29

7.2.4 Startingtreatment ------------------------------------------------------------------------------------------- 29

7.2.5 Duringtreatment -------------------------------------------------------------------------------------------- 29

7.2.6 Aftertreatment ----------------------------------------------------------------------------------------------- 29

7. 3 Vacuum ---------------------------------------------------------------------------------------------------------30

8. Operating Instructions ---------------------------------------------------------------------------------- 30

8. 1 OperatorControls --------------------------------------------------------------------------------------------30

8. 2 BasicOperation -----------------------------------------------------------------------------------------------32

8.2.1 Turningonthedevice -------------------------------------------------------------------------------------- 32

8.2.2 Displayscreen ----------------------------------------------------------------------------------------------- 32

8.2.3 Navigation ----------------------------------------------------------------------------------------------------- 33

8.2.4 Shuttingdevicedown -------------------------------------------------------------------------------------- 42

8.2.5 Operatingdetails -------------------------------------------------------------------------------------------- 43

9. Maintenance and Troubleshooting ----------------------------------------------------------------- 45

9. 1 CleaningandDisinfection ----------------------------------------------------------------------------------45

9.1.1 Cleaning ------------------------------------------------------------------------------------------------------- 45

9.1.2 Disinfection --------------------------------------------------------------------------------------------------- 46

9. 2 Troubleshooting ----------------------------------------------------------------------------------------------- 46

9.2.1 Errorcode ----------------------------------------------------------------------------------------------------- 46

9.2.2 Warningmessage ------------------------------------------------------------------------------------------- 46

9. 3 Maintenance ---------------------------------------------------------------------------------------------------48

9.3.1 Optimizecontactcontrolultrasoundapplicator ------------------------------------------------------ 48

9.3.2 Back-upandrestorefavorites---------------------------------------------------------------------------- 48

9.3.3 To restore your favorites----------------------------------------------------------------------------------- 48

9.3.4 Firmware update -------------------------------------------------------------------------------------------- 48

9. 4 TechnicalMaintenance--------------------------------------------------------------------------------------49

9. 5 Disposal ---------------------------------------------------------------------------------------------------------49

10. Specications --------------------------------------------------------------------------------------------- 50

10. 1 TechnicalData ------------------------------------------------------------------------------------------------50

10. 2 SafetyandPerformanceStandards ---------------------------------------------------------------------50

10. 3 DescriptionofSymbols -------------------------------------------------------------------------------------51

10. 4 EMCDetails ---------------------------------------------------------------------------------------------------52

11. Consumable Parts --------------------------------------------------------------------------------------- 56

12. Warranty and Disclaimer ------------------------------------------------------------------------------- 57

13. Supplementary Information --------------------------------------------------------------------------- 58

1. Foreword

1. 1 Intended User / Operator

Thismanualhasbeenwrittenfortheownersandoperatorsofthisproduct.Itcontainsgeneral

instructionsonoperation,precautionarypractices,maintenanceandpartsinformation.Inorderto

maximizetheuse,eciencyandlifespanofyourunit,pleasereadthismanualthoroughlyandbecome

familiar with the controls as well as the accessories before operating the unit.

This product is intended to be used, and shall only be used, by or under the supervision of professional

usersintheeldofphysicaltherapyandrehabilitation.

Thisproductisprescriptionequipment.Usebyanypersonsotherthanphysiciansisprohibited.

Specicationsputforthinthismanualwereineectatthetimeofpublication.However,owingtoOG

WellnessTechnologiesherpolicyofcontinualimprovement,changestothesespecicationsmaybe

made at any time without obligation on the part of OG Wellness Technologies.

1. 2 Product Liability

Tothemaximumextentpermittedbyapplicablelaw,innoeventwillEnraf-Noniusoritssuppliersor

resellers be liable for any indirect, special, incidental or consequential damages arising from the use of

orinabilitytousetheproduct,including,withoutlimitation,damagesforlossofgoodwill,workand

productivity, computer failure or malfunction, or any and all other commercial damages or losses, even

if advised of the possibility thereof, and regardless of the legal or equitable theory (contract, tort or

otherwise)uponwhichtheclaimisbased.Inanycase,Enraf-Nonius’sentireliabilityunderany

provision of this agreement shall not exceed in the aggregate the sum of the fees paid for this product

andfeesforsupportoftheproductreceivedbyEnraf-Noniusunderaseparatesupportagreement(if

any),withtheexceptionofdeathorpersonalinjurycausedbythenegligenceofEnraf-Noniustothe

extent applicable law prohibits the limitation of damages in such cases.

Enraf-Noniuscannotbeheldliableforanyconsequenceresultingfromincorrectinformationprovided

byitspersonnel,orerrorsincorporatedinthismanualand/orotheraccompanyingdocumentation

(including commercial documentation).

Theopposingparty(product’suseroritsrepresentative)shalldisclaimEnraf-Noniusfromallclaims

arising from third parties, whatever nature or whatever relationship to the opposing party.

2. Product Description

Combination Therapy Equipment CT-7:

This product is a combination device, combining the functions of the electrotherapy and the ultrasound

therapy in a single device.

The simultaneous application of ultrasound and electrotherapy (combination therapy) is also possible.

The remaining electrotherapy channel can then be used independently.

Vacuum unit for CT-7 (CT7-001):

ElectrotherapycanbeperformedusingtheoptionalVacuumunit.Electrotherapycanbeapplied

throughstandardorvacuumelectrodes.WithvacuumelectrodestheVacuumunitforCT-7generates

the vacuum through which the vacuum electrodes are attached to the patient. The unit is placed

beneathCombinationTherapyEquipmentCT-7,fromwhichitspowerisderivedandthroughwhichitis

also operated.

StatUS for CT-7 (CT7-005):

StatUStherapy(StationaryUltraSoundtherapy)canbeperformedusingtheoptionalStatUSforCT-7.

WhenperformingStatUStreatment,readtheinstructionmanualaccompanyingtheStatUSforCT-7

(CT7-005).

☞ElectrotherapyandStatUStherapycannotbeusedincombination.

☞StatUSforCT-7(CT7-005)isnotdesignedforuseincombinationwiththeVacuumUnitforCT-7

(CT7-001).

3. Precautionary Instructions

Inthissection,generalWarningsandPrecautionsarelisted,thatyoushouldbeawareofwhenusingthis

product.Shouldtheuseofthisdeviceleadtoanundesirableeventsuchasdeathor serious injury to the

user,themanufacturerandthecompetentauthorityoftheMemberStateMUSTbeinformedwithoutdelay.

Seealsochapter4. 1 and 4. 2forWarningsandPrecautionsthatareapplicationspecic.

D WARNING:

•This product should be used only under the continued supervision of a physician or licensed

practitioner.

•Makecertainthatthisproductiselectricallygroundedbyconnectingonlytoagroundedelectrical

service receptacle conforming to the applicable national and local electrical codes.

•Do not operate the unit in an environment of short-wave or micro-wave diathermy.

•Thisproductisnotsuitableforuseinthepresenceofammableanestheticsmixturewithair,oxygen,

or nitrous oxide.

•Thisproductshouldbekeptoutofthereachofchildren.

•Thisproductisnotsuitableforuseinthepresenceofammableanestheticmixturewithair,oxygen,

or nitrous oxide.

•Useofcontrolsoradjustmentsorperformanceofproceduresotherthanthosespeciedhereinmay

resultinhazardousexposuretoultrasonicenergy.

•Useofaccessories,transducersandcablesotherthanthosespeciedorprovidedbythe

manufacturer of this equipment could result in increased electromagnetic emissions or decreased

electromagnetic immunity of this equipment and result in improper operation.

•Caremustbetakenwhenoperatingthisequipmentaroundotherequipment.Potential

electromagneticorotherinterferencecouldoccurtothisortotheotherequipment.Trytominimize

this interference by not using other equipment in conjunction with it.

•Itisrecommendedthatthisproductshouldnotbeusedafterextremetemperatureuctuations.

•This product should not be used when any sort of mechanical damage is noticed.

•Do not operate the unit in an environment of short-wave or micro-wave diathermy.

D CAUTION:

•Alwaysdeterminethedosagebasedonthepatient’sperceptionofheat.Anysensationgreaterthan

mild warmth could cause a burn.

•Do not operate this product when connected to any other devices.

•Donotusethisdeviceinsocalled“WetRooms”(hydrotherapyrooms)

•Thisunitshouldbeoperatedintemperaturesbetween10°Cand40°C(50°Fand104°F),witha

RelativeHumidityrangingfrom10-90%(non-condensing).

•Do not expose the unit to direct sunlight, heat radiated from a heat radiator, excessive amounts of

dust,moisture,vibrationsandmechanicalshocks.

•Inthecaseofingressofliquids,unplugtheunitfromthemainssupplyandhaveitcheckedbyan

authorizedperson(seetheparagraphontechnicalmaintenance).

•Beforeadministeringanytreatmenttoapatient,youshouldbecomeacquaintedwiththeoperating

procedures for each mode of treatment available, as well as the indications, contraindications,

warnings and precautions.

•Handleultrasoundtreatmentheadwithcare.Inappropriatehandlingoftheultrasoundtreatmenthead

mayadverselyaectitscharacteristics.

•Inspectultrasoundtreatmentheadforcracksandothermechanicaldefectswhichmayallowthe

ingressofconductiveuidbeforeeachuse.

4. Intended Use

This product is designed to only be used by or under the supervision of persons using the medical device

inthecourseoftheirworkandintheframeworkofaprofessionalhealthcareactivity,whounderstandthe

benetsandlimitationsofelectrotherapyandultrasoundtherapy.

4. 1 Electrotherapy

This product is intended to be used to treat nerve disorders or muscle disorders or pain, by providing

transcutaneous stimulation to mitigate of pain or musculer atrophy.

4.1.1 Pain management

PainManagementistheuseofelectricalstimulationforpainrelief.

4.1.1.1 Indications - Pain management

Symptomaticreliefofchronic,intractablepain.Managementofpainassociatedwithpost-traumaticor

postoperative conditions.

4.1.1.2 Contra-indications - Pain management

•This product should not be used for symptomatic pain relief unless etiology is established or unless a

pain syndrome has been diagnosed.

•Thisproductshouldnotbeusedonpatientswithdemand-typecardiacpacemakers.

•This product should not be used over cancerous lesions.

•Electrodeplacementsthatapplycurrenttothecarotidsinusregion(anteriorneck)mustbeavoided.

•Electrodeplacementsthatapplycurrenttranscerebrally(throughthehead)mustbeavoided.

•Electrodeplacementsthatapplycurrenttransthoracically(theintroductionofelectricalcurrentintothe

heart may cause cardiac arrhythmias) must be avoided.

4.1.1.3 Warnings - Pain management

•BenetsofTENScurrentshavenotbeenestablishedforpainofcentralorigin.

•Thisproductistobeusedasasymptomatictreatmentforpainandhasnocurativevalue.Patients

should be cautioned and their activities regulated if pain that would otherwise serve as a protective

mechanism is suppressed.

•Thelong-termeectsofchronicelectricalstimulationareunknown.

•Safetyhasnotbeenestablishedfortheuseoftherapeuticelectricalstimulationduringpregnancy.

•Stimulationshouldnotbeappliedoverswollen,infected,orinamedareasofskineruptionse.g.,

phlebitis, thrombophlebitis, varicose veins, etc.

•Seealsochapter3,PrecautionaryInstructions,forgeneralWarningsandPrecautions.

4.1.1.4 Precautions - Pain management

•Isolatedcasesofskinrashmayoccuratthesiteofelectrodeplacementfollowinglong-term

applications. The irritation may be reduced by use of an alternate conductive medium or an alternative

electrode placement.

•Eectivenessofthistreatmentisdependentuponpatientselection.

•Seealsochapter3,PrecautionaryInstructions,forgeneralWarningsandPrecautions.

4.1.1.5 Adverse eects - Pain management

Skinirritationandburnsbeneaththeelectrodeshavebeenreportedwiththeuseoftherapeutic

electrical stimulation.

4.1.1.6 Current waveforms - Pain management

For pain management the following current waveforms are recommended.

4.1.3.1, 4.1.3.2, 4.1.3.3, 4.1.3.5, 4.1.3.6, 4.1.3.8, 4.1.3.9.2

4.1.2 Muscle stimulation

MuscleStimulationistheuseofelectricalstimulationtotreatmuscledisorders.

4.1.2.1 Indications - Muscle stimulation

•Relaxationofmusclespasms

•Preventionorretardationofdisuseatrophy

•Increasinglocalbloodcirculation

•Musclere-education

•Immediatepost-surgicalstimulationofcalfmusclestopreventvenousthrombosis

•Maintainingorincreasingrangeofmotion

•Dysphagia

4.1.2.2 Contra-indications - Muscle stimulation

•Thisproductshouldnotbeusedonpatientswithdemand-typecardiacpacemakers.

•This product should not be used over cancerous lesions.

•Electrodeplacementsthatapplycurrenttothesinuscarotidregion(anteriorneck)mustbeavoided.(1)

•Electrodeplacementsthatapplycurrenttranscerebrally(throughthehead)mustbeavoided.

•Electrodeplacementsthatapplycurrenttransthoracically(theintroductionofelectricalcurrentintothe

heart may cause cardiac arrhythmias) must be avoided.

(1)

However,theapplicationareaforthetreatmentofDysphagiaisdistantenoughfromthesinuscarotis

area,whenthetherapistfollowstheguidelinesasdescribedinthetherapybook“Dysphagia(by

H.C.A.BogaardtSLP,PhD)”

4.1.2.3 Warnings - Muscle stimulation

•Thelong-termeectsofchronicelectricalstimulationareunknown.

•Safetyhasnotbeenestablishedfortheuseoftherapeuticelectricalstimulationduringpregnancy.

•Stimulationshouldnotbeappliedoverswollen,infected,orinamedareasofskineruptionse.g.,

phlebitis, thrombophlebitis, varicose veins, etc.

•Seealsochapter3,PrecautionaryInstructions,forgeneralWarningsandPrecautions.

4.1.2.4 Precautions - Muscle stimulation

•Adequateprecautionsshouldbetakenwhentreatingindividualswithsuspectedordiagnosedheart

problems, or epilepsy.

•Caution should be used when there is a tendency to hemorrhage following acute trauma or fracture.

•Caution should be used following recent surgical procedures when muscle contraction may disrupt

the healing process.

•Caution should be used over the menstruating uterus.

•Cautionshouldbeusedoverareasoftheskinwhichlacknormalsensation.

•Somepatientsmayexperienceskinirritationorhypersensitivityduetoelectricalstimulationor

electrical conductive medium. The irritation can usually be reduced by using an alternative conductive

medium, or alternate electrode placement.

•Seealsochapter3,PrecautionaryInstructions,forgeneralWarningsandPrecautions.

4.1.2.5 Adverse eects - Muscle stimulation

Skinirritationandetchingbeneaththeelectrodeshavebeenreportedwiththeuseoftherapeutic

electrical stimulation.

4.1.2.6 Current waveforms - Muscle stimulation

•For muscle stimulation the following current waveforms are recommended.

4.1.3.2.1, 4.1.3.3, 4.1.3.4, 4.1.3.6, 4.1.3.9.1

These waveforms are often applied in combination with a surge program, which consists of a sequence

of exercise and rest periods. Two options are available here:

•Reciprocalapplication,wherestimulationalternatesbetweenagonistsandantagonists.Thisis

accomplished through asynchronous stimulation over two current channels with an appropriate delay

between the two channels.

•Co-contract application, where two channels operate synchronously to co-contract agonist and

antagonistordierentsectionsofalargermusclegroup.

Seeparagraph8.2.5.6 for the available parameters.

4.1.3 Description of current waveforms

4.1.3.1 4-pole interferential currents

With the interferential current type a medium frequency carrier frequency is used to pass the low

frequencystimulation(beat)frequencythroughtheskin.Therelativelylowresistanceoftheskintothe

carrier frequency contributes to the patient comfort that is often associated with this current type.

InterferentialcurrentsareallACcurrentswithoutanyresidualDCcomponents.Severalvariationsof

theinterferentialcurrenttypeareknown,ofwhichthefollowingareavailableinthisproduct.

4.1.3.1.1 Classical interferential

With this therapy method four electrodes are used and two non modulated currents are generated. The

frequencyofonechannelisxedatthecarrierfrequency,whiletheotherchannelhasavariable

frequency,basedontheBeatfrequencyandFrequencyModulationsettings.Interferenceoccurswhere

the two currents intersect in the tissue. The modulation depth (which determines the current amplitude

ofthestimulation)dependsonthedirectionofthecurrents,andcanvaryfrom0to100%.100%

modulation depth only occurs at the diagonals (and hence at the intersection) of the two currents. This

isofcourseatheoreticalsituation,basedontheassumptionthatthetissueishomogeneous.Inreality,

the tissue is heterogeneous, so that the current balance between the two channels has to be used to

obtainthe100%modulationdepth(Fig.1).Thecurrentbalancecanalsobeusedtocompensatefor

dierencesinsensationoccurringundertheelectrodes.

Modulationdepthisonly100%atthediagonal

4.1.3.1.2 Isoplanar vector

Theisoplanarvectortechniqueisintendedtoincreasetheareawhereeectivestimulationoccurs.

Amplitude modulation occurs in the equipment and a special phase relation between the two channels

ensuresa100%modulationdepthbetweenthefourelectrodesinallpositions.

Modulationdepthis100%overtheentiretreatmentarea.

Theadvantageofthismethodisthatthepositioningofthefourelectrodestoeectivelytreatthe

aectedtissueislesscritical.ThesensationoftheIsoplanarvectormodeissoftandequallydivided

over the treatment area.

Fig.1

4.1.3.1.3 Dipole vector manual

With the dipole vector technique the currents from the two electrode pairs are vectorially summed in

thetissue.Theeectisthatstimulationonlyoccursintothedirectionoftheresultingvector,whichcan

be adjusted over a range of 360º. Amplitude modulation occurs in the equipment and the modulation

depthis100%.

Stimulationwith100%modulationdepthonlyoccursintothe

direction of the vector.

The advantage of this method is that the direction of the stimulation

can be adjusted electronically after positioning the electrodes.

4.1.3.1.4 Dipole vector automatic

With the automatic dipole technique the dipole vector described above is rotated at an adjustable

speed.Ifthecurrentamplitudeisincreasedexceedingthemotorialthreshold,thetissuewillcontract

and relax rhythmically. The automatic dipole vector current is ideally suited for areas where mechanical

pressure (massage) is not desirable.

Parameters:

•Carrier frequency, expressedinkHz,isthebasefrequencyofthealternatingcurrent.

•Beat frequency, expressedinHz,denesthechannelfrequencydierenceinclassicalinterferential

mode and the rate at which the amplitude is internally modulated in the vector modes.

•Frequency Modulation, expressedinHz,denesavariablefrequencyrangethatissummedtothe

Beatfrequencyi.ewhentheBeatfrequencyissetto80HzandtheFrequencymodulationissetto40

Hz,thenalfrequencywillvaryfrom80to120Hz.Frequencymodulationisoftenusedtoprevent

accommodation to stimulation or to improve patient tolerance.

•Modulation Programdenesthetimeandsequenceinwhichthefrequencywillsweepthroughthe

Frequency modulation range.

•Balancedenesthedierenceincurrentamplitudebetweenthetwochannels.Onlyavailablein

classical interferential mode.

•Vector position adjustmentdenestheangleofthedipolevectorwithrespecttothepositionofthe

electrodes.

•Rotation Speed, expressedinsecond,denesthetimeelapsedduringonerevolutionofthevectorin

automatic dipole vector mode.

4.1.3.2 Biphasic pulsed currents (TENS)

4.1.3.2.1 Asymmetrical and alternating asymmetrical

TheasymmetricalbiphasicpulsedcurrentwaveformisoftenusedinTENS(TranscutaneousElectrical

NerveStimulation)applications.Thiswaveformischaracterizedbyvariablephasedurationand

variablepulsefrequency.Itstypicalamplitude,duration,andrateofriseanddecayareunequalfor

each phase with respect to the baseline. The waveform is fully balanced, i.e. the phase charges of

eachphaseareequal.Seeg4.1.4.3.1 for a graphical representation.

A variation to the standard biphasic asymmetrical pulsed current is the alternating one, in which the

successivepulsephasesalternatewithrespecttothebaseline.Seeg4.1.4.3.2 for details. This

waveform is also fully balanced.

To prevent accommodation to stimulation or to improve patient tolerance, the pulse frequency can be

variedthroughfrequencymodulation.Severalfrequencymodulationprogramsareavailable.Seeg

4.1.4.7 for details.

Parameters:

•Phase Duration, expressed in µs, is the elapsed time from the beginning to the end of the initial pulse

phase.Seeg4.1.4.3.1 for details.

•Pulse Frequency, expressedinHzorpps(pulsespersecond),denestherepetitionrateofthe

TENSpulses.Seeg4.1.4.3.1 for details.

•Frequency Modulation, expressedinHz,denesavariablefrequencyrangethatissummedtothe

Pulsefrequencyi.ewhenthePulsefrequencyissetto80HzandtheFrequencymodulationissetto

40Hz,thenalfrequencywillvaryfrom80to120Hz.

•Modulation Program, denesthetimeandsequenceinwhichthefrequencywillsweepthroughthe

Frequencymodulationrange.SeefortheavailableModulationprograms4.1.4.7.

4.1.3.2.2 Burst asymmetrical and burst alternating asymmetrical

The burst biphasic and burst biphasic alternating asymmetrical pulsed currents are variations to their

nonburstcounterparts,inwhichthecontinuoustrainofpulsesisinterruptedbypulsepauses.Seeg

4.1.4.3.3andg4.1.4.4.4 for details. A burst frequency can be set for treating chronic pains, where the

useofcontinuousstimulationwithalowpulsefrequencywouldbetoopainful.Eachburstlastsfor

100msandtheburstratecanbeadjustedseparately.WiththismilderTENSwaveformitiseasierto

exceed the motorial threshold stimulus.

Parameters:

•Phase Duration, expressed in µs, is the elapsed time from the beginning to the end of the initial pulse

phase.Seeg4.1.4.3.3 for details.

•Pulse Frequency, expressedinHzorpps(pulsespersecond),denestherepetitionrateofthe

TENSpulses.Seeg4.1.4.3.3 for details.

•Burst Frequency, expressedinHz,denestherepetitionrateofburstsofpulses.Aburstconsistsof

atrainofpulses.Eachburstlastsfor100msandthenumberofpulsesinaburstdependsonthe

selectedPulsefrequencyi.eataPulseFrequencyof100Hz,10pulsesareavailableineachburst.

Seeg4.1.4.3.4 for details.

4.1.3.2.3 Symmetrical

TENScurrentpulsescanalsobeusedformusclestimulationapplications.Oftenthesymmetrical

biphasicpulsedcurrentwaveformisused.Seeg4.1.4.3.5 for a graphical representation. The

speciedphasedurationappliestobothpulsephases,whichdoublestheamountofavailableenergy

with respect to the asymmetrical pulsed current waveform. This waveform is fully balanced (no residual

DC components are present).

Parameters:

•Phase Duration, expressed in µs, is the elapsed time from the beginning to the end of a pulse phase.

Thephasedurationappliestoeachpulsephase.Seeg4.1.4.3.5 for details.

•Pulse Frequency, expressedinHzorpps(pulsespersecond),denestherepetitionrateofthe

TENSpulses.Seeg4.1.4.3.5 for details.

•Frequency Modulation, expressedinHz,denesavariablefrequencyrangethatissummedtothe

Beatfrequencyi.ewhentheBeatfrequencyissetto80HzandtheFrequencymodulationissetto40

Hz,thenalfrequencywillvaryfrom80to120Hz.

•Modulation Program denesthetimeandsequenceinwhichthefrequencywillsweepthroughthe

Frequencymodulationrange.SeefortheavailableModulationprogramsg4.1.4.7.

•Surge Programcanbeusedtoadjustrepeatedsequencesofcontractionandrestperiods.See

paragraph 8.2.5.6 for details.

4.1.3.2.4 Burst symmetrical

The burst biphasic symmetrical pulsed current is a variation to its non burst counterpart, in which the

continuoustrainofpulsesisinterruptedbypulsepauses.Seeg4.1.4.3.6 for details. A burst frequency

can be set for treating chronic pains, where the use of continuous stimulation with a low pulse

frequencywouldbetoopainful.Eachburstlastsfor100msandtheburstratecanseparatelybe

adjusted.WiththismilderTENSwaveformitiseasiertoexceedthemotorialthresholdstimulus.

Parameters:

•Phase Duration, expressed in µs, is the elapsed time from the beginning to the end of the initial pulse

phase.Seeg4.1.4.3.5 for details.

•Pulse Frequency, expressedinHzorpps(pulsespersecond),denestherepetitionrateofthe

TENSpulses.Seeg4.1.4.3.5 for details.

•Burst Frequency, expressedinHz,denestherepetitionrateofburstsofpulses.Aburstconsistsof

atrainofpulses.Eachburstlastsfor100msandthenumberofpulsesinaburstdependsonthe

selectedPulsefrequencyi.eataPulseFrequencyof100Hz,10pulsesareavailableineachburst.

Seeg4.1.4.3.6 for details.

4.1.3.3 Premodulated

AswithInterferentialcurrents,amediumcarrierfrequencyisusedtopassthelowfrequency

stimulation(beat)frequencythroughtheskin.Seeg4.1.4.1forthecurrentwaveform.‘Premodulated’

implies that amplitude modulation occurs in the equipment, allowing it to be applied with a single

electrode pair.

ThePremodulatedalternatingcurrentisoftenusedwheretheobjectiveistostrengthenthemuscleand

changethedistributionofmusclebers(twitchspeed).TheBeatfrequencyisusedtoaectthemuscle

berdistribution.Theoptimumcarrierfrequencyforthispurposevariesbetween2000and4000Hz.

AtalowBeatfrequency(uptoabout20Hz)themusclebecomes‘red’,whileatahigherBeat

frequency(uptoabout150Hz)themusclebecomes‘white’.Thiscanbeusedtoincreasethe

explosive release of energy in high-jumpers, provided that is supplemented by functional exercises.

ThemostcomfortabletetaniccontractionsareobtainedataBeatfrequencybetween40and80Hz.

MusclestimulationisnormallyappliedwithaSurgeprogram,allowingthemusclestorestbetween

exercise cycles.

Parameters:

•Carrier Frequency, expressedinkHz,isthebasefrequencyofthealternatingcurrent.

•Beat Frequency, expressedinHz,denestherateatwhichtheamplitudeisinternallymodulated.

•Frequency Modulation, expressedinHz,denesavariablefrequencyrangethatissummedtothe

Beatfrequencyi.e.whentheBeatFrequencyissetto80HzandtheFrequencymodulationissetto

40Hz,thenalfrequencywillvaryfrom80to120Hz.

•Modulation Programdenesthetimeandsequenceinwhichthefrequencywillsweepthroughthe

Frequencymodulationrange.SeefortheavailableModulationprogramsg4.1.4.7.

•Surge Programcanbeusedtoadjustrepeatedsequencesofcontractionandrestperiods.See

paragraph 8.2.5.6 for details.

4.1.3.4 Russian stimulation

Thiscurrenttypeisanintermittentalternatingcurrentwithacarrierfrequencyaround2500Hz.Seeg

4.1.4.2forthecurrentwaveform.RussianStimulationwasrstusedbyKots,alecturerinsports

medicineattheMoscowStateAcademy.Kotsuseditformusclestrengtheninginprosthesiologyandin

thetrainingofRussiancosmonauts.Withthistechniquetheelectrostimulationisappliedbothto

individualmusclesandtogroups(eitherdirectlyorviathenerve).Indirectstimulation,afrequencyof

2500Hzwasfoundtoproducethelargestcontraction,whiletheoptimumfrequencyinindirect

stimulationwas1000Hz.

Aspecicfeatureofthistypeofmusclestimulationisthatthealternatingcurrentisinterrupted50times

persecond.Thisresultsinapulsetrain,comparabletothe‘burst’inTENS.Thetotaldurationofthe

pulsetrainis20ms,givingaphaseduration/phaseintervalratioof1:1.KotsusesaBurstfrequencyof

50Hz,approximatelyinthemiddleofthefrequencyspectrumusedtoproducetetaniccontraction(40

to80Hz).Inadditiontothe1:1ratio,Kotsalsodescribesaphaseduration/phaseintervalratioof1:5.

The amplitude should be increased until a powerful contraction is produced (from the motor stimulation

leveluptothelimitoftolerance).AswithallmusclestimulationapplicationsaSurgeprogramcanbe

used, allowing the muscles to rest between exercise cycles.

Parameters:

•Carrier Frequency, expressedinkHz,isthebasefrequencyofthealternatingcurrent.

•Burst Frequency, expressedinHz,denestherepetitionrateofthebursts.

•Burst / Interval Ratio, denestheratiooftheburstlengthtotheintervalbetweenthebursts.The

sum of the burst and interval duration is the reciprocal of the burst frequency i.e. with a burst

frequencysetat50Hzandaburst/intervalratioof1:5,theburstdurationwillbe20*1/6=3.3ms

andtheintervaldurationwillbe20*5/6=16.7ms.

•Surge Program canbeusedtoadjustrepeatedsequencesofcontractionandrestperiods.See

paragraph 8.2.5.6 for details.

4.1.3.5 Micro current

MicroCurrentisamonophasicrectangularwaveformwithmanuallyselectableoralternatingpolarity.

Seeg4.1.4.5.4foragraphicalrepresentation.ManytherapistspreferMicroCurrenttherapybecause

of the low current amplitudes used. Alternating polarity can be used to average out the DC component,

thereby reducing the formation of electrolysis by-products.

Parameters:

•Frequency, expressedinHz,isthenumberofcyclespersecond.

•Alternation mode deneswhetherthepolarityofthewaveisautomaticallyalternatingornot.

•Alternation Period, expressedinsecond,denesthepolarityreversaltiminginthealternatingmode.

•Surge Program canbeusedtoadjustrepeatedsequencesofcontractionandrestperiods.See

paragraph 8.2.5.6fordetails.Surgeprogramsareonlyavailableinthenonalternatingmode.

4.1.3.6 High voltage

Thiscurrenttypehasatwinpeakmonophasicwaveformwithaxeddurationof64µsbetweenthetwo

voltagepeaks.TheamplitudeisadjustedinvoltsratherthaninmA.Theshortrisetimeandshort

durationofeachvoltagepeak(approximately7µs)iswellsuitedtonervestimulationandecient

discrimination between sensory, motor and pain responses. The very short pulse duration of high

voltage creates a stimulation which is quite comfortable, and one which most patients can tolerate.

The very short pulse duration followed by a very long interpulse interval eliminates the formation of any

appreciablechemicalorthermaleectsinthetissue.Highvoltageisusedforstimulatingnervesand

muscles,causingmusclecontractions.Examplesforclinicalusearetotreatacuteorchronicpain,

edemaabsorptionandulcerhealing.Musclecontractionormotorresponseofisolatedmusclegroups,

supercialordeep,canbeeasilyandcomfortablystimulated.Therelativecomfortanddepthof

penetrationmaybethekeyfortheusefulnessofhighvoltagestimulationinclinicalconditionssuchas

tendontransplants,jointmobilizationandmusclere-education.

Parameters:

•Pulse Frequency, expressedinHzorpps(pulsespersecond),denestherepetitionrateofthetwin

pulses.See4.1.4.5.3 for details.

•Frequency Modulation, expressedin%,denesavariablefrequencyrangethatissubtractedfrom

thePulsefrequencyi.e.whenthePulsefrequencyissetto80HzandtheFrequencymodulationis

setto50%,thenalfrequencywillvaryfrom40–80Hz.

•Modulation Program denesthetimeandsequenceinwhichthefrequencywillsweepthroughthe

Frequencymodulationrange.SeefortheavailableModulationprogramsg4.1.4.7.

•Alternation Modedeneswhetherthepolarityofthepulsesisautomaticallyalternatingornot.

•Alternation Period, expressedins,denesthepolarityreversaltiminginthealternatingmode.

•Surge Program canbeusedtoadjustrepeatedsequencesofcontractionandrestperiods.See

paragraph 8.2.5.6fordetails.Surgeprogramsareonlyavailableinthenonalternatingmode.

4.1.3.7 Diadynamic currents

TheDiadynamicCurrentsthatwereintroducedbyBernard(2) are mainly used for pain reduction and the

improvement of blood circulation.

Bernardusestheterm‘DiadynamicCurrent’torefertoamonophase(MF–MonophaséFixe)or

double-phase(DF–DiphaséFixe)rectiedalternatingcurrent.Thefrequencywasdirectlyderived

from the mains supply, resulting in sinusoidal pulses with a duration of 10ms. This phase time of 10ms

willmainlydepolarizethickbers.Stimulationofthinberscanonlybeobtainedathighercurrent

amplitudes.

(2)Bernard,PierreD.

Lathérapiediadynamique,

Paris,Editions‘Physio’,1962.

D CAUTION:

•Diadynamic currents are monophasic currents that produce electrolysis by-products. These by-

products can result in burns beneath the electrodes. Always use properly moistened sponge and

electrodecombinationstoabsorbtheseby-productsduringtreatment.Seeparagraph7.1.8 for details.

The following variations are available:

4.1.3.7.1 MF (Monophasé Fixe)

Isasinglephaserectiedsinusoidalcurrentwithafrequencyof50Hz.Seeg4.1.4.6.1fordetails.MF

is a vibrating waveform that easily induces contractions.

4.1.3.7.2 DF (Diphasé Fixe)

Isadualphaserectiedsinusoidalcurrentwithafrequencyof100Hz.Seeg4.1.4.6.2 for details. DF

isusuallyexperiencedasaslightvibration.Itisapleasantwaveformthatisoftenusedasan

introductiontoCPorLP.

4.1.3.7.3 LP (Longues Périodes)

IsaslowalternationbetweensixsecondsofMFcurrentandasix-secondDFcurrent.IntheDFphase

theintervalsbetweentheMFpulsesarelledwithadditionalpulseswithgraduallyincreasingand

decreasingamplitude.Seeg4.1.4.6.3fordetails.LPissmootherthanCP.

4.1.3.7.4 CP (Courtes Périodes)

IsarapidalternationbetweenonesecondofMFcurrentandonesecondofDFcurrent.Seeg

4.1.4.6.4fordetails.CPhasastrongresorbingeect.

4.1.3.7.5 CPid

IsidenticaltoCP,exceptthatthecurrentamplitudeduringtheMFphaseis12.5%lowerthanduring

theDFphase.Seeg4.1.4.6.5fordetails.Normallyalowerfrequencyisexperiencedtobemore

aggressivethanahigherfrequency.CPidpreventsthisdierenceinsensation.

Parameters:

•Surge Program canbeusedtoadjustrepeatedsequencesofcontractionandrestperiods.See

paragraph 8.2.5.6fordetails.SurgeprogramsareonlyavailablewithMFandDF.

4.1.3.8 Galvanic current

4.1.3.8.1 Continuous galvanic current

Galvaniccurrentworkswhencombinedwiththecorrectionized/electricallychargedsolutions,(i.e.

theyareionscarryingeitherapositiveornegativeelectricalcharge,orwillionizewithelectricity).

Thismakesitpossibletoinuencetheskin'sabilitytoabsorbserumsintotheintracellularspacesinthe

dermis. The absorption process is called iontophoresis because the electrical currents literally carry

ionsintothetissuesbetweenthecells(seeg4.1.4.5.2 for details).

D CAUTION:

The continuous galvanic current is a monophasic current that produces electrolysis by-products. These

by-products can result in burns beneath the electrodes. Always use properly moistened sponge and

electrodecombinationstoabsorbtheseby-productsduringtreatment.Seeparagraph7.1.8 for details.

4.1.3.8.2 Interrupted galvanic current

The medium frequency interrupted galvanic current is a monophasic rectangular waveform with a pulse

frequencyof8000Hzandadutycycleof90%.Seeg4.1.4.5.1 for details. As opposed to direct

galvanic current, the pulsed waveform provides increased patient comfort.

D CAUTION:

•The interrupted galvanic current is a monophasic current that produces electrolysis by-products.

These by-products can result in etching beneath the electrodes. Always use properly moistened

spongeandelectrodecombinationstoabsorbtheseby-productsduringtreatment.Seeparagraph

7.1.8 for details.

4.1.3.9 Faradic current

4.1.3.9.1 Faradic Rectangular or Triangular Pulsed Current

Faradic currents are often used for muscle stimulation applications that are based on prior diagnostics.

Seeg4.1.4.4.2 and 4.1.4.4.3 for the current waveforms. The diagnostic objective is to obtain

information on the sensitivity of the neuromuscular apparatus to electrical stimulation. This gives an

indication of the degree of denervation of the muscle tissue. With this technique the relationship

between the current amplitude and phase duration of a rectangular and triangular pulse is plotted in a

strength/durationcurve.Thestrength/durationcurveisrecordedbyobservingthecurrentamplitude

required at various phase duration values (ranging from 0.01 to 1000ms) that produce a just

perceptible (i.e. just visible or palpable) contraction of a muscle or muscle group. The values observed

canbeplottedongraphpaperwithalogarithmicscale.Inthecaseofreducedorabsentsensitivityto

electricalstimulation,thestrength/durationcurvegivesanindicationofthecurrentwaveform,phase

duration and current amplitude of the electrical stimulus to be used in any therapy that may be applied.

D CAUTION:

Faradic currents are monophasic currents that produce electrolysis by-products. These by-products

can result in etching beneath the electrodes. Always use properly moistened sponge and electrode

combinationstoabsorbtheseby-productsduringtreatment.Seeparagraph7.1.8 for details.

Parameters:

•Phase Duration, expressed in ms or s, is the elapsed time from the beginning to the end of the pulse

phase.Seeg4.1.4.4.2 and 4.1.4.4.3 for details.

•Pulse Frequency, expressedinHzorpps(pulsespersecond),denestherepetitionrateofthe

currentpulses.Seeg4.1.4.4.2 and 4.1.4.4.3 for details.

•Surge Programcanbeusedtoadjustrepeatedsequencesofcontractionandrestperiods.See

paragraph 8.2.5.6 for details.

4.1.3.9.2 Träbert, 2 – 5 Current

The2-5or‘Ultra-Reiz’currentwasintroducedbyTräbert.(1)Itisoftenusedtotreatheadachesandneck

pain.The2-5currentisafaradicrectangularpulsedcurrentwithaphasedurationof2msandaphase

intervalof5ms.Thesesettingsarethedefaultsettingsforthefaradicrectangularcurrentwaveformand

resultinapulsefrequencyofapproximately143Hz.Träbertoerednoexplanationforthechoiceof

theseparameters.Nevertheless,manyspecialistshaveadoptedthetherapyanditisstillappliedwith

success.Seeg4.1.4.4.1 for a graphical representation.

(1) Träbert,H.

Ultra-Reizstrom,einneuestherapeutischesPhänomen,

Elektromedizin2,1957(7).

D CAUTION:

Faradic currents are monophasic currents that produce electrolysis by-products. These by-products

canresultinburnsbeneaththeelectrodes.Alwaysuseproperlymoistenedsponge/electrode

combinationstoabsorbtheseby-productsduringtreatment.Seeparagraph7.1.8 for details.

Parameters:

•Phase Duration, expressed in ms or s, is the elapsed time from the beginning to the end of the pulse

phase.Thedefaultsettingis2ms.Seeg4.1.4.4.1 for details.

•Phase Interval, expressed in ms or s, is the elapsed time between successive pulse phases. The

defaultsettingis5ms.Seeg4.1.4.4.1 for details.

4.1.4 Illustrations of current waveforms

4.1.4.1 Premodulated / Isoplanar vector / Dipole vector

fb Beatfrequency

4.1.4.2 Russian stimulation

fBBurstfrequency

4.1.4.3 Biphasic pulsed current TENS

4.1.4.3.1 Asymmetrical

tPhaseduration

fpPulsefrequency

4.1.4.3.2 Asymmetrical alternating

tPhaseduration

fpPulsefrequency

4.1.4.3.3 Burst asymmetrical

fBBurstfrequency

4.1.4.3.4 Burst asymmetrical alternating

fBBurstfrequency

100mA max.

1/fb

4.1.4.3.5 Symmetrical

tPhaseduration

tiPhaseinterval

fpPulsefrequency

4.1.4.3.6 Burst symmetrical

fBBurstfrequency

4.1.4.4 Faradic current

4.1.4.4.1 Träbert, 2 – 5 Current

tpPhaseduration:2ms

tiPhaseinterval:5ms

4.1.4.4.2 Rectangular pulsed current (ms)

tpPhaseduration

tiPhaseinterval

4.1.4.4.3 Triangular pulsed current (ms)

tpPhaseduration

tiPhaseinterval

4.1.4.4.4 Rectangular pulsed current (Hz)

tpPhaseduration

fpPulsefrequency

4.1.4.4.5 Triangular pulsed current (Hz)

tpPhaseduration

fpPulsefrequency

4.1.4.5 Galvanic current

4.1.4.5.1 Galvanic interrupted

fCarrierfrequency-8kHz

xed

Dutycycle-90%xed

4.1.4.5.2 Galvanic continuous

4.1.4.5.3 High voltage

tPeakinterval-64µsxed

fpPulsefrequency

4.1.4.5.4 Micro current

f Frequency

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