Home

Rehab/Theta/Physio User Manual EN

Contents

1. 18 Device components and accessories ttt tte ttt ttt EEEE ttti 18 3 2 Explanation or symbols connections and ierat b iet neon 21 321 and PONE SUB techie a ut dra 21 3 3 Description of the 23 PN END ERN E Cee OE IR RE te ee Nee tera 24 PN Connecting the cables ekr NIRE REN 24 pont 24 ac a SEDE TIENE en ree ee Cnn te Oe Neen a ete eet nee et remem ner ete ten 25 4 4 Preliminary SEITE ee cutn cersnetnsaretdarshonceenstesnanceds xetaniceasndeancedeaceonsichondelowsnelodanpdcertiaeseenaiedsincedannedadieseandsonadandanconaseeionctoeacneleeneonie 26 PE PASE ME SUVS SES COE etches cence R neti tnus tu uf cues ect ctm 26 5 How to perform a treatment Neurostimulation programs essere tenentes 27 5 1 Select a neurostimulation beth beret bue Its nandi dti 27 Sree Ne esos DIE D rea DEUS osos 27 53 Choosing a programme Category aeneis rtt aeter i 27 LO Rocio cec INI ERN 28 Sa c aA programe a Nae a 29 5 5 1 Choosing
2. 29 5 5 2 Activate the warm up SCSSION cccssssssecssssssssesssccssecsssssssesssscssessssesssccssscsssesssccasscsssessscsessessuessscsssecssscsssesssscessesssesseccesecesseesses 30 eat eee tem Em 30 Level Progressio ER a EE A EEA E AREE E EE E EEEa EEEE R 30 5 6 Placement of ClOCHFOMES 3l RM 3l 5 8 Adjusting stimulation 2 224424 2020 ttt 22 een nT ee ee 33 exercit MINIS RU TNNT ne nse beac ea elspa eens 34 PINS 2 e E RCNH mm 35 EPA ENC OL DOEA Missierna a TE 35 513 erformance r dE 36 REHAB THETA PHYSIO CONTENTS 6 Treatment COBEIDEIS beo ene errr berita tac ated e iu us co feat 357 63 Muscle Intelligence TeChpnmolOgy M assente erant ttnbk tnnt ttn 37 PS arias Ec 38 Energy management Sl TEN Sic edi ertet ia el aided dedidit 39 6 1 3 Triggering of contraction 40 6 2 SKIP Function Move on to the evt nette 42 SINE 42 6 4 How to use the Motor Point 43 een D NO
3. WARM UP CONTRACTION REST PHASE FREQUENCY 45 Hz DURATION OF nee RAMP UP B DURATION OF 65 65 PHASE DURATION OF O 75 S RAMP DOWN PATELLOFEMORAL SYNDROME LEVEL 3 DISUSE ATROPHY LEVEL 1 15 MIN FINAL RECOVERY RAMP DOWN WARM UP CONTRACTION REST PHASE FREQUENCY 75 Hz E DURATION OF TT RAMP UP DURATION OF 8 4S 115 PHASE DURATION OF 0 75 S z 124 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY PROGRAM REHABILITATION II ACL WHEN As a supplement to rehabilitation of a ligamentoplasty of the anterior cruciate ligament of the knee The programme can be used early as it does not put any stress on the tendon graft WHY To restore the muscular qualities of the quadriceps and the hamstrings and recover a stable knee to allow the safe resumption of active sport HOW The ACL programme is specifically designed for the rehabilitation of ligamentoplasties It allows intensive use of the quadriceps while protecting the tendon graft during the first few post operative weeks due to co activation of the hamstring muscles Stimulation starts with the hamstrings channels 1 and 2 While they are contracted stimulation continues on the quadriceps channels 3 and 4 thus preventing any risk of anterior draw movement PULSE WIDTH To make it as comfortable as possible for the patient use pulse widths equiv
4. 118 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS 15 2 Full Version Programs and their usage Theta Physio devices only Note The Full Version offers additional programs to the Standard Version Additional programs to already at Standard version existing program categories are automatically included within the corresponding program category Full Versions programs are only included in Theta and Physio devices REHABILITATION II 120 PROG FOR HAEMOPHILIACS 135 Hip prosthesis 120 Atrophy 135 Patellofemoral syndrome 122 Reinforcement 136 ACL 124 Rotator cuff 126 NEUROLOGICAL 137 Lumbar stabilization 128 Hemiplegic foot 137 Cardiac rehabilitation 129 Spasticity 138 Atrophy modulated frequency 130 Hemiplegic shoulder 139 Reinforcement modulated frequency 131 Slow start neuro rehabilitation 149 AGONIST ANTAGONIST 132 Atrophy 132 Reinforcement 134 119 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS PAIN RELIEF II 142 CONDITIONING II 155 TENS Gate control 80Hz 142 Potentiation 155 Knee pain 143 Endurance 156 Trapezius muscle pain 144 Explosive strength 158 Shoulder pain 145 Plyometry 160 Fracture pain 146 Hypertrophy 161 Cervical pain 147 Muscle building 163 Thoracic back pain 148 Low back reinforcement 165 Low back pain 149 Core stabilization 167 Lumbosciatica 150 R
5. 83 REHAB THETA PHYSIO 14 ELECTROTHERAPY THEORY 14 2 3 Summary The pulse current that is able to produce excitation action potential and also offer the patient the maximum amount of comfort can be called the optimum current This pulse must have the following characteristics e 1 Constant pulses of current i e produced by a constant current generator 2 Vertical establishment in order to be effective immediately and to reduce the application time of the current 3 Rectangular shape in order to apply the lowest possible electrical intensity 4 Pulse duration that is equal to the chronaxy of the nerve structure requiring stimulation is order to minimise electrical energy 5 Compensated pulse with an electrical mean of zero in order to prevent side effects linked to polarisation 25 14 3 Basic concepts of excitation electrophysiology 14 3 1 Introduction Passing an electrical current through an excitable living tissue results in a change to the resting potential Vo The changed resting potential is called the local potential V If the variation in the local potential is sufficiently intense and in the right direction a state of instability is reached and excitation i e the action potential occurs The value that the local potential V must reach so that action potential appears is called the excitation threshold So The local potential V caused by electrical charges provided by the curren
6. During the following weeks the objective is the restoration of near normal muscle volume When open kinetic chain exercises are permitted which is normally at the end of the fourth month after the operation NMES of the quadriceps can be continued using the Reinforcement programmes Level 1 then 2 16 6 2 Treatment frequency One to two sessions every day if two sessions are carried out every day enough time must be given to rest between the two sessions Minimum three sessions per week 209 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 6 3 Electrode position The stimulation sequence means that the order of channel numbers must be complied with as the stimulation of the hamstrings must start before that of the quadriceps Channels 1 and 2 are used to stimulate the hamstrings and channels 3 and 4 are used to stimulate the quadriceps For this program it is therefore particularly important to follow the order of channel For each muscle group it is recommended that the small electrodes be placed precisely on the motor points as shown in the illustration or better yet that the motor points be found using the instructions for the indication Locating a motor point in this manual For optimum effectiveness the positive pole should preferably be positioned on the motor point 16 6 4 Patient position The very first sessions the primary objective of which is to elimi
7. Rheobase The pulse times t1 t2 and t3 cannot be used since during these periods lt i Fig 1 EN Only one way of establishing the electrical stimulation wave is effective immediately which is vertical Fig 2 In this case there is no delay in its efficacy and the duration of the electrical wave is further reduced by it E The stimulation current established vertically with a value higher than i the rheobase instantaneously produces an accumulation of charges modifying the resting potential Fig 2 79 REHAB THETA PHYSIO 14 ELECTROTHERAPY THEORY 14 2 2 3 Shape of the electrical stimulation wave When the stimulation current has vertically reached an intensity higher than the rheobase how should it develop in order to offer maximum comfort With minimum intensity it must provide in time t the quantity of electrical charges Q it q required to trigger the action potential Since Q Lt it is clear that the rectangle is the wave shape capable of providing the quantity of charges 0 with minimum intensity I Fig 3 di Comparison of different electrical pulse shapes of equal duration established vertically and providing the same quantity of electrical charges which correspond graphically to identical areas Fig 3 V E In order to create the same quantity of charges with pulses with shapes other than rectangular higher intensitie
8. To relieve knee joint pain irrespective of its cause gonarthrosis rheumatoid WHEN polyarthritis chondromalacia etc WHY For the relief of pain Using the Gate control principle This involves causing high levels of sensitivity impulses HOW in order to limit the input of pain impulses when they return to the posterior horn of the spinal cord The pulse width varies continuously with this programme This avoids habituation by PULSE WIDTH using a system of stimulation that is perceived as more pleasant by some patients De r round th lla pr FIECTRGDES pending upon the pain four large elect odes placed around the patella produce a significant analgesic effect on all knee pain The intensity must be increased gradually until the patient feels a tingling sensation INTENSITY that is pronounced without being painful OPTION 2 2 Yes KNEE PAIN FREQUENCY PULSE WIDTH MODULATION TIME TREATMENT TIME 80 Hz 75 180 uS 25 min 144 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY PAIN RELIEF II PROGRAM TRAPEZIUS MUSCLE PAIN As with all muscular pains pain in the trapezius muscles can best be relieved by WHEN endorphin stimulation However TENS stimulation may be preferable for the first sessions if there is acute pain in an area of inflammation WHY For the relief of pain Using the Gate control principle This involves c
9. 8 DENERVATED PROGRAMS PHYSIO DEVICE ONLY 8 1 4 Partial manual Partial denervation with choice of stimulation parameters to define the desired ramp To use a ramp of your choice first select the pulse width option in the corresponding channel Confirm your choice and increase the stimulation intensity to the desired level FERIOD Fig 32a Press the On Off button to return to the previous screen Fig 32b Use the channel 1 button to select the parameter you wish to edit pulse width for each channel period or programme duration Fig 32c Use the channel 2 button to edit the value of the parameter you have selected Fig 32e Press the channel 4 button to confirm your choice and start the treatment NOTE Hold down the i button when in the stimulation or end of programme screen to access the parameters for the programme you are using 57 REHAB THETA PHYSIO 9 TROUBLESHOOTING 9 1 Electrode or cable failure The Rehab Theta Physio will beep and alternately display a pair of electrodes and an arrow pointing to the channel where the problem was detected In the example below the stimulator has detected an error in channel 2 B lt ooo ooo ooo ooo The electrode error message can mean that There are no electrodes connected to this channel The electrodes are old worn and or the contact is poor try using new electrodes The electrode cable is faulty try connecting it to another channel If
10. chattanooga Moving Rehabilitation Forward Rehab Theta Physio User Manual EN REHAB THETA PHYSIO QUICK START GUIDE Note It is strongly advised to carefully read the contraindications and safety measures described in chapter 1 and 2 in this manual before using your device For detailed information on usage also see Chapters 3 to 16 of this manual A Press ON OFF button Connect the cables N B The Mi sensor cable if available with the device can be connected to any socket on the stimulator C Select language contrast and volume D Choose a type of treatment E Choose a programme category PREV OF DISUSE ATROPHY F Choose a programme NEURO RENG SL G Personalise a programme H Start a programme l End a programme pressing ON OFF button REHAB THETA PHYSIO CONTENTS How to use the medical equipment Intended 7 IRE skis Eie Ies d oT NN RR 2 deiade Se ea chee ee 7 d el OESTE 8 gt ORO TE 8 Secondary 9 2 Safety 55 E 10 3 Description of the
11. Phase 2 Three to five sessions per week until the pain disappears Phase 3 Three to five sessions per week until the end of treatment When the patient has recovered good motor control of the stabilizing muscles it is beneficial to perform the last sessions of the treatment in mi ACTION mode When this function is active the initiation of the electrically induced contraction requires voluntary contraction on the part of the patient For this exercise it is recommended that the mi sensor be positioned on the electrode placed on the infraspinous muscle and to ask the patient to perform a voluntary isometric contraction of his her lateral rotators 16 8 1 3 Electrode position Phase 1 Four large electrodes are placed in such a way as to cover the whole shoulder as well as possible Phase 2 A small electrode is placed on the fleshiest part of the infraspinous fossa and the other small electrode is positioned on the external part of the supraspinous fossa but not over rear deltoid as this result in unwanted shoulder extension For optimum effectiveness the positive pole should preferably be positioned on the infraspinous muscle If the patient is still experiencing pain TENS can be combined using the other channels The specific placement of electrodes for TENS used for phase 1 will be applied to channels 2 and 3 216 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS Phases 2 amp 3 P
12. Urge incontinence Weeks 1 3 16 14 1 2 Treatment frequency Three sessions per week 16 14 1 3 Electrode position Use of an intravaginal probe 16 14 1 4 Patient position The patient reclines on her back on a couch with a cushion under the buttocks and the knees flexed at 909 feet flat on the couch 266 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 14 1 5 Stimulation energies Gradually increase the energies until the patient feels the stimulation i e five pulses per second Then increase the energies again to a value equal to three times that of the perception threshold 16 14 2 Stress incontinence Three concentric elements operate in the area of the sphincter urethrae 1 The smooth muscles of the urethra 2 The intramural striated sphincter 3 The paraurethral components of the striated pelvic floor musculature The intramural striated sphincter is composed exclusively of slow fibres type 1 while the paraurethral components also contains fast fibres type IIb The intramural striated sphincter is therefore resistant to fatigue but not strong It is able to maintain a prolonged closure of the bladder but it is unable to withstand a sudden and intense increase in pressure within the bladder for example during coughing In this case it is the fast fibres of the paraurethral muscle that have to maintain continence by contracting strongly during the brief moment
13. A small electrode is placed on the fleshy part of the epicondylar muscles approximately two finger widths below the epicondyle The second electrode also small is placed on the dorsal aspect of the forearm where the lower and middle thirds meet The position of these electrodes must be adjusted so as to firstly obtain extension of the fingers and then extension of the wrist Extension of the wrist alone with flexion of the proximal and distal interphalangeal joints will not produce optimum results Extension of the interphalangeal joints is therefore the first objective 16 11 3 4 Patient position The patient is seated beside a table The elbow and forearm rest on the table the shoulder is in a functional position with the elbow bent and the hand in pronation 251 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 11 3 5 Stimulation energy Always work with an energy that is too low to produce diffusion of stimulation to the flexors of the fingers and wrist Ideally the stimulation energy should be adjusted so that the contraction of the extensors extends the fingers and wrist to the maximum range of movement The complete movement cannot be carried out if the spasticity of the flexor muscles exceeds the contraction strength of the atrophied extensors Stimulation will only cause reduced movement or even no movement at all in extreme cases Treatment with NMES should be carried out e
14. HOW the programme correspond to the Disuse atrophy level 1 and 2 programmes and the Reinforcement level 1 programmes respectively for which the low frequencies have been removed so as not to cause micro trauma in the patella To make it as comfortable as possible for the patient use pulse widths equivalent to the PULSE WIDTH of the motor nerves of the gluteal muscles The mi SCAN function can be used to determine the pulse widths suitable for the patient s muscles Electrodes positioned on the quadriceps or only on the vastus medialis in accordance ELECTRODES FM with the specific indication The maximum tolerable stimulation energy which is one of the key factors determining the effectiveness of the treatment The higher the stimulation energy the higher the number of muscle fibres motor units being used Progressively increase the level of energy during the course of a treatment session OPTION 242 Yes as 3 1 as ch 1 ch 2 ch 3 are used for patellar syndrome program 1233 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS PATELLOFEMORAL SYNDROME LEVEL 1 DISUSE ATROPHY LEVEL 1 30 MIN FINAL RECOVERY WARM UP CONTRACTION REST PHASE FREQUENCY 35 Hz DURATION OF RAMP UP B DURATION OF T PHASE DURATION OF RAMP DOWN us PATELLOFEMORAL SYNDROME LEVEL 2 DISUSE ATROPHY LEVEL 2 30 MIN FINAL RECOVERY
15. REINFORCEMENT LEVEL 1 20 MIN FINAL RECOVERY RAMP DOWN WARM UP CONTRACTION ACTIVE REST PHASE FREQUENCY 6 Hz 75 Hz 4 Hz 3 HZ DURATION OF fs mee 155 RAMP UP gt gt gt DURATION OF 2 gifs PHASE 4 3 DURATION OF T o Ere 4 RAMP DOWN 75 5 3 REINFORCEMENT LEVEL 2 20 MIN FINAL RECOVERY WARM UP CONTRACTION ACTIVE REST PHASE FREQUENCY 6 Hz 85 Hz 4 Hz 3 HZ DURATION OF p OES 155 RAMP UP 2 3 P DURATION OF 2min 4S 85 3 MIN PHASE DURATION OF 25 O 75 S 055 35 95 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY PROGRAM REHABILITATION PREVENTION OF DISUSE ATROPHY WHEN After an operation or a bone fracture a limb or a section of a limb is immobilised the muscles of this part of the body are affected very quickly by disuse atrophy This rapid decrease in muscle volume is mainly due to reflex inhibition and a total absence of muscle activity It is also important to note that disuse atrophy tends to disproportionally affect type fibres more than type II WHY To compensate for total or partial inactivity of the muscle following an osteoarticular injury HOW In order to prevent disuse atrophy electrostimulation has to compensate for the total inactivity of the muscle by reproducing a series of contractions similar to the different ways in which the muscle functions when it i
16. RES EAD PTR aC 72 14 1 1 The fundamental law of electrostimulation 72 sib ania nisi t 76 MTS SINE Lor soc aduentus 77 14 2 The Optimum Current tentent tentent tentent tetti ttt tetti te ttt EEEE 77 ire MT OGU CION PT i 77 1123 naracrersucs f the optimal CUEITIBPIC sauer acetum burnt anthesin biker taies 77 14 2 2 1 Electrical stimulation wave produced by the current generator 77 1412 5 Type of establishment of the electrical stimulation Wa ar att ie pa ot Date 78 14 2 2 3 Shape of the electrical stimulation WAVE csccescssssssssssssssssesssccssssssesssccessssseesseccsssssssessecssnesssssssecessecsscssncssecsssesssecessees 79 14 2 2 4 Duration of rectangular electrical cota eit Datis o 80 11235T0pensSation TOF EHE ACTA rie ular PUISE Non 82 SUIT EE 83 14 3 Basic concepts of excitation electropHySIDIOBWV usadas a o E Ptr 83 ce case na cea TR RN TN NE 83 14 3 2 Study Of the excitation process USING constant CUETGDIE 85 14 3 3 Excitation by a current with any shape tnnt 87 14 3 4 Chronaxy excitation constant BILE ck aed o buc 88 Dt 3c EID model 88 15 Available Therapy Meu trap uei a Cui redu nee mE cU ns E 90 15 1 Standard Version Programs and
17. dnas To develop the active stability of the shoulder by restoring the functional attributes of l the muscles supporting the glenohumeral joint Selective stimulation of the infraspinatus and supraspinatus muscles using parameters HOW adapted to their postural function type I fibres Combination with a TENS programme for a combined analgesic effect To make it as comfortable as possible for the patient use pulse widths equivalent to the chronaxies of the motor nerves of the infraspinatus and supraspinatus muscles The PULSE WIDTH MEN mi SCAN function can be used to determine the pulse widths suitable for the patient s muscles ELECTRODES _ Electrodes positioned according to the specific indication The maximum tolerable stimulation energy on the 4 channels which is one of the key MERE factors determining the effectiveness of the treatment The higher the stimulation energy the higher the number of muscle fibres motor units being used Progressively increase the level of energy during the course of a treatment session OPTION 2 2 Yes 127 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS ROTATOR CUFF LEVEL 1 25 MIN FINAL RECOVERY RAMP DOWN WARM UP CONTRACTION ACTIVE REST PHASE FREQUENCY 6 Hz 35 Hz 4 Hz 3 HZ DURATION OF fee T TT Te RAMP UP 9 3 DURATION OF Es T PHASE 7 3 DURATION T e E
18. symbols will stop flashing You are at the minimum level of energy that provides therapeutic results If the stimulation is well tolerated by the patient it is advised to increase the energy level slightly At the end of the treatment or during a break a statistic showing the percentage of time spent in the effective range will appear on the screen 237 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 10 3 Endorphinic treatment of low back pain Chronically contractured lumbar paravertebral muscles are often the source of pain felt by patients with lumbago Although a physiotherapist must naturally find the cause of the pain and treat it accordingly treatment of these chronic contractions using the Low back pain programme brings about fast significant pain relief In the lumbar region the stimulation currents required to obtain visible or at least palpable muscle twitches are generally high and can be difficult to tolerate by some patients This is why it is generally recommended to combine TENS treatment with the Low back pain programme to make treatment more comfortable for the patient This treatment should be continued for at least ten sessions in order to restore the capillary network which is usually atrophic in chronically contractured muscles 16 10 3 1 Protocol Low back TENS 10 to 12 sessions The Low back pain programme is designed to provide endorphinic stimulation on the
19. 65 OS RAMP UP DURATION OF 35 155 PHASE DURATION OF 1 55 OS 137 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS 15 2 4 NEUROLOGICAL CATEGORY NEUROLOGICAL PROGRAM HEMIPLEGIC FOOT One of the problems faced by hemiplegics is the greater or lesser degree of difficulty in raising the toe of the foot Consequently this produces steppage during the swing phase of the gait This programme is recommended if l a the stimulation of the levator muscles in the foot causes a spasm in the muscles of the lower limb to reflex b the spasticity of the triceps surae is high In such cases use a preparation programme which inhibits the tone WHY To prevent foot drop during the swing phase of the gait By manually triggering an electrically induced tetanic contraction in the levator muscles HOW of the foot that is synchronised with the gait phase where the foot is lifted off the ground To make it as comfortable as possible for the patient use pulse widths equivalent to the PULSE WIDTH chronaxies of the motor nerves of the abdominal and lumbar muscles The mi SCAN function can be used to determine the pulse widths suitable for the patient s muscles Electrodes positioned depending on the muscle to be stimulated in accordance with ELECTRODES the instructions INTENSITY In this case use an intensity that is sufficient to provide a degree of contraction that
20. E benelux orderseDJOglobal com DENMARK FINLAND NORWAY amp SWEDEN T Denmark 89 88 48 57 Finland 46 40 39 40 00 T Norway 23 96 09 27 T Sweden 040 39 40 00 E info nordic DJOglobal com ITALY T 39 02 484 63386 F 39 02 484 09217 E vendite DJOglobal com SPAIN T 34 934 803 202 F 34 934 733 667 E ventas DJOglobal com UNITED STATES T 41800 336 6569 F 1 800 936 6569 E customercaree DJOglobal com DJO GLOBAL EXPORT CENTRES ASIA PACIFIC DJO Asia Pacific Limited Unit 1905 19 F Tower II Grand Central Plaza 138 Shatin Rural Committee Road Shatin HONG KONG T 852 3105 2237 F 852 3105 1444 info asia DJOglobal com DJO Nan v EUROPE MIDDLE EAST amp AFRICA DJO Benelux Welvaartstraat 8 2200 Herentals BELGIUM T 32 0 14248350 F 32 0 14248358 info emea DJOglobal com CANADA T 1 1866 866 5031 1 1866 866 5032 canada orders DJOglobal com T 33 0 5 59 52 80 88 33 0 5 59 52 62 99 E physio D Oglobal com INDIA T 91 44 6693 6882 customercare india DJOglobal com SWITZERLAND T 41 0 21 695 2360 41 0 21 695 2361 E info compex ch LATIN AMERICA DJO Global Inc 1430 Decision Street Vista CA 92081 8553 U S A 1 800 336 6569 F 1 800 936 6569 info latam DJOglobal com MOTION IS MEDICINE 2015 DJO 4526420 EN Rev A
21. EUBETHOSBES ectrodes positioned depending on the muscle to be stimulated in accordance with the instructions Use the necessary energy to produce a contraction that is capable of causing INTENSITY movement across the whole of its range Care must always be taken to ensure that the stimulation does not spread as far as the spastic muscle OPTION 2 2 NO SPASTICITY 21 MIN TRIGGERED CONTRACTION REST FREQUENCY 35 Hz o Hz DURATION OF 455 OS RAMP UP DURATION OF 5S 55 PHASE DURATION OF 35 OS RAMP DOWN 139 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY NEUROLOGICAL PROGRAM HEMIPLEGIC SHOULDER The shortage of suspensory muscles in the humeral head combined with spasticity WEHEN of the pectoralis major can often be a cause of a lower subluxation of the shoulder in hemiplegic patients This is always painful and often develops into a complex regional pain syndrome WHY To reduce shoulder pain and to treat or prevent subluxations of the shoulder Stimulating the deltoid and the supraspinatus facilitates a reduction of spasticity in HOW the pectoralis major by reciprocal inhibition reflex This programme has a very gradual rate of tensioning and does not use low frequencies order to avoid myotatic reflex stretching monosynaptic stretch reflex of the spastic muscle To make it as comfortable as possible for the patient use pulse widths equivalent to the PULSE WIDTH chronax
22. I pulse duration t and electrical energy W Having set out the conditions we will now determine the qualities of the current that fulfils these conditions 14 2 2 Characteristics of the optimal current 14 2 2 1 Electrical stimulation wave produced by the current generator We can already state that pulses of current i e produced by a current generator must be used for the following reasons The first point shown by Weiss is the importance of the quantity of electrical charges provided by the stimulation current however the quantity of charges can only be controlled by a current generator Only a current generator can ensure stable and reproducible conditions given the variations in skin resistance If a certain electrical pulse shape is required only a current generator can maintain a constant current wave shape as it passes through the skin and tissue 78 REHAB THETA PHYSIO 14 ELECTROTHERAPY THEORY 14 2 2 2 Type of establishment of the electrical stimulation wave According to Weiss law Q it therefore t it q therefore J i t q with i rheobase iis a current which resists the stimulation current If the stimulation current J has a value lower than i i e the rheobase it cannot be used because it cannot change the resting potential by accumulating electrical charges in the excitable membrane Fig 1 Analysis of the different ways to establish the stimulation current
23. The intensity must be increased gradually until the patient feels a tingling sensation INTENSITY that is pronounced without being painful If the nerve trunks are stimulated the stimulation should cause the tingling to radiate into the painful area OPTION 2 2 Yes FRACTURE PAIN FREQUENCY PULSE WIDTH MODULATION TIME TREATMENT TIME 70 Hz 170 uS 25 min 147 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY PAIN RELIEF Il PROGRAM CERVICAL PAIN WaN Neck pain most often results from chronic contractures of the levator scapulae muscle and or the upper trapezius and is due for example to non ergonomic work posture WHY For pain relief and relaxation of muscle contractures Endorphin stimulation aids pain relief by increasing production of endogenous opioids HOW The associated vascular effect results in effective drainage of acidic metabolites and enables the elimination of muscular acidosis Endorphin stimulation first targets the sensitive nerve fibres which are best stimulated with a larger pulse of 200us However the vascular effect is secondary to PULSE WIDTH 0 i the co activation of the motor units which have a slightly higher chronaxy that is measured at the start of the session using the mi SCAN function ELECTRODES Electrodes positioned according to the specific indication An essential factor in the effectiveness of electrotherapy
24. WHEN Gate control which is activated during TENS stimulation is particularly effective for the relief of localised pain of non muscular origin It is particularly effective for relieving neuropathic pain and inflammatory conditions The sessions may be repeated at will and without restriction depending upon the intensity of the pain WHY Pain relief is now a priority in therapy which must be provided by all healthcare professionals As TENS treatment is generally palliative it improves the patient s comfort and helps the therapist to start the process HOW The principle is to cause a significant influx of tactile sensitivity in order to restrict the entry of pain impulses upon their return to the posterior horn of the spinal cord We must therefore stimulate the sensitivity fibres on the skin of the painful area To do this it is necessary to use a frequency that is the same as the operational frequencies for the tactile sensitivity nerve fibres i e from 50 to 150 Hz PULSE WIDTH Use very short pulse widths corresponding to the chronaxies of the tactile sensitivity fibres i e 50 or 70 us depending on whether the patient is very sensitive normal not very sensitive level 1 2 or 3 respectively ELECTRODES INTENSITY As a general rule the electrodes are placed on or near the painful area The electrodes may also be placed at the nerve trunks depending on the conditions being treated The
25. energy during the course of a treatment session OPTION 2 2 Yes 121 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS HIP PROSTHESIS LEVEL 1 30 MIN FINAL RECOVERY RAMP DOWN WARM UP CONTRACTION REST PHASE FREQUENCY 35 Hz DURATION OF T RAMP UP gt DURATION OF 65 Bs PHASE DURATION OF RAMP DOWN 79 HIP PROSTHESIS LEVEL 2 30 MIN FINAL RECOVERY WARM UP CONTRACTION REST PHASE FREQUENCY 45 Hz DURATION OF RAMP UP B DURATION OF 65 65 PHASE DURATION OF O 75 S RAMP DOWN HIP PROSTHESIS LEVEL 3 15 MIN FINAL RECOVERY WARM UP CONTRACTION REST PHASE FREQUENCY 75 Hz E DURATION OF nee RAMP UP DURATION OF 8 4S 115 PHASE DURATION OF 0 75 S z 122 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY REHABILITATION II PROGRAM PATELLOFEMORAL SYNDROME WaN In conjunction with the rehabilitation of centred post traumatic chondropathy or decentred external subluxation of the patella patellofemoral syndromes uan To restore the trophicity of muscle fibres altered during the muscle disuse atrophy process and to develop the active stability of the knee Depending upon the diagnosis stimulation will either involve all of the heads of the quadriceps muscle or it will be limited solely to the vastus medialis The three levels of
26. for 4 weeks 212 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 7 3 Electrode position Two channels are used one for stimulation of the gluteus maximus and the other for the gluteus medius A small electrode is placed at the intersection of the orthogonal axes dividing the buttock into four quadrants with the same area motor point of the gluteus maximus A second small electrode is placed above and outside of the upper external quadrant of the buttock on the gluteus medius at the point where it passes over the gluteus maximus For optimum effectiveness the positive pole should preferably be positioned on the motor point The other negative poles are connected to the two outputs of one large electrode positioned diagonally in the lower lateral quadrant of the buttock taking care to avoid placing this electrode on a scarred wounded area 16 7 4 Patient position If the patient s condition allows the patient is placed in a standing position which requires him her to exert additional effort that is beneficial for proprioceptive control If this is not possible all or part of the session can be conducted in a side lying or prone position 16 7 5 Stimulation energy In NMES the stimulation energy is directly responsible for spatial recruitment the higher the stimulation energy the higher the percentage of motor units recruited and the greater the impact of the progress The gene
27. oedema provided they are carried out in a certain order and under certain conditions The most effective way consists of producing an initial ejection effect in the leg and then in the thigh without relaxing the compression of the deep veins in the leg In this way the venous blood is pushed in the first stage towards the thigh by a contraction of the leg muscles Then in the second stage the contraction of the thigh muscles eject the blood upwards provided however that the leg muscles remain contracted to prevent regurgitation 16 12 2 1 Protocol Venous insufficiency 2 16 12 2 2 Treatment frequency 3to 6 sessions per week for approximately 6 weeks to treat the acute episode It is then recommended to keep up treatment with a few weekly sessions 16 12 2 3 Electrode position It is necessary to work in staggered contractions mode This means that only channels 1 and 2 start to produce a tetanic contraction while channels 3 and 4 are at rest After 3 seconds of tetanic contraction via channels 1 and 2 the contraction starts only on channels 3 and 4 while the contraction induced by channels 1 and 2 continues After 3 seconds of simultaneous contraction on the four channels there is a complete rest phase of 20 seconds on the four channels 258 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS For this program it is therefore particularly important to follow the order of channel numbers
28. 4 7 Stimulation intensities The maximum tolerable intensity should always be used in order to obtain the greatest spatial recruitment possible For safety reasons in the Denervated programme the maximum intensity is limited to 30 mA By increasing the intensity strength Compex 3 adjusts the pulse width so that the ramp remains constant 16 15 4 8 Stimulation frequency The triangular pulses are repeated every two seconds frequency o 5 Hz The muscle fibres respond to each pulse with a single twitch 16 15 4 9 Duration and frequency The treatment lasts for 8 minutes and must be repeated 5 times a week until re innervation is achieved It will be abandoned as soon as the re innervation time has elapsed If re innervation is only partial once the time has elapsed a disuse atrophy treatment on card 1 must be used in order to achieve compensating hypertrophy see Situation 2 DJO GLOBAL AUSTRALIA T 1300 66 77 30 F 1300 66 77 40 E customerservice au D Oglobal com CHINA T 8621 6031 9989 F 8621 6031 9709 E information chinaeDJOglobal com GERMANY T 49 761 4566 01 F 49 761 456655 01 E infoservice DJOglobal com SOUTH AFRICA T 27 0 87 3102480 F 27 0 86 6098891 E info southafricaeDJOglobal com UK amp IRELAND T 44 0 1483 459 659 F 44 0 1483 459 470 ukorderseDJOglobal com BENELUX T Belgium 0800 18 246 T Netherlands 0800 0229442 T Luxemburg 8002 27 42
29. Battery powered device Not applicable Battery powered device The quality of the electrical power supply should be that of a typical commercial or hospital environment The quality of the power supply should be that of a typical commercial or hospital environment Voltage dips short interruptions and voltage variations on power supply lines CEI 61000 4 11 5 6 VT dips gt 95 6 de UT for o 5 cycle 40 VT dips gt 60 de UT for 5 cycles lt 70 VT dips gt 30 de UT for 25 cycles 5 VT dips gt 95 de UT for 5 Not applicable Battery powered device The quality of the power supply should be that of a typical commercial or hospital environment If the device user requires continuous operation during mains power Cuts it is recommend that the device is powered by a UPS or a battery CEI 61000 4 8 seconds Magnetic field at Magnetic fields at the mains frequency grid frequency Alm should be at a level characteristic of a 50 60 Hz 3 typical location in a typical commercial or hospital environment NOTE VT is the AC supply voltage before application of the test level 69 REHAB THETA PHYSIO 12 EMC TABLES RECOMMENDATIONS AND DECLARATION BY THE MANUFACTURER CONCERNING ELECTROMAGNETIC IMMUNITY Device is designed for use in the electromagnetic environment stipulated below The buyer or user of the device must ensure it is used in this r
30. Hz 4 Hz 3 2 DURATION OF D iss ex RAMP UP P 8 DURATION OF 5 min 65 95 min PHASE DURATION OF 3 ees Sis 5 RAMP DOWN uS B 3 CORE STABILISATION LEVEL 3 36 MIN FINAL RECOVERY WARM UP CONTRACTION ACTIVE REST PHASE FREQUENCY 5 Hz 50 HZ 4 Hz 3 Hz DURATION OF Tn T T wee RAMP UP DURATION OF 5 min 75 85 10 min PHASE DURATION OF 2S 0 75 S 055 35 169 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY CONDITIONING II PROGRAM RECOVERY PLUS WaN To promote muscle recuperation following an exhausting exertion that caused cramps or is likely to induce them when the activity is stopped To increase blood flow to drain away toxins that have accumulated in the muscles WHY To relieve and or prevent aching pains To promote muscle relaxation To accelerate restoration of the muscular qualities following a workout or competition To make it as comfortable as possible for the patient use pulse widths equivalent to the PULSE WIDTH of the motor nerves of the muscles being stimulated The mi SCAN function can be used to determine the pulse widths suitable for the patient s muscles Precision in positioning the electrodes is less significant than for programmes aiming ELECTRODES to develop muscle quality The electrodes can be placed in an alternative way reducing the number of electrodes needed and stimulat
31. Hz continuous 150 15 stimulation 175 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY INCONTINENCE PROGRAM MIXED INCONTINENCE WHEN Combination of urge and stress incontinence in greater or lesser proportions This programme treats both aspects of this form of incontinence at the same time Firstly using tetanic contractions at the frequency of fast fibres 75 Hz it strengthens the paraurethral components of the striated muscle of the pelvic floor so increasing the pressure of urethral closure Secondly during the resting phases between contractions it inhibits the activity of the smooth muscle of the bladder using very low frequencies 5 HZ WHY ELECTRODES Use of an intravaginal probe Use of the maximum energy level tolerated during the tetanic contraction phases to obtain the maximum possible space recruitment and therefore maximum possible INTENSITY efficacy The intensity will be increased regularly during the session every 3 or 4 contractions During the rest phase the low frequency intensity should be adjusted to at least three times the intensity of the perception threshold OPTION 2 2 No MIXED INCONTINENCE 30 MIN CONTRACTION ACTIVE REST FREQUENCY 75 Hz 5 Hz DURATION OF 1 55 O 5 S RAMP UP DURATION OF 4S 235 PHASE DURATION OF 0 75 S O 5 S RAMP DOWN 176 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PRO
32. If the stimulation is well tolerated by the patient it is advised to increase the energy level slightly At the end of the treatment or during a break a statistic showing the percentage of time spent in the effective range will appear on the screen 235 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 10 2 Endorphinic treatment of thoracic back pain Whatever the trigger chronic contractures of the dorsal paravertebral muscles erector spinae are responsible for the pain that incapacitates patients suffering from thoracic back pain Provided that sufficient stimulation energy is used to obtain clear muscle twitches the dorsalgia treatment thanks to the remarkable hyperaemia it causes will be particularly effective for draining the metabolic acids that have built up in the contractured muscle A significant analgesic effect will therefore usually be observed in the first treatment sessions This treatment should however be continued for at least ten sessions in order to restore the capillary network which is usually atrophied in chronically contractured muscles 16 10 2 1 Protocol Thoracic back pain 10 to 12 sessions 16 10 2 2 Treatment frequency Three to five sessions per week for two to three weeks 10 to 12 sessions in total A session should last at least 20 minutes Ideally it may be beneficial to carry out two successive stimulation sessions within the Thoracic back pain program
33. NMES of the abductor muscles of the arm deltoid and supraspinatus may be used to prevent or treat atrophy and reduce spasticity in the latissimus dorsi and pectoralis major muscles This technique is indicated in the prevent or treatment of subluxation of the shoulder in hemiplegic patients Radiological investigations show evidence of re centring of the humeral head in relation to the glenoid cavity Moreover pain in the shoulder and upper limb often associated with subluxation is effectively reduced by this type of treatment However in the event of pain radiating in the upper limb the analgesic action can be supported by using TENS Gate control which is programmed on the third and fourth channel In shoulder hand syndrome in addition to shoulder pain which is itself a secondary problem associated with hemiplegia complex regional pain syndrome CRPS can occur which affects the hand In this situation CRPS should be treated using the programmes and method described in this chapter which deal with this disorder algoneurodystrophy 16 11 4 1 Protocol The hemiplegic shoulder 253 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 11 4 2 Treatment frequency One 25 minute session per day five days per week for 4 weeks Regular treatment carried out in one single session per week may then be necessary in the absence of significant recovery or the persistence of considerable spasticity of th
34. PHYSIO ON SPECIFIC INDICATIONS 16 3 3 Electrode position A single channel is enough for the stimulation of the peroneus muscles A small electrode is placed under the head of the fibula at the passage of the Common Peroneal nerve The large electrode is placed mid way up the external lateral side of the leg For optimum effectiveness the positive electrode should preferably be positioned on the motor point 16 3 4 Patient position First of all the patient is seated on the rehabilitation table barefoot and without touching the floor In this position the therapist gradually increases the stimulation energy until a motor response is manifested by an eversion of the foot As soon as this response is obtained most often after 2 or 3 contractions the barefoot patient is put into standing position This position is particularly useful because it requires an associated proprioceptive effort which can be of increasing difficulty two feet one foot balance board etc 16 3 5 Stimulation energy In NMES the stimulation energy is directly responsible for spatial recruitment the higher then stimulation energy the higher the percentage of motor units recruited and the greater the impact of the progress The general rule is to always try to increase the energy to the maximum level tolerated by the patient The therapist plays a fundamental role by encouraging and reassuring the patient who can then tolerate levels of energy that pr
35. Pain relief is now a priority in therapy which must be provided by all healthcare WHY professionals As TENS treatment is generally palliative it improves the patient s comfort and helps the therapist to start the process The principle is to cause a significant influx of tactile sensitivity in order to restrict the entry of pain impulses upon their return to the posterior horn of the spinal cord We HOW must therefore stimulate the sensitivity fibres on the skin of the painful area To do this it is necessary to use a frequency that is the same as the operational frequencies for the tactile sensitivity nerve fibres i e from 50 to 150 Hz The pulse width varies continuously with this programme This avoids habituation by PULSE WIDTH using a system of stimulation that is perceived as more pleasant by some patients EUEETHOSBES As a general rule the electrodes are placed on or near the painful area The electrodes may also be placed at the nerve trunks depending on the conditions being treated The intensity must be increased gradually until the patient perceives a tingling INTENSITY sensation that is pronounced without being painful OPTION 2 2 Yes PULSE WIDTH MODULATED TENS FREQUENCY PULSE WIDTH MODULATION TIME TREATMENT TIME 80 Hz 70 180 US 25 min 102 REH AB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY PAIN RELIEF PROGRAM ENDORPHI
36. S or will S have time to escape The local potential V starts at Vo and increases exponentially according to the relationship to a final value depending on the intensity of the current C V V Vo V 1 e The threshold S starts from So and increases according to a more complicated curve which can only be shown in part and up to a value depending on the final stable value of V if excitation has not occurred in the meantime In Figure 2a the intensity of the current is set at a value we will take as 1 which without accommodation would allow V to reach So and to trigger excitation In fact V reaches the value So but in the meantime the threshold increased therefore V So lt S and excitation cannot occur To allow V to reach the value S the current must be 8 more intense This is shown in Figure 2b where the threshold has just been reached in 4 ms indicated by the arrow that is the principal useful time 86 REHAB THETA PHYSIO 14 ELECTROTHERAPY THEORY In Figure 2c a stronger current with a value of 1 2 is applied and V passes the threshold after 1 85 ms In Figure 2d an even stronger current value 2 is applied and V S after 0 7 ms Cathode Fig 2 VL So Vo c ES So Vo d A We can therefore see the intensity duration relationship appear which gives the time at which V passes S for different current intensities The useful times are even sh
37. SCAN function can be used to determine the pulse widths suitable for the patient s muscles Electrodes positi EUECTHOBES positioned depending on the muscle to be stimulated in accordance with the instructions The maximum tolerable stimulation energy which is one of the key factors determining INTENSITY the effectiveness of the treatment The higher the stimulation energy the higher the number of muscle fibres motor units being used OPTION 2 2 Yes 116 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS STRENGTH LEVEL 1 33 MIN FINAL RECOVERY WARM UP CONTRACTION ACTIVE REST PHASE FREQUENCY 5 Hz 75 Hz 4 Hz 3 HZ DURATION OF T Eu 155 RAMP UP 5 gt gt x DURATION OF 45 PHASE gt 4 9 DURATION OF ds eyes ane RAMP DOWN 7 gt 3 STRENGTH LEVEL 2 35 MIN FINAL RECOVERY WARM UP CONTRACTION ACTIVE REST PHASE FREQUENCY 5 Hz 83 Hz 4 Hz 3 2 DURATION OF T Biss 155 RAMP UP P 8 DURATION OF 5 min 4S 235 1o min PHASE DURATION OF 3 Sk 5 RAMP DOWN wa B 3 STRENGTH LEVEL 3 38 MIN FINAL RECOVERY WARM UP CONTRACTION ACTIVE REST PHASE FREQUENCY 5 Hz 90 Hz 4 Hz 3 Hz DURATION OF T Biss 155 RAMP UP 2 DURATION OF 5 min 4S 275 1o min PHASE DURATION OF 2S O 75 S 0 5 5 35 RAMP DOWN REHAB THETA PHYSIO 117 15 AVAILABLE THERAPY PROGRAM
38. The effect of capsular venting on glenohumeral laxity Clin Orthop 268 120 6 1991 Howell SM Galinat BJ The glenoid labral socket A constrained articular surface Clin Orthop 243 122 1989 214 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS Itoi E Motzkin NE Morrey BF KN Bulk effect of rotator cuff on inferior glenohumeral stability as function of scapular inclination angle a cadaver study Tohoku J Exp Med 171 4 267 76 1993 16 8 1 Rotator cuff tendinopathy The anatomical location of the rotator cuff exposes it in particular to significant stress and rotator cuff tendinopathy therefore constitutes a real public health problem A study conducted in the United Kingdom in 1986 showed that 20 of the population has consulted a doctor for shoulder problems The pathogenesis of these cases of tendinopathy is associated with multiple factors intrinsic factors vascularisation deficiency structural abnormality of collagen fibres etc or extrinsic factors excessive mechanical stress kinematic defects etc sometimes combined these can be considered as causes of tendon dysfunctions Kinematic defects appear to play an important role and most often involve limitations in range of motion pain phenomena and functional constraint The limitations in range of motion observed in specific tests involve flexion elevation and or abduction A limitation in flexion shows anterosupe
39. at 6 8 cm The re innervation time is therefore 3 months or 6 months at most As the injury is 9 months old there is therefore no hope of re innervation Question n 2 Is the denervation total or partial Testing for total or partial denervation of the deltoid 16 15 1 1 Protocol Disuse atrophy level 1 16 15 1 2 Electrode position Use two channels one for the anterior fascicle and the other for the centre fascicle of the deltoid A positive electrode is placed on the motor point of the medial part a few centimetres below the outer edge of the acromion Another positive electrode is centred on the fleshy body of the anterior fascicle The two negative connections are connected to a large electrode positioned on the shoulder 16 15 1 3 Stimulation energy The energy will be gradually increased until significant figures are reached above 40 or 50 mA 272 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 15 1 4 Results No muscular contraction of the deltoid is observed either visually or by palpation It can then be concluded that denervation is total CONCLUSION Our patient has paralysis of the axillaris nerve with total denervation of the deltoid with no hope of re innervation PRACTICAL THERAPEUTIC APPROACH Electrostimulation of the deltoid using Denervated programmes is of very little value here Whatever is done a denervated muscle without any hope of re innervation wi
40. at least 30 minutes 188 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS C Protocol a Treatment frequency 3 per day or even up to one session every four hours b Position of the electrodes The negative pole is the active pole It is necessary to try to cover the oedematous region with negative electrodes For example for oedema caused by an ankle sprain two stimulation channels will be used two large negative electrodes will be placed on the malleolar and perimalleolar region and one of the two outputs of each electrode is not used A large electrode is positioned above the patella at the level of the quadricipital tendon and will be connected to the positive poles of the two stimulation channels c Patient position The patient will be placed in the most comfortable position for him or her with the treated limb elevated For example for oedema of the ankle the patient will be in the supine position with the lower limbs elevated by about thirty centimetres relative to the plane of the table d Stimulation intensities The Oedema programme begins automatically with a short test in which the stimulation intensity increases automatically The rehabilitation therapist visually or by palpation attempts to detect the start of muscular activity As soon as the motor threshold is reached the therapist presses of the or keys on one of the channels used MEMO symbol and the Oedema programme then being
41. below For the calf channels 1 and 2 A small electrode is placed just under the head of the fibula on the common peroneal nerve and another small electrode in the upper part of the popliteal fossa over the tibial nerve For optimum effectiveness the positive pole should preferably be positioned on these two small electrodes For the thigh channels 3 and 4 For the quadriceps channel 3 large electrode is placed diagonally on the lower third of the quadriceps a second large electrode is placed at the top of the thigh For optimum effectiveness the positive pole should preferably be positioned on the large lower electrode For the hamstrings channel 4 a large electrode is placed diagonally on the lower third of the hamstrings a second large electrode is placed diagonally on the upper third of these muscles For optimum effectiveness the positive pole should preferably be positioned on the large lower electrode 259 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS The two other negative poles are connected to the two outputs of a large electrode placed on the upper part of the calf just below the popliteal fossa 16 12 2 4 Patient position The patient must be in a supine position with his her legs inclined so that gravity encourages venous return 16 12 2 5 Stimulation energy Adjust the stimulation energy to obtain significant contraction
42. between the chest and arm etc 230 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 9 5 Stimulation energy The stimulation energy must first be adjusted on the third channel which stimulates the target nerve at the axilla supraclavicular popliteal or inguinal regions The energy level is gradually increased until the patient feels paresthesia tingling at the end of the limb being treated Then the energy level is adjusted on the other two channels so that the patient feels an increase in the tingling sensation During the session because of the habituation phenomenon the sensation of paresthesia will gradually be reduced and even disappear It is then recommended that the energy be increased slightly to maintain the sensation but without causing muscle contractions The mi TENS function eliminates this possibility by automatically reducing the stimulation energy to below the motor excitation threshold 231 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 10 Endorphinic treatment of Rachialgia and Radiculalgia This chapter deals with the analgesic treatment of spinal pain Rachialgia and nerve root pain Radiculalgia The practical methods of treatment described in this chapter are based on the following reference publications 1 Hollt V Przewlocki R Herz A Radioimmunoassay of beta endorphin basal and stimulated levels in extracted
43. can cause dorsiflexion of the ankle during the swing phase of the gait OPTION 2 2 No HEMIPLEGIC FOOT 13 MIN TRIGGERED CONTRACTION FREQUENCY 50 Hz DURATION OF O 5 S RAMP UP DURATION OF 1 55 5 DURATION OF 0 25 S RAMP DOWN 138 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY NEUROLOGICAL PROGRAM SPASTICITY Spastic hypertonia develops in the different types of lesions of the central nervous system pathways Since It is no longer under the control of the higher nervous centres WHEN the myotatic reflex becomes hyperactive and hypertension develops predominantly in the anti gravity muscles Over time spasticity may lead to muscle contractures and a decreased range of movement SUE To reduce spasticity by inhibiting the motor neurons of the spastic muscle through reciprocal inhibition reflex Stimulating the antagonistic muscle to the spastic muscle by reciprocal inhibitory reflex B This programme has a very gradual rate of tensioning and does not use low frequencies in order to avoid triggering the myotatic reflex monosynaptic stretch reflex of the spastic muscle To make it as comfortable as possible for the patient use pulse widths equivalent to the PULSE WIDTH chronaxies of the motor nerves of the abdominal and lumbar muscles The mi SCAN function can be used to determine the pulse widths suitable for the patient s muscles iti
44. channel used for this purpose 16 5 1 2 Treatment frequency Three sessions per week 204 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 5 1 3 Electrode position Only one channel is used Place a small electrode on the distal motor point of the vastus medialis which innervates the oblique fibres A second electrode is placed at the upper end of the vastus medialis at around mid thigh level For optimum effectiveness the positive pole should preferably be positioned on the lower electrode corresponding to the distal motor point of the vastus medialis This placement of electrodes makes it possible to focus contraction of the vastus medialis which cannot be achieved during voluntary exercises 16 5 1 4 Patient position The focused contraction of the vastus medialis moves the patella upward and inward thus re centring the kneecap and reducing the joint stresses in the lateral compartment of the knee This makes it possible to place the patient in a sitting position with the knee bent at 60 90 in order to apply high stimulation energies to the vastus medialis During stimulation the patient s ankle will be tied firmly to the chair or the medical table on which he she is seated In case the patient finds this position painful the first sessions will be carried out with the knee in full extension After this we will try to gradually put the knee in a flexed position 1
45. current does not flow Pure water does not allow the current to flow acting as an insulator If a substance such as sugar is added to the water the current still does not flow However if salt sodium chloride NaCl is added the current does flow Some substances such as salt can turn the medium into a conductor when dissolved in water These substances known as electrolytes allow the current to flow because they dissociate into ions in the water This dissociation is known as ionization The dissolved ions are attracted to the opposite pole resulting in ionic migration lonic migration explains why the electric current flows through the solution Positive ions attracted to the negative pole the cathode are called cations Negative ions attracted to the positive pole the anode are called anions Cations are involved in chemical changes when placed in contact with the cathode The same occurs when anions come into contact with the anode NaCl dissolved in water is ionized into Na and Cl Na is attracted by the cathode and CI by the anode 178 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS At the cathode At the anode Na captures an electron and becomes Na Cl gives up an electron and becomes CI Na 1 electron gt Na Cl 1 electron gt and Na reacts with the water to give NaOH and Cl reacts with the water to give HCl and a release of hydrogen and a release of oxygen Na H20 NaHO 1 2H2 2Cl H20 gt
46. ducts which are approximately 10 microns 10 thousandths of a millimeter in diameter Proportionately this is gigantic when compared to the diameter of the largest molecules 1 SOLUBILITY The medicine being used to penetrate by ionic migration obviously has to be an electrolyte in other words it must be soluble in water and ionizable The recommended substances and how to use them are given in the practical section 2 CONCENTRATION OF THE SOLUTION The concentration of the medicine in the solution affects the quantity of ions transferred the concentrations usually recommended are 1 to 2 or 1to 2 g 100 ml However some substances with very strong biological activity i e potent at very weak concentrations can be used in solutions diluted to as little as 0 01 0 1 mg ml 181 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS 3 COMPETING IONS lonic migration indiscriminately affects all ions present in the solution anions being attracted by the anode and cations by the cathode If ions other than the medicinal substance are present in the solution they will compete for migration Therefore the greater the quantity of competing ions in relation to the quantity of medicinal ions the lower the penetration by the medicine This is why it is desirable for the medicine to be in solution in distilled water and for the active electrode to be impregnated with that solution only 4 THE PH The pH plays a part because it can in
47. first two channels and TENS stimulation on the other two channels 16 10 3 2 Treatment frequency Three to five sessions per week for two to three weeks 10 to 12 sessions in total a session should last at least 20 minutes Ideally it may be beneficial to carry out two successive stimulation sessions within the Low back pain programme ensuring a ten minute rest period is taken between the two sessions to allow the stimulated muscles to recover 238 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 10 3 3 Electrode position Three stimulation channels are used In the Low back pain programme endorphinic stimulation is always used on channels 1 and 2 while the TENS stimulation is provided on channels 3 and 4 For endorphinic treatment Two small electrodes are placed on the most painful points which can be easily located by palpitating the lumbar paravertebral muscles For optimum effectiveness the positive pole should preferably be positioned on the painful area Two large electrodes with two outputs are placed a finger width outside the small electrodes and are attached to the negative poles of the two previous channels For the TENS treatment The free outputs of the two large electrodes are used to connect the third channel 16 10 3 4 Patient position The patient is placed in the position he she finds the most comfortable in the side lying or prone position taking care to
48. function 48 REHAB THETA PHYSIO 7 DIRECT CURRENTS PHYSIO DEVICE ONLY Direct currents are provided by Physio device only Never use direct currents on patients with osteosynthesis devices or other metal implants lontophoresis Hyperdrosis and Oedema programmes use Direct currents Do not use these currents in the chest region 7 1 lontophoresis Read the chapter lontophoresis in the practical guide to become fully familiar with this programme before using it NOTE Use the coloured electrodes red green yellow supplied with the stimulator whenever you use an lontophoresis programme The lontophoresis programme is in the direct current category in the specific type of treatment SPECIFIC TREATMENT DIRECT CURRENT DENERVATED AGONIST ANTAGONIST INCONTINENCE SPASTICITY Fig 20a 20b 20e Fig 20a Press the On Off button to return to the previous screen Fig 20b Use the channel 1 button to choose the category you want Fig 20e Press the channel 4 button to confirm your choice and access the programme selection screen 49 REHAB THETA PHYSIO 7 DIRECT CURRENTS PHYSIO DEVICE ONLY all lOHTOPHORESE H FEFHIDFEOZE DECEME Fig 21a 21b 21e Fig 21a Press the On Off button to return to the previous screen Fig 21b Use the channel 1 button to choose a programme Fig 21e Press the channel 4 button to confirm your choice When working with an lontophoresis prog
49. identified Do not repeat lontophoresis treatment if any local allergic reaction however mild was observed during the last treatment ATTENTION No lontophoresis treatment near a metal implant Electrodes for lontophoresis treatment must not be placed close to metallic bone or joint implants prosthesis or bone fixing b Preparing the patient and the area to be treated by iontophoresis 1 Thoroughly clean the area of skin to be treated then rinse and dry 2 Correct cleaning of the skin is not enough It must also be degreased with a fat solvent such as ether applied to swabs ATTENTION Do not shave the area of skin onto which the electrodes are placed Hair does not interfere with lontophoresis treatment If treatment is done in an area where hair is shaved there is a risk of causing small skin wounds These wounds form points of low electrical resistance where the current will flow preferentially 3 Place the patient in a relaxed position so that he moves as little as possible during treatment c Preparing the electrodes and solution of ionized medicine 1 Apply the solution of ionized medicine to a dry electrode previously rinsed with distilled water 2 Apply the ionized medicinal solution to the electrode of the same polarity In this way the medicinal ions are repelled from that electrode and attracted to the other with the opposite polarity 3 In order to make the circuit conductive the active electrode has been impregnat
50. in which case it is appropriate to choose triangular shaped pulses i e the form suitable for stimulation of partly denervated muscles see Situation 4 below 277 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 15 4 Situation 4 Partial denervation within the time Example PARALYSIS OF THE LATERAL POPLITEAL NERVE Questioning the patient gives us the following information e The level of the injury This is a complication of a total knee prosthesis The date of the injury The operation was carried out 45 days ago Question n 1 Are we outside or within the re innervation time The distance between the injury and the motor points of the muscles of the antero external part can be assessed at about fifteen centimetres the re innervation time will therefore be around 5 months As the injury only goes back a month and a half we are within the re innervation time Question n 2 Is the denervation total or partial Testing for total or partial denervation of the muscles of the antero external part of the leg 16 15 4 1 Protocol 1 Disuse atrophy level 1 16 15 4 2 Electrode position Use one stimulation channel A small positive electrode is placed under the head of peroneous where the lateral popliteal nerve passes through The negative electrode large is placed crosswise at mid height on the outside of the leg 278 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON
51. intensity must be increased gradually until the patient perceives a tingling sensation that is pronounced without being painful Acclimatisation is normal if a non modulated TENS programme is used In this case it is advisable to slightly increase the stimulation energies on a regular basis so that the patient continues to feel a tingling sensation The mi TENS function prevents any kind of muscle contraction If the sensor detects a muscle response the stimulator automatically reduces the stimulation energy in order to stop the muscle response OPTION 2 2 Yes 100 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS TENS FREQUENCY LEVEL PULSE WIDTH TREATMENT TIME 100 Hz 1 30 US 20 min 100 Hz 2 50 us 20 min 100 Hz 3 70 15 20 min FREQUENCY MODULATED TENS FREQUENCY LEVEL PULSE WIDTH en TREATMENT TIME 50 150 HZ 1 30 15 25 20 50 150 HZ 2 50 US 25 20 50 150 HZ 3 70 Us 25S 20 min 101 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY PAIN RELIEF PROGRAM PULSE WIDTH MODULATED TENS Gate control which is activated during TENS stimulation is particularly effective for the relief of localised pain of non muscular origin It is particularly effective for relieving neuropathic pain and inflammatory conditions The sessions may be repeated at will and without restriction depending upon the intensity of the pain WHEN
52. is Low frequency stimulation can act on the fibres capacity to use oxygen Considerable studies have shown that low frequency stimulation leads to an improvement in the oxidative capacity of the stimulated muscle increase in the number and size of mitochondria increase in oxidative enzymatic activity Electrostimulation therefore improves the tolerance of muscle fibres to physical activity in the case of arterial insufficiency and thus increases the walking range of patients suffering from intermittent claudication 16 13 1 1 Protocol Arterial insufficiency 1 16 13 1 2 Treatment frequency 5 Sessions per week for 12 weeks to treat the acute episode It is then recommended to keep up treatment with a few weekly sessions 262 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 13 1 3 Electrode position Two stimulation channels are required for each leg A small electrode is placed just under the head of the fibula on the common peroneal nerve and another small electrode in the upper part of the popliteal fossa at the nerve trunk of the tibial nerve For optimum effectiveness the positive pole should preferably be positioned on these two small electrodes The two other negative poles are connected to the two outputs of a large electrode placed on the upper part of the calf just below the popliteal fossa ES 16 13 1 4 Patient position Place the patient in a comfortable
53. is an extremely common painful state that can result from a wide variety of anatomical lesions and various physiopathological mechanisms Whatever the triggering factors the quasi systematic occurrence of contracture of the paravertebral muscles is often directly responsible for spinal pain The increase in the tension of the contractured muscle fibres and the crushing of the capillary network resulting from this causes a decrease in the blood flow and a gradual accumulation of acid metabolites and free radicals This muscular acidosis is directly responsible for the pain which in turn sustain and reinforce the degree of contracture If left untreated there is a risk that the contracture will become chronic and real atrophy of the capillary network will gradually develop the aerobic metabolism of the muscle fibres deteriorates giving way to glycolytic metabolism which gradually becomes predominant This mechanism of chronic contracture is summarised in the following diagram Muscle contracture Increased muscle activity T Reduced blood flow in Accumulation of acid metabolites Ac A Pain In addition to the general effect of increasing endorphin production which raises the pain perception threshold stimulation with an endorphinic programme produces marked local hyperaemia and allows drainage of acid metabolites and free radicals The major analgesic effect obtained in this way during each session s
54. is particularly effective for the relief of localised pain of non muscular origin It is particularly effective for relieving neuropathic pain and inflammatory conditions The sessions may be repeated at will and without restriction depending upon the intensity of the pain WHEN Without side effects TENS Gate control effectively relieves pain and improves the WHY patient s level of comfort The sedation period that results from the stimulation allows the vicious self perpetuating cycle of pain to be broken The principle involves causing high levels of sensitivity impulses in order to limit the input of pain impulses when they return to the posterior horn of the spinal cord Apart from the 80 Hz frequency this programme specifically tries to stimulate other sensory fibres pressure vibration in addition to stimulation of the fibres tactile sensitivity HOW PULSE WIDTH pulse width for the programme is 180 US ELECTRODES electrodes are usually placed in such a way as to cover or surround the painful area The intensity must be increased gradually until the patient feels a tingling sensation INTENSITY that is pronounced without being painful OPTION 2 2 Yes TENS FREQUENCY PULSE WIDTH MODULATION TIME TREATMENT TIME 80 Hz 180 Us 30 min 1433 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY PAIN RELIEF II PROGRAM KNEE PAIN
55. isotonic contraction of the antagonist muscle causes movement to the maximum range of motion thus creating maximum stretch of the spastic muscle This action cannot be carried out if the agonist antagonist imbalance is too great this occurs when spasticity of a muscle exceeds the contraction strength of its atrophied antagonist Stimulation then only allows for more or less reduced movement or even no movement at all However the treatment should be carried out even in this situation because stimulation even subliminal has a beneficial effect on the reduction of spasticity 249 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 11 2 6 Manual activation of stimulation When the mi SCAN is activated the stimulation session starts automatically with a measurement of the chronaxy This is a short test lasting around ten seconds which allows the optimum duration of the stimulation pulse to be adjusted ensuring maximum comfort The energy should then be gradually increased to cause the first contraction of the antagonist muscle Each contraction is followed by a five second rest period Once this rest period has finished press any button on any channel to trigger the next contraction By doing so each contraction is triggered and therefore controlled by a manual action This technique provides a clear psychological benefit for the patient who can trigger contractions with his her good hand and it al
56. just for a fraction of a second In this case the stimulation will be interrupted and the equipment will signal an electrode fault In such a case ignore the message put the tip of the pen back in contact with the skin and gradually increase the energy while moving the pen over the gel layer 45 REHAB THETA PHYSIO 6 TREATMENT OPTIONS 6 5 Statistics The stimulator includes a statistics menu containing important programme information that can be consulted in real time To access the statistics screen you must place the stimulator in pause mode or wait for the programme to end Fig 16 Neuromuscular electrostimulation programmes MAX indicates the maximum stimulation energy level reached per channel during the contraction phase AVG indicates the average stimulation energy level used by the different channels during the contraction phase Fig 17 In low frequency programmes the mi RANGE function figure enclosed by a single square bracket shows what percentage of stimulation time was spent in the optimal energy range Fig 16 17e Press the channel 4 button to resume the programme at the point where it was interrupted 46 REHAB THETA PHYSIO 6 TREATMENT OPTIONS 6 6 Programming mode In the programming mode you could create a custom programme and select your own parameters Then name your programme and save it in the custom programmes category Go to the programming category MRIN MENU COMMON TREATMENT SPECIF
57. level simply ignore this message If you start a programme with the 2 2 function the following screen will be displayed 34 REHAB THETA PHYSIO 5 HOW TO PERFORM A TREATMENT NEUROSTIMULATION PROGRAMS 2307 GICISUSE ATROPHY STOP ic The horizontal bars on top of the display shows the total duration and different phases of the programmes Left bar for P1 and right bar for P2 P1 shows the programme chosen for channel 1 and 2 P2 shows the programme chosen for channel 3 and 4 5 10 Program progression Session sequences Warm up Work period Relaxation ar 2 ss ES EE 9b 9C m Time bar showing contraction time and active rest time Shown only during work sequence in ge Fig 9 b c de The different energies reached during the contraction phase are shown by series of black bar graphs Active rest phase energies are shown by hatched bar graphs NOTE Active rest phase stimulation energies are automatically set at 50 of contraction intensities but can be modified during the rest phase Once modified they will be totally independent of the contraction intensities 35 REHAB THETA PHYSIO 5 HOW TO PERFORM A TREATMENT NEUROSTIMULATION PROGRAMS 5 11 Pause mode s s m s M 030 Fig 10a Fig 10a Press the On Off button to interrupt
58. position 16 13 1 5 Stimulation energy Adjust the stimulation energy to the maximum level the patient can tolerate to recruit as many fibres as possible 263 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 13 2 Stage III arterial insufficiency The same benefit can be obtained using low frequency electrostimulation in Stage III arterial insufficiency In this case because of the more severe obstruction of the arterial width and the more serious deterioration of the muscle qualities stimulation frequencies lower than those used for intermittent claudication must be used To carry out a Stage III arterial insufficiency session we will proceed in the same way as in stage II but using a programme adapted to more severe deterioration of the arterial capital 16 13 2 1 Protocol Arterial insufficiency 2 The protocol is absolutely identical apart from the patient position 16 13 2 2 Patient position The difficulty with which the arterial blood is transported to the distal extremities makes it preferable to position the patient in such a way that gravity aids the arterial circulation The patient is therefore placed on a comfortable seat in such a way that does not compress the posterior arterial trunks 264 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 14 Urinary incontinence This section deals with the treatment of female incontinence It
59. relaxation of muscle contractures in the lumbar area and to relieve WHY oM MM neurogenic sciatic pain The release of endorphins and the elimination of acidic toxins allow lumbar pain to HOW be treated effectively The TENS Gate control effect works more specifically on sciatic nerve neuralgia Endorphinic stimulation is primarily aimed at the sensitive nerve fibres which are best stimulated with pulse width of 200uUs However the vascular effect is secondary to the co activation of the motor units which have a slightly higher chronaxy that is PULSE WIDTH measured at the start of the session using the mi SCAN function Channels 2 3 and 4 provide Gate control stimulation and use a larger pulse adapted to the chronaxy of the Ap fibres Electrodes positioned according to the specific indication Combining 2 stimulation ELECTRODES 8 currents The intensity must first be set on channels 2 3 and 4 which deliver the TENS programme according to the usual TENS rules tingling It will be gradually increased INTENSITY on channel 1 until visible or palpable muscle twitches are produced The mi RANGE function can be used to determine the minimum level of energy required to produce an appropriate muscle response Yes forced a minimum of 2 channels with muscular work imposed by the Low back pain programme OPTION 2 2 2 channels with the TENS programme Electrodes positioned on the pa
60. state through Vand S increase action potential V V Vo Vm ax 1 Fig 1 NL zx 85 REHAB THETA PHYSIO 14 ELECTROTHERAPY THEORY The excitation process is therefore determined by two time constants k the excitation constant the accommodation constant These are independent from each other This means that to a large extent 2 can be modified by experiment separately to k by changing the ionic concentration of Calcium Ca These two constants have values that are very different to each other but is always much larger 100 to 200 times than k In the case of human motor neurons approximate values of 300 us be retained for k and 50 ms for This means that k must be lower than for the excitation process to occur The local potential V can therefore increase more quickly than the threshold S and catch up with it If k were greater than A the threshold would increase more quickly than the local potential which would never catch up with the threshold 14 3 2 Study of the excitation process using a constant current For the sake of simplicity at this stage we will only study the excitation process produced by a constant current The same study can be carried out using exponential sinusoidal linear progressive or any other type of current as the results are similar For example let us use the values k lms 50 ms The issue in the excitation process is whether V will catch up with
61. the instructions An essential factor in the effectiveness of electrotherapy is the ability to cause visible INTENSITY muscle twitches The mi RANGE function can be used to determine the minimum level of energy required to produce an appropriate muscle response OPTION 2 2 Yes CAPILLARISATION CONTINUOUS STIMULATION FREQUENCY 8 Hz DURATION OF RAMP UP 1 55 DURATION OF PHASE 25 min DURATION OF RAMP DOWN 1 55 13 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS 15 1 4 CONDITIONING I CATEGORY CONDITIONING I PROGRAM RESISTANCE For athletes wishing to increase their ability to sustain intense and prolonged exertion WHEN or to develop their ability to maintain or repeat a muscular activity carried out at a high percentage of the maximum strength WHY Increased anaerobic lactic capacity in the muscles Increased strength endurance To make it as comfortable as possible for the patient use pulse widths equivalent to the PULSE WIDTH of the motor nerves of the muscles being stimulated The mi SCAN function can be used to determine the pulse widths suitable for the patient s muscles Electrodes positioned depending on the muscle to be stimulated in accordance with ELECTRODES the instructions The maximum tolerable stimulation energy which is one of the key factors determining INTENSITY the effectiveness of the treatment The higher the stimulation energy the higher the numb
62. the patient use pulse widths equivalent to the PULSE WIDTH chronaxies of the motor nerves of the muscles being stimulated The mi SCAN function can be used to determine the pulse widths suitable for the patient s muscles Electrodes positioned depending on the muscle to be stimulated in accordance with ELECTRODES the instructions The maximum tolerable stimulation energy which is one of the key factors determining INTENSITY the effectiveness of the treatment The higher the stimulation energy the higher the number of muscle fibres motor units being used OPTION 2 2 Yes 162 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS HYPERTROPHY LEVEL 1 31 MIN FINAL RECOVERY RAMP DOWN WARM UP CONTRACTION ACTIVE REST PHASE FREQUENCY 5 Hz 45 Hz 8 Hz 3 HZ DURATION fm 15 5 RAMP UP 5 E DURATION OF 8s PHASE gt 4 DURATION OF T T ea 4 RAMP DOWN 3 HYPERTROPHY LEVEL 2 32 MIN FINAL RECOVERY WARM UP CONTRACTION ACTIVE REST PHASE FREQUENCY 5 Hz 50 Hz 9 Hz 3 2 DURATION OF 1 55 155 OS 15S RAMP UP DURATION OF 5 min 5S 75 1o min PHASE DURATION OF 2S 15 OS 35 RAMP DOWN HYPERTROPHY LEVEL 3 33 MIN FINAL RECOVERY WARM UP CONTRACTION ACTIVE REST PHASE FREQUENCY 5 Hz 55 Hz 1o Hz 3 Hz DURATION OF 1 55 155 OS 15S RAMP UP DURATION OF 5 min 65 65 min PHASE DURATION OF 2S 1S
63. to 12 sessions in total a session should last at least 20 minutes Ideally it may be beneficial to carry out two successive stimulation sessions within the Lumbosciatica programme ensuring a ten minute rest period is taken between the two sessions to allow the stimulated muscles to recover 241 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 10 4 3 Electrode position Two stimulation channels are used ensuring they are switched on in the correct order as this determines the order in which the channels deliver stimulation With the Lumbosciatica programme the endorphinic stimulation is always provided on channel 1 whereas the TENS stimulation is delivered by channels 2 3 and 4 For endorphinic treatment e A small electrode is placed on the top of the root of the sciatic nerve which is painful to palpate For optimum effectiveness the positive pole should preferably be positioned on this painful area e Another small electrode is placed two finger widths above the previous electrode and is attached to the negative pole of the same channel For TENS treatment Two large electrodes are placed on the path of the sciatic nerve e one on the lower part of the buttock and e the other on the posterior thigh e The second channel is connected to these large single output electrodes Note The 3rd and or 4th channel TENS can be used in two situations In the event of more extensive irr
64. to do with burning 3 If there is an electrode fault during treatment The Physio measures the impedance of the circuit and when this is too high the equipment stops and indicates ELECTRODE FAULT as well as the number of the channel on which there is a problem There are a number of possible reasons for this safety and efficacy check system coming into operation electrode disconnected poor connection channel reversal defective cable defective electrode solution not conducting non ionizable medicine or concentration too low 185 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS f After treatment 1 Thoroughly clean the skin over the treated area using tap water During lontophoresis treatment acids and bases form on the electrodes and hence come into contact with the skin If the concentration of these substances is too high and they stay on the skin for too long chemical burns may result It is advisable to clean the patient s skin immediately after the treatment to remove these chemical substances 2 Clean the electrodes thoroughly with tap water then rinse with distilled water before leaving them to dry 15 3 2 2 Hyperhidrosis Sweating is a physiological phenomenon intended to contribute to heat regulation in order to maintain a constant body temperature at 37 C Hyperhidrosis Hyper hidros sweat occurs when sweating is excessive Indeed the amount of sweat produced considerably exceeds the
65. values are given as a quantity of electricity in electrical charges that must be created to achieve these the values are similar even if the electrical pulse with the same overall duration is a different shape As a reminder the quantity of electrical charges 0 supplied by an electric current with intensity in a given time 2 is the product of the intensity multiplied by the time Q xt Since the quantity of electrical charges provided by the stimulation current is the fundamental factor Weiss studied the way in which the necessary quantity of charges is modified in order to achieve the threshold i e to cause stimulation based on the duration of the current being applied He performed a series of measures to determine the relationship between the quantity of current and the duration of the pulse for durations ranging from 0 23 to 3 ms From his experiments Weiss found that there is a linear relationship between the quantity of charges required to reach the stimulation threshold and the duration of the pulse Fig 2 d Quantity of current required to reach the stimulation threshold Duration of the pulse c 02m 3ms t electricity applied to reach the stimulation threshold Linear relationship between the duration of the electrical pulse and the amount of Q qrtit Fig 2 74 REHAB THETA PHYSIO 14 ELECTROTHERAPY THEORY Weiss therefore discovered the mathematical relationship tha
66. volume required for thermoregulation The neurological control responsible for sweating is provided by the hypothalamus and the sympathetic system In some cases hyperhidrosis in particular in its general form constitutes only a symptom the cause of which must be found Treatment with iontophoresis involves localized palmar or plantar or mixed forms which are usually idiopathic although a psychological cause is sometimes suspected The problems caused are significant difficulty in performing manual tasks cutaneous symptoms etc and have social and professional repercussions It is estimated that around 1 of the population is affected by localized hyperhidrosis Treatment with iontophoresis Hyperhidrosis programme makes it possible to obtain lasting remission of hyperhidrosis after around ten sessions The remission period can last up to six months and the treatment can be started again when the signs reappear METHOD USE CHANNEL 1 other channels inactive for this programme A Protocol Hyperhidrosis The first session will be conducted with the electrical density automatically provided by default of 0 05 mA cma2 You must then increase this electrical density by 0 01 in each of the subsequent sessions First session D 0 05 mA cm2 Second session D 0 06 mA cm2 Third session D 0 07 mA cm2 etc 186 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS B Treatment Frequency Three sessions per week unt
67. when pressure is increased Normally the paraurethral components of the striated muscle of the pelvic floor is capable by contracting of generating a urethral closing pressure well above that produced in the bladder during coughing But when these muscles are unable to develop sufficient strength rapidly enough at the appropriate moment urine escapes from the bladder This is stress incontinence The objective of any treatment of this type of incontinence is to strengthen the sphincter In order to do this it is necessary to use a programme that brings about tetanic contractions of the paraurethral components of the pelvic floor musculature using fast fibre tetanization frequencies 16 14 2 1 Protocol Stress incontinence weeks 1 3 16 14 2 2 Treatment frequency Five sessions per week 267 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 14 2 3 Electrode position Use of an intravaginal probe 16 14 2 4 Patient position The patient reclines on her back on a couch with a cushion under the buttocks and the knees flexed at 90 feet flat on the couch 16 14 2 5 Stimulation energy It is always necessary to work with the maximum tolerable energy It is therefore important to regularly increase the energy level during the session every 3 or 4 contractions The therapist plays a decisive role in reassuring the patient and encouraging her to work with the strongest possible contract
68. which have regained their volume as a WEHEN result of electrostimulation with disuse atrophy treatment programmes or as a first line treatment on non atrophied muscles which have lost their strength and speed of contraction The programme imposes a work regime adapted to the physiology of the type II fibres WHY to restore contraction strength in the case of muscular insufficiency without marked disuse atrophy or following recovery of muscle volume How Progressive incrementation of the frequency 35 60 Hz at the beginning of each contraction may improve the comfort of the stimulation in hypersensitive patients To make it as comfortable as possible for the patient use pulse widths equivalent to the PULSE WIDTH chronaxies of the motor nerves of the abdominal and lumbar muscles The mi SCAN can be used to determine the pulse widths suitable for the patient s muscles Electrodes positioned depending on the muscle to be stimulated in accordance with ELECTRODES the instructions The maximum tolerable stimulation energy on the 4 channels which is one of the key factors determining the effectiveness of the treatment The higher the stimulation energy the higher the number of muscle fibres motor units being used Progressively increase the level of energy during the course of a treatment session OPTION 2 2 Yes FORCE MOD FREQUENCY 30 MIN FINAL RECOVERY WARM UP CONTRACTION ACTIVE REST PHASE FREQUENCY 6 Hz 35 60 Hz 4 Hz
69. 0 1 3 Electrode position Depending on the location of the pain unilateral or bilateral one or two stimulation channels are used A small electrode is placed on the most painful point that can be found by palpation In most cases this point of maximum contracture is found in the levator scapulae or superior trapezius n the case of bilateral pain another small electrode is likewise placed on the most painful point For optimum effectiveness the positive pole of each channel should preferably be positioned on the painful area One or two small electrodes are placed on the cervical paravertebral muscles at C3 C4 level 234 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 10 1 4 Patient position The patient is placed in the position most comfortable for him her prone position or seated facing a medical table with a chest support 16 10 1 5 Stimulation energy The energy must be increased gradually until it causes clearly visible muscle twitches which are required to induce hyperaemia The mi RANGE function makes it possible to work with certainty within a therapeutically effective range The stimulator prompts you to firstly increase the level of energy beep sound accompanies the flashing symbols e When it detects that the muscles have started to pump the symbols will stop flashing You are at the minimum level of energy that provides therapeutic results
70. 2 0 2 0 23 0 38 0 38 0 73 1 1 2 1 2 2 3 10 3 8 3 8 73 100 12 12 23 In the case of transmitters whose maximum output power is not shown in the table above the recommended spacing of d in metres m can be calculated using the appropriate equation for the transmitter frequency where P is the maximum output power of the transmitter in watts W as set by the transmitter manufacturer NOTE 1 At 80 MHz and at 800 MHz the spacing for high frequency amplitude is applied NOTE 2 These guidelines may not be appropriate for some situations Electromagnetic wave propagation is modified by absorption and reflection due to buildings objects and persons 71 REHAB THETA PHYSIO 13 We would be happy to answer any questions you may have about our products and services Please contact your local dealer or your corresponding DJO Global site DJO Global sites are listed on the backside of the cover For technical service from DJO Global please contact internationalproductsupport D Oglobal com 72 REHAB THETA PHYSIO 14 ELECTROTHERAPY THEORY 14 1 Introduction In recent years significant progress has been made in field of electrotherapy of which many users are still largely unaware Changes and improvements in electrotherapy are so numerous that this discipline appears to be a new concept that can only be applied correctly and effectively using sophisticated high tech equipment The aim of these articles i
71. 2 HCI 1 2 02 In total the cathode has given up one electron and the anode has captured one electron in other words the electric current has circulated An alkaline reaction production of sodium hydroxide NaOH is produced at the cathode with release of hydrogen At the anode an acidic reaction production of hydrochloric acid HCl is produced with release of oxygen Therapists should concern themselves with the alkaline reaction at the cathode because an accumulation of sodium hydroxide on the negative electrode may cause a chemical burn to the skin in contact with the electrode Thus the burn that may be caused during iontophoresis treatment is primarily a chemical burn due to sodium hydroxide accumulating on the cathode The quantity of accumulated sodium hydroxide depends on current density intensity divided by the surface area of the electrode and application time C Direct Current Direct current DC or galvanic current has a constant intensity over time The graph of this consists of a straight line parallel to the time axis x axis It is the intensity of the current I that is constant over time not necessarily the tension or voltage U constant 179 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS The current of choice for iontophoresis treatment is direct current because it ensures maximum ionic transfer All studies evaluating penetration and chemical research demonstrating efficacy have been performe
72. 3 Hz DURATION OF m T RAMP UP 2 DURATION OF 2min 85 155 3 min PHASE DURATION OF 2 15 0 55 35 RAMP DOWN 132 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS 15 2 2 AGONIST ANTAGONIST CATEGORY AGONIST ANTAGONIST PROGRAM ATROPHY REINFORCEMENT The alternate stimulation of the two antagonistic muscle groups has the advantage WHEN of allowing the active mobilisation of a joint while inducing muscle work which is beneficial to functional recuperation To combine muscle work aimed at successively restoring the two types of muscle fibres WHY disuse atrophy then reinforcement to give mobility across the full range of movement of the joint This type of use is particularly interesting for combating adhesion There are four different programmes Atrophy 1 1 and Reinforcement 1 1 These programmes produce Identical length contractions for the agonist and the HOW antagonist Atrophy 2 1 and Reinforcement 2 1 These programmes produce contractions for the agonist which are twice as long as for the antagonist To make it as comfortable as possible for the patient use pulse widths equivalent to the PULSE WIDTH chronaxies of the motor nerves of the abdominal and lumbar muscles The mi SCAN function can be used to determine the pulse widths suitable for the patient s muscles Electrodes iti nding on the muscl imul in rdance with EIEETHOBES pos tioned depending o
73. 6 5 1 5 Stimulation energy In NMES the stimulation energy is directly responsible for spatial recruitment the higher the stimulation energy the higher the percentage of motor units recruited and the greater the impact of the progress The general rule is to always try to increase the energy to the maximum level tolerated by the patient The therapist plays a fundamental role by encouraging and reassuring the patient who can then tolerate levels of energy that produce powerful contractions The levels of energy reached must increase throughout the session and also from session to session because the patients quickly get used to the technique With this programme the stimulation starts directly with a tetanic contraction because the warm up phase has been eliminated so as not to produce muscle twitches that are likely to cause unwanted microtraumas to the kneecap 205 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 5 2 Post traumatic condition Repeated traumas to the knee joint like those caused by the practice of certain sports may entail cartilaginous lesions of the kneecap These lesions can lead to pain of varying intensity and the occurrence of reflex inhibition which in turn can result in disuse atrophy of the entire quadriceps The resulting insufficiency of the quadriceps negatively affects the active stability of the joint and increases pain This vicious circle can be interrupted
74. AM REHABILITATION REINFORCEMENT WHEN WHY For use either on previously atrophied muscles which have regained their volume as a result of electrostimulation through disuse atrophy treatment programmes or as a first line on non atrophied muscles which have lost their strength and speed of contraction To restore the strength of the contraction in the case of muscle insufficiency without pronounced disuse atrophy or after restoration of muscle volume HOW By using frequencies creating a tetanic contraction in the quick fibres type IIb which are the strength and speed fibres PULSE WIDTH To make it as comfortable as possible for the patient use pulse widths equivalent to the chronaxies of the motor nerves of the muscles being stimulated The mi SCAN function can be used to determine the pulse widths suitable for the patient s muscles ELECTRODES Electrodes positioned depending on the muscle to be stimulated in accordance with the instructions INTENSITY Use the maximum stimulation energies The first and second sessions help the patient become accustomed to the method by gradually increasing the stimulation energy every 3 or 4 contractions In the following sessions it is important to support the patient s progress by setting targets which go beyond the energy levels reached in the previous session OPTION 2 2 Yes 94 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS
75. B THETA PHYSIO 3 2 Explanation of symbols connections and nameplates 3 2 1 Symbols on device and AC Power Supply Read the user manual or operating instructions Caution Observe warnings set forth in operation manual The Rehab Theta Physio is a class II device with internal electric power and type BF applied parts The power switch On OFF button is a multi function button The name and address next to this factory symbol is the manufacturer The date is the manufacturing date The number next to this symbol is the article reference number Device complies with Council Directive 93 42 EEC as amended concerning medical devices The number next to this symbol is the serial number WEEE Mark European Directive 2002 96 EC Indicates separate treatment from general waste at end of life x gag Keep dry IP20 IP02 IP classification indicates the degree of protection and thus defines its suitability for use under various ambient conditions IP 20 on the unit means the protection is effective against ingress of foreign solid objects diameter greater than 12 5 mm IPo2 on the carrying case means the device is protected against ingress of water when tilted up tp 15 22 REHAB THETA PHYSIO 3 DESCRIPTION OF THE REHAB THETA PHYSIO Non ionising radiation Not made with natural latex rubber Keep away from direct sunlight Alt
76. CAPILLARISATION The 8 Hz frequency produces the greatest increase in blood flow in young patients who are in a good state of physical health Use of the Capillarisation programme must therefore be restricted to sport rehabilitation and will be proposed in situations where a hyperaemia is desired e g to accelerate the scarring process The Capillarisation WHEN programme can also be used for non injured athletes as part of their physical preparation to achieve a variety of ends To supplement endurance training To optimise the overcompensation phase prior to an endurance or resistance competition e Supplementary use of the Hypertrophy programme WIE To induce the greatest circulatory activation in patients who are athletes To increase l the capillary network and make the muscle fibres more resistant to fatigue When using low stimulation frequencies of 8 Hz the increase in blood flow is greatest How in young people who are in good physical condition However a frequency of 8 Hz may cause early muscle fatigue and a depletion in the muscular response in patients with underperforming muscles To make it as comfortable as possible for the patient use pulse widths equivalent to the PULSE WIDTH chronaxies of the motor nerves of the muscles being stimulated The mi SCAN function can be used to determine the pulse widths suitable for the patient s muscles Electrodes positioned depending on the muscle to be stimulated in accordance with ELECTRODES
77. CTRODES cover the whole of the desired area The intensity must be increased gradually until the patient feels a tingling sensation that is pronounced without being painful The mi TENS function prevents kind of muscle contraction If the sensor detects a muscle response the stimulator automatically reduces the stimulation energy in order to stop the muscle response OPTION 2 2 Yes EPICONDYLITIS FREQUENCY PULSE WIDTH MODULATION TIME TREATMENT TIME 50 150 HZ 50 US 25 20 153 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY PAIN RELIEF II PROGRAM TORTICOLLIS This type of treatment is indicated to relieve pain following acute muscle contractures WHEN in the neck region It will also reduce tension in the contracted muscles to facilitate manual handling techniques WHY To reduce muscular tension and to provide a relaxing effect Highly individualised muscular twitching that is induced by a very low frequency 1 Hz HOW has a relaxing effect To make it as comfortable as possible for the patient use pulse widths equivalent to PULSE WIDTH the chronaxies of the motor nerves of the muscles in the lumbar region The mi SCAN function can be used to determine the pulse widths suitable for the patient s muscles A small electrode preferably connected to the positive pole is placed on the most ELECTRODES painful area which can be detected by palpation A second elec
78. DE RED DENSITY ma cme o 050 mum um uum Fig 26a 26e Fig 26a Press the On Off button to return to the previous screen Fig 26e Press the channel 4 button to confirm your choices and start the programme Use the i button to access the electrode placement pictogram NOTE Press the i button from the stimulation screen or the end of programme screen to access the programme parameters 52 REHAB THETA PHYSIO 7 DIRECT CURRENTS PHYSIO DEVICE ONLY 7 3 Oedema Read the chapter Dedema in the Practical Guide to become fully familiar with this programme before using it The Oedema programme is in the Direct Current category of the Specific Treatment type DIRECT CURRENT IDNTOFHORESIS HYFERHIDROSIS EI Fig 27a 27b Fig 27a Press the On Off button to return to the previous screen Fig 27b Use the channel 1 button to choose a programme Fig 27e Press the channel 4 button to confirm your choice and execute the programme The Oedema programme begins by looking for the motor evoked potential MEP threshold in order to calculate the current intensity that will offer optimal therapeutic efficacy While this is happening the MEMO symbol will be displayed over any channels that are connected To confirm the MEP threshold press any of the active buttons as soon as you see or feel a motor response Fig 28a 28b 28c 28d Fig 28a Press the On Off button to stop the p
79. E SKIN A layer of grease between the medicinal solution and the skin will prevent penetration of the ionized medicine This is why proper preparation of the skin that is going to be covered by the electrodes is so important A description of the preparation method is given in the practical section 7 QUANTITY OF SWEAT GLAND DUCTS The skin with its top layer of keratin is impermeable to water and substances dissolved in it so penetration can only take place through the pores of the skin and the more abundant the sweat gland ducts in the skin the greater the penetration The skin beneath the active electrode can be seen as being pierced by a number of micro pipettes from which the ionized medicine will penetrate into the tissues 8 DENSITY OF THE ELECTRIC CURRENT The greater the current density the greater the penetration However if the density is too high there is a risk of burning The most appropriate density appears to be 0 05 mA cma 182 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS 9 DURATION OF TREATMENT Owing to the inertia inherent in any dynamic phenomenon effective mobilization of ionized medicines requires a certain amount of time The first 15 seconds are necessary for effective activation of the migration process Thereafter as more time elapses more medicine will penetrate the tissues However the increase in the quantity penetrating over time is obviously not infinite since the substance disappears from
80. E WIDTH Electrodes positioned according to the specific indication Combining 2 stimulation currents ELECTRODES The intensity must first be set on channels 3 and 4 which deliver the TENS programme according to the usual TENS rules tingling It will be gradually increased on channels 1 INTENSITY or 2 until visible or palpable muscle twitches are produced The mi RANGE function can be used to determine the minimum level of energy required to produce an appropriate muscle response Yes forced a minimum of 2 channels with muscular work imposed by the Low back pain programme OPTION 2 2 2 channels with the TENS programme Electrodes positioned on the painful area e Sufficient stimulation energy to produce a clear tingling sensation Take care to properly observe the correct order of the channels LOWER BACK PAIN FREQUENCY PULSE WIDTH TREATMENT TIME 5 Hz 250 US 20 min 150 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY PAIN RELIEF II PROGRAM LUMBOSCIATICA Patients with lumbosciatica have lumbar pain which is most commonly caused chronic contractures of the paravertebral lumbar muscles In addition involvement of WHEN the spinal nerve root leads to irradiation of pain over a shorter or longer distance along the sciatic nerve and in some cases along one or the other of its branches common peroneal or tibial For pain relief and
81. EE 4 RAMP DOWN 75 gt 3 ROTATOR CUFF LEVEL 2 25 MIN FINAL RECOVERY WARM UP CONTRACTION ACTIVE REST PHASE FREQUENCY 6 Hz 45 Hz 4 Hz 3 Hz DURATION OF di iss ex RAMP UP P 8 s DURATION OF 2min 65 55 3 min PHASE DURATION OF 3 ees Sis 5 RAMP DOWN uS B 3 ROTATOR CUFF LEVEL 3 20 MIN FINAL RECOVERY WARM UP CONTRACTION ACTIVE REST PHASE FREQUENCY 6 Hz 75 Hz 4 Hz 3 Hz DURATION OF Tn TT Bis wee RAMP UP 2 DURATION OF 2 min 4S 105 3 min PHASE DURATION OF 2S 0 75 S 055 35 128 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY REHABILITATION II PROGRAM BACK TRUNK STABILISATION After an episode of low back pain once the pain has been relieved Muscular work by WHEN electrostimulation has the advantage of being carried out isometrically with very little stress on the vertebral structures and discs MYERS To develop the support qualities of the abdominal and lumbar muscles and to restore awareness of postural control By simultaneously stimulating the abdominal and lumbar muscle groups using HOW parameters adapted to restoring the qualities of type muscle fibres used in postural control To make it as comfortable as possible for the patient use pulse widths equivalent to the PULSE WIDTH chronaxies of the motor nerves of the abdominal and lumbar muscles The mi SCAN function can be used to determine the pulse widths suitable for t
82. ENSITY During the tetanic contraction phases ensure that the energy stimulation is sufficient to impose significant muscle contractions OPTION 242 Yes TONING MASSAGE 29 MIN 1ST SEQUENCE 2ND SEQUENCE 3RD SEQUENCE 4TH SEQUENCE VIBRATIONS WITH FREQ MODULATION 1 8 HZ gt gt CONTRACTION RELAXTION 10 reps gt 8 reps gt 5TH SEQUENCE 6TH SEQUENCE 7TH SEQUENCE 8TH SEQUENCE VIBRATIONS WITH FREQ MODULATION 1 8 HZ gt gt CONTRACTION RELAXTION 7 reps 6 reps 171 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY CONDITIONING II PROGRAM RELAXING MASSAGE WaN To eliminate uncomfortable or painful sensations resulting from an exaggerated increase in muscle tone dnas To allow a decrease in muscle tension To drain away the toxins responsible for the increase in muscle tone The programme produces a sense of well being and relaxation To make it as comfortable as possible for the patient use pulse widths equivalent to the PULSE WIDTH chronaxies of the motor nerves of the muscles being stimulated The mi SCAN function can be used to determine the pulse widths suitable for the patient s muscles Precision in positioning the electrodes is less significant than for programmes aiming ELECTRODES 0 develop muscle quality The electrodes can be placed in an alternative way reducing the number of electrodes needed and stimula
83. ENSITY muscle twitches The mi RANGE function can be used to determine the minimum level of energy required to produce an appropriate muscle response OPTION 2 2 Yes THORACIC BACK PAIN FREQUENCY PULSE WIDTH TREATMENT TIME 5 Hz 250 15 20 min 149 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY PAIN RELIEF II PROGRAM LOW BACK PAIN Low back pain most frequently results from chronic contractures of the paravertebral WHEN lumber muscles It may be caused by a mechanical conflict vertebral osteoarthritis disc space narrowing etc WHY For pain relief and relaxation of muscle contractures Endorphin stimulation aids pain relief by increasing production of endogenous opioids The associated vascular effect results in effective drainage of acidic metabolites and enables the elimination of muscular acidosis TENS Gate control applied using the third channel improves comfort during endorphin stimulation HOW Endorphinic stimulation is primarily aimed at the sensitive nerve fibres which are best stimulated with pulse width of 200uUs However the vascular effect is secondary to the co activation of the motor units which have a slightly higher chronaxy and which is measured at the start of the session using the mi SCAN function Channels 3 and 4 provide Gate control stimulation and use a larger pulse adapted to the chronaxy of the Ap fibres PULS
84. EQUENCE 2 AGONIST ANTAGONIST AGONIST ANTAGONIST FREQUENCY 70 Hz 4 Hz 4 Hz 70 Hz DURATION OF vers ges use 155 RAMP UP 5 gt gt 5 DURATION OF F r PHASE 4 3 3 4 DURATION OF bee eee EE RAMP DOWN 75 gt 75 REINFORCEMENT 2 17 MIN SEQUENCE 1 SEQUENCE 1 SEQUENCE 2 SEQUENCE 2 AGONIST ANTAGONIST AGONIST ANTAGONIST FREQUENCY 70 Hz 4 Hz 70 Hz 4 Hz DURATION OF fee cee T RAMP UP gt 9 DURATION OF 6s PHASE 4 3 3 DURATION OF 0 75 S 055 0 75 5 0 5 5 135 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS 15 2 3 PROGRAMMES FOR HAEMOPHILIACS CATEGORY PROGRAMMES FOR HAEMOPHILIACS PROGRAM ATROPHY REINFORCEMENT To prevent disuse atrophy restore muscular qualities in haemophilia patients i suffering from arthropathy Repeated episodes of haemarthrosis intra articular bleeding may lead to actual cases wi of arthropathy which cripple haemophiliacs especially as they are usually accompanied by a loss of joint stability Specific programmes for haemophiliacs aim to improve the active joint stability by restoring the qualities specific to each type of muscle fibre The characteristic of the programmes for haemophiliacs is to induce muscular HOW contractions very gradually to avoid any risk of causing microlesions in the muscle fibres and or supporting connective tissue and secondary bleeds To make it as comfortable as possible for the p
85. GRAMS CATEGORY INCONTINENCE PROGRAM POST PARTUM PREVENTION Labour causes considerable trauma to the pelvic region The consequences of this WHEN trauma are various strained muscle torn muscle partial denervation loss of body image loss of strength and control of the striated muscles of the pelvic floor etc MES Incontinence is a relatively common result of this situation which is why prophylactic pelvic re training treatment by neuromuscular electrostimulation is indicated ELECTRODES Use of an intravaginal probe Use of the maximum electrical intensity tolerated by the patient in order to achieve the INTENSITY greatest possible space recruitment The electrical intensity is increased regularly every 3 Or 4 contractions throughout the session OPTION 2 2 NO POST PARTUM PREVENTION 20 MIN CONTRACTION ACTIVE REST FREQUENCY 50 Hz o Hz DURATION OF nee RAMP UP gt DURATION OF fate PHASE gt DURATION OF ee RAMP DOWN 79 177 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS 15 3 2 Direct Current 15 3 2 1 lontophoresis A Introduction A source of electric current applied to any part of a patient s body sets up an electric field between the electrodes and through the tissues In this electric field the positive particles are attracted to the negative pole while the negative particles are attracted to the positive pole This means that migration
86. IC TREATMENT CONDITIONING CUSTOM PROGRAMS Select NMES or TENS Select the stimulation form CONT CONVENTIONAL CONT MODULATED FU CONT MODULATED FREQ BURST INTERMITT CONVENTIONAL ra ee LL In order to personalize the parameters F CONT CONVENTIONA uz Hz e 20 00 min Omm NO 2 2 Fig 18a 185 18C 18e Fig 18a Press the On Off button to return to the previous screen Fig 18b Use the channel 1 button to move the cursor between the different settings Fig 18c Use the channel 2 button to increase or decrease the setting values Fig 18e Use the channel 4 button to save the programme 47 REHAB THETA PHYSIO 6 TREATMENT OPTIONS Saving programme ENTER NRME CONUENTI ION Z B lt Em Fig 19a 19b 19c Fig 19a Press the On Off button to return to the previous screen Fig 19b Use the channel 1 button to move the cursor in the programme name Fig 19c Use the channel 2 button to write letters and figures Fig 19d Use the channel 3 button to maximize or minimize the space Fig 19e Use the channel 4 button to save the programme NOTE You can save maximum 10 custom programmes NOTE Custom programmes can be combined with a programme from the 2 2 list by adding and selecting the 2 2 option This programme will consist of one programme on channel 1 2 P1 and one programme for channel 3 4 P2 please see section Choosing the 2 2
87. If however the current lasts longer the threshold increases S This phenomenon is demonstrated by the well known fact that a current which increases slowly must reach a higher value in order to produce stimulation than a current which increases quickly The increase in the excitation threshold is known as accommodation Accommodation is an increase in the threshold S which is the result of the change in the local potential caused by the electrical charges provided by the current passing through the neuron The increase in the threshold does not occur instantly but gradually and at a particular speed A second time factor A is therefore involved in the process of electrical excitation which defines the rate at which the threshold changes S When the local potential V is returned to its resting potential Vo S returns exponentially to its initial value So with as the time constant according the mathematical law ds dt S So A 2 This equation is for 5 what equation 1 is for V with replacing k The electrical charges provided by the current passing through the neuron change the membrane potential They produce a local potential V and this causes the threshold S to increase Excitation occurs if a sufficient quantity of electrical charges is provided to allow the local potential to catch up with the threshold value i e when V S Fig 1 Resting State Stimulation current is passed Excitation
88. LE BUILDING LEVEL 2 25 MIN FINAL RECOVERY WARM UP CONTRACTION ACTIVE REST PHASE FREQUENCY 6 Hz 45 Hz 4 Hz 3 2 DURATION OF T wee Biss 155 RAMP UP B 2 DURATION OF 2min 65 95 3min PHASE DURATION OF 3 m 5 RAMP DOWN 75 gt 3 MUSCLE BUILDING LEVEL 3 26 MIN FINAL RECOVERY WARM UP CONTRACTION ACTIVE REST PHASE FREQUENCY 6 Hz 50 Hz 4 Hz 3 HZ DURATION OF Tn ved Biss wee RAMP UP 2 DURATION OF 2min 7S 8s 3min PHASE DURATION OF 2S O 75 S O 5S 35 165 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY CONDITIONING II PROGRAM LOW BACK REINFORCEMENT WaN The low back muscles play an important role in protecting the lumbar region Some sporting activities such as rowing require specific work from the low muscles Improve the active stability and contraction qualities of the lumbar region This WHY programme enables these muscles to be worked in an intense and isolated manner in order to maintain and improve the strength of the low back muscles To make it as comfortable as possible for the patient use pulse widths equivalent to the PULSE WIDTH chronaxies of the motor nerves of the muscles being stimulated The mi SCAN function can be used to determine the pulse widths suitable for the patient s muscles ELECTRODES Place the electrodes on the paravertebral muscles of the low back area The maximum tolerable stimulation energy which is one of th
89. N I 91 VASCULAR 106 Treatment of disuse atrophy 91 Heavy legs 106 Reinforcement 93 Venous insufficiency I 107 Prevention of disuse atrophy 95 Venous insufficiency II 108 Muscle lesion 97 Arterial infufficiency I 109 Motor point with motor point pen 98 Arterial infufficiency II Cramp prevention m PAIN RELIEF I 99 Capillarisation 12 TENS Gate control 2 99 Frequency modulated TENS 100 CONDITIONING I 113 Pulse width modulated TENS 101 Resistance 13 Endorphinic 102 Strength 115 Burst 103 Active recovery 117 Mixed Burst TENS alternated 104 Decontracturing 105 91 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS 15 1 1 Program category REHABILITATION I CATEGORY REHABILITATION PROGRAM TREATMENT OF DISUSE ATROPHY WHEN A muscle that is normally innervated after a period of immobilisation or diminished movement rapidly decreases in volume This decrease depends on the degree and duration of the functional deficit Slow fibres type 1 in particular are affected by disuse atrophy WHY To reactivate the trophicity of the muscle fibres altered during disuse atrophy To reverse muscle wastage HOW By using frequencies creating a tetanic contraction in type I fibres to impose a significant workload on the atrophied muscle so that it recovers volume Recovery therefore takes place far more quickly than by simply using muscle activities PULSE WIDTH To make it as comf
90. N TRO EN Pr 45 OPPOSITO en hth Aaa deel densa 46 7 Direct Currents Physio device Orly 48 c CNN ONIS RETE TP 48 FP TAN MM SU E 5O T t 52 8 D nervated programs Physio device Orly 53 SHARES MOCE R E ne 53 SA NEGO EIE TULGO NY TH TN 53 year quz NERONE e aE a 54 dian nutus RP TET 55 Lee ee Le ee RR RR ENTER RETE PETERS 56 co Mel fo 0 gt p eer RETE an matt 57 91 Electrode or cable TANI st eet tie cmd 57 Battery 21121 57 o R81 0 RP NER E ee me ene 58 Care Maintenance Transport Enviromental Statement seen 60 ONE AGS UN ME 60 102 TESTI SNNT TR ORE 61 TIAN OR 62 10 3 1 Transport of the Rehab Theta Physio ccccsssssssscsssscssssssssssccsssssecsssssscsssscsssssscssssssc
91. NIC WHEN An increase in the tension of the contractured muscle fibres and the crushing of the capillary network resulting from this causes a decrease in the blood flow and a gradual accumulation of acid metabolites and free radicals Without treatment there is a risk that the contracture will become chronic and genuine atrophy of the capillary network may gradually occur WHY To relieve chronic muscle pain HOW Studying publications about reducing pain by increasing endorphin production shows that the pulses have to be large enough to excite type nerve fibres as well as type Aa which is shown by the production of muscle twitches The effects of endorphinic stimulation are described for frequencies between 2 and 8 Hz In addition to the general effect of increasing endorphin production in the hypothalamus which elevates the pain perception threshold there is a very significant localised effect The 5 muscle twitches induced every second by stimulation produce very significant hyperaemia which drains the acid metabolites and free radicals that had accumulated in the chronically contractured muscle areas PULSE WIDTH Endorphinic stimulation is primarily aimed at the sensitive nerve fibres which are best stimulated with pulse width of 200us However the vascular effect is secondary to the co activation of the motor units which have a slightly higher chronaxy that is measured at the start of the session using t
92. O USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 10 4 Treatment of lumbosciatic pain Patients suffering from lumbosciatic pain most often present lumbar pain that commonly originates from chronic contractures of the lumbar paravertebral muscles In addition involvement of the spinal nerve root leads to irradiation of pain over a shorter or longer distance along the sciatic nerve and in some cases along one or the other of its branches common peroneal or tibial The combination of the Lumbosciatica programme and the TENS programme is the preferred treatment as it produces through its endorphinic effect Lumbosciatic programme a significant analgesic effect on chronic contractures of the lumbar region and through the TENS programme reduces the medullar input of the nociceptive impulse Gate control due to painful irradiation of the sciatic nerve Combining endorphinic stimulation with TENS stimulation is entirely appropriate here as on one hand it treats low back pain caused by chronic contractures of the muscles in that area and on the other hand relieves neurogenic pain of the sciatic nerve for which TENS is the treatment of choice 16 10 4 1 Protocol Lumbosciatica 1O to 12 sessions The Lumbosciatica programme is designed to provide endorphinic stimulation on the first channel and TENS stimulation on the other three channels 16 10 4 2 Treatment frequency Three to five sessions per week for two to three weeks 10
93. ORMATION Loss of sensation Proceed with caution if stimulation is applied to areas of the skin whose level of sensation is lower than normal Do not apply stimulation to a person who cannot express themselves Battery leakage If there is leak from a component take steps to ensure the liquid does not come into contact with skin or eyes Should this occur wash the affected area with water and consult a doctor Strangulation Do not wind cables around the neck Tangled cables can cause strangulation Post surgery Proceed with caution after recent surgery Accessibility of the power adaptor The plug socket must be close to the power adaptor and be easily accessible Internal bleeding Proceed with caution if you are prone to internal bleeding for example after an injury or a fracture The Rehab Theta Physio must only be operated in dry rooms Do not use the Rehab Theta Physio in water or in a humid atmosphere sauna bath shower Ere ete When connecting the unit to other equipment or when creating a medical system check that the sum of leakage currents will not cause any hazard Please contact DJO GLOBAL if you have questionsregarding this matter No modification of this equipment is allowed Do not open the product and its accessories as there is risk of electrocution Before cleaning and service interventions turn the device off Liquids and foreign material such as dust metal etc must not be allowed
94. OS 35 163 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY CONDITIONING II PROGRAM MUSCLE BUILDING WaN For those who wish to improve overall muscle quality in balance with a discrete effect on increasing muscular volume dnas To improve muscular trophicity and increase the tone and volume of the muscles in a balanced way To make it as comfortable as possible for the patient use pulse widths equivalent to the PULSE WIDTH chronaxies of the motor nerves of the muscles being stimulated The mi SCAN function can be used to determine the pulse widths suitable for the patient s muscles Electrodes positioned depending on the muscle to be stimulated in accordance with ELECTRODES the instructions The maximum tolerable stimulation energy which is one of the key factors determining INTENSITY the effectiveness of the treatment The higher the stimulation energy the higher the number of muscle fibres motor units being used OPTION 2 2 Yes 164 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS MUSCLE BUILDING LEVEL 1 23 MIN FINAL RECOVERY RAMP DOWN WARM UP CONTRACTION ACTIVE REST PHASE FREQUENCY 6 Hz 40 Hz 4 Hz 3 HZ DURATION fs mee 155 RAMP UP gt gt gt gt DURATION OF Stain r MN PHASE gt 3 DURATION OF T RAMP DOWN 75 gt 3 MUSC
95. RAPY PROGRAMS ENDURANCE LEVEL 1 55 MIN FINAL RECOVERY WARM UP CONTRACTION ACTIVE REST PHASE FREQUENCY 5 Hz 10 Hz 3 HZ 3 2 DURATION OF vers 6s 155 RAMP UP gt DURATION OF T a iain PHASE gt DURATION OF r RAMP DOWN gt 3 ENDURANCE LEVEL 2 55 MIN FINAL RECOVERY WARM UP CONTRACTION ACTIVE REST PHASE FREQUENCY 5 Hz 12 Hz 3 2 3 HZ DURATION OF 155 055 OS 15S RAMP UP DURATION OF 5 min 85 25 1o min PHASE DURATION OF 25 055 OS 35 RAMP DOWN ENDURANCE LEVEL 3 55 MIN FINAL RECOVERY WARM UP CONTRACTION ACTIVE REST PHASE FREQUENCY 5 Hz 14 Hz 3 Hz 3 HZ DURATION OF 155 0 5 5 OS 15S RAMP UP DURATION OF 5 min 85 25 10 min PHASE DURATION OF 25 055 OS 3S RAMP DOWN 158 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY CONDITIONING II PROGRAM EXPLOSIVE STRENGTH WaN For athletes who practise a discipline where explosive strength is a significant performance factor To increase the maximum capacity for instantaneous power dnas To increase the speed at which the maximum power is attained and to improve the effectiveness of explosive actions such as jumping sprinting etc To make it as comfortable as possible for the patient use pulse widths equivalent to the PULSE WIDTH chronaxies of the motor nerves of the muscles being stimula
96. ROGRAMS CATEGORY VASCULAR PROGRAM VENOUS INSUFFICIENCY 1 WHEN In the event of venous insufficiency without oedema To increase the general blood flow so as to improve the circulation of the interstitial WHY fluid and increase oxygenation of the tissues and the intima of the veins To drain the veins as much as possible in order to combat stasis Howi Send pulses so as to cause short tetanic contractions to drain the deep veins separated by long periods to increase the flow To make it as comfortable as possible for the patient use pulse widths equivalent to the PULSE WIDTH chronaxies of the motor nerves of the muscles being stimulated The mi SCAN function can be used to determine the pulse widths suitable for the patient s muscles ELECTRODES _ Electrodes positioned according to the specific indication INTENSITY Adjust the stimulation energy so as to produce appropriate muscle responses both in the tetanic contraction phase and in the phase to increase blood flow OPTION 2 2 No VENOUS INSUFFICIENCY 1 21 MIN CONTRACTION ACTIVE REST FREQUENCY 50 HZ 8 Hz DURATION OF RAMP UP 155 15 DURATION OF PHASE 4S 215 DURATION OF RAMP DOWN ins 15 108 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY VASCULAR PROGRAM VENOUS INSUFFICIENCY 2 WHEN In the event of venous insufficiency without oedema WHY To encourage drainage of the deep veins and o
97. S CATEGORY CONDITIONING I PROGRAM ACTIVE RECOVERY To facilitate and accelerate muscle recuperation after intense exertion Use this WHEN programme during the three hours which follow a period of intense training or a competition wi Strong increase in blood flow accelerated elimination of waste products from muscle l contraction and a relaxing endorphinic effect To make it as comfortable as possible for the patient use pulse widths equivalent to the PULSE WIDTH chronaxies of the motor nerves of the muscles being stimulated The mi SCAN function can be used to determine the pulse widths suitable for the patient s muscles Precision in positioning the electrodes is less significant than for programmes aiming ELECTRODES develop muscle quality The electrodes can be placed in an alternative way reducing the number of electrodes needed and stimulating more muscles during a session An essential factor in the effectiveness of electrotherapy is the ability to cause visible INTENSITY muscle twitches The mi RANGE function can be used to determine the minimum level of energy required to produce an appropriate muscle response OPTION 2 2 Yes ACTIVE RECOVERY 24 MIN 1ST SEQUENCE 2ND SEQUENCE 3RD SEQUENCE 4TH SEQUENCE FREQUENCY 9 Hz 8 Hz 7 Hz 6 Hz TIME 2 min 2 min 2 min 3min 5TH SEQUENCE 6TH SEQUENCE 7TH SEQUENCE 8TH SEQUENCE FREQUENCY 5 Hz 4 Hz 3 2 2 Hz 3min 3 min 3min 3min
98. SPECIFIC INDICATIONS 16 15 4 3 Results By gradually increasing the current an incomplete dorsal flexing movement of the ankle is seen as well as a hint of an eversion movement of the foot CONCLUSION Our patient has paresis of the lateral popliteal nerve with partial denervation of the muscles of the antero external part of the leg there is hope of reinnervation for the denervated fibres PRACTICAL THERAPEUTIC APPROACH With a denervated muscle several therapeutic choices are available to the rehabilitating physiotherapist See Choice of pulse shape and parameters Denervated muscles Theory Depending on the clinical circumstances and the school we subscribe to we can work on the innervated part of the muscle using the short duration rectangular biphasic pulses supplied by the Neurostimulation programmes However it seems necessary to try to prevent atrophy and limit the phenomenon of sclerosis of denervated fibres To do this use the sloped pulses of the Partial automatic or Partial manual programmes 16 15 4 4 Protocol 2 Partial automatic or Partial manual Unless the exact stimulation parameters are known for that one would have to have the precise results of a recent electromyograph it is recommended that the Partial automatic programme be used Physio will work with default figures 16 15 4 5 Choice and position of the electrodes Self adhesive electrodes are not very suitable for the stimulation of denervated muscl
99. TIVE REST PHASE FREQUENCY 6 Hz 40 Hz 4 Hz 3 HZ DURATION OF Ens T RAMP UP 2 DURATION OF 2min 65 125 3 MIN PHASE DURATION OF 2S 0 75 S 055 35 Sy REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY REHABILITATION PROGRAM MUSCLE LESION It is well known that early but well controlled muscle work has a positive impact on the scarring process of the muscle fibres and the connective supporting tissues WHEN The Muscle Lesion programme can be used as soon as the scar begins to form and is considered satisfactory but as a general rule not until the 10th day after the initial lesion SUUS To direct and speed up the scarring process and prevent disuse atrophy To enable the patient to return to sport more quickly The muscle lesion programme is designed to cause extremely gradual muscle HOW contractions using a rate of tensioning 4 times longer than for standard programmes This aims to reduce the risk of adverse secondary ruptures To make it as comfortable as possible for the patient use pulse widths equivalent to the PULSE WIDTH chronaxies of the motor nerves of the muscles being stimulated The mi SCAN function can be used to determine the pulse widths suitable for the patient s muscles Electrodes positioned depending on the muscle to be stimulated in accordance with ELECTRODES the instructions Use the maximum stimulation energies Th
100. YSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY CONDITIONING II PROGRAM PLYOMETRY WHEN To develop muscular explosive power by imposing a stress similar to that induced by voluntary plyometry exercises while reducing stress on joints and tendons Increase the speed of contraction the capacity to perform actions at maximum strength jump bound shoot etc To make it as comfortable as possible for the patient use pulse widths equivalent to the PULSE WIDTH chronaxies of the motor nerves of the muscles being stimulated The mi SCAN function can be used to determine the pulse widths suitable for the patient s muscles iti Eigene ectrodes positioned depending on the muscle to be stimulated in accordance with the instructions The maximum tolerable stimulation energy which is one of the key factors determining INTENSITY the effectiveness of the treatment The higher the stimulation energy the higher the number of muscle fibres motor units being used OPTION 2 2 Yes 161 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY CONDITIONING II PROGRAM HYPERTROPHY WHEN For body building enthusiasts and athletes wishing to increase their muscle mass Possibility of combining this programme with voluntary training WHY Increase the volume of stimulated muscles and improve muscular resistance To make it as comfortable as possible for
101. a 11 1 1 General information Model Rehab Theta Physio Part number 253311 253481 253511 MDD Class lla IP class IP22 Applied part Type BF Battery 941213 Nickel metal hydride NiMH rechargeable battery 4 8 V 2000 mA h Only battery chargers bearing the part number 68301X can be used to B h m A recharge the batteries supplied with Rehab Theta Physio stimulators 11 1 2 Neuro Stimulation Parameters All electrical specifications are given for an impedance of 500 1 000 ohms per channel Four independent and individually adjustable channels that are dal electrically isolated from each other Constant rectangular current with pulse compensation to eliminate Pulse shape any direct current component to prevent residual polarisation at skin level Maximum pulse intensity 120 MA Manual adjustment of stimulation intensity from o to 999 energy in Pulse intensity increments minimum increments of 0 25 mA Pulse width 30 tO 400 US Maximum electrical charge per pulse 96 micro coulombs 2 x 48 uC compensated Standard pulse ramp up time us 20 80 of maximum current Pulse frequency 1to 150 Hz 64 REHAB THETA PHYSIO 11 TECHNICAL DATA STANDARDS GUARANTEE PATENTS 11 1 3 Denervated currents Physio device only Impulse shape Compensated rectangular or triangular Maximum pulse intensity 3O mA Minimum intensity increment 0 25 mA Pulse width 10 ms 1000 ms Pulse freq
102. ack DaIN ccccsssscsssccsssssscsssccsssssssessscssssssseessscssssssssesssessssssssssssesseecsscsssscssecceseesssessee 237 1610 4 Treatment OT lumbosciatic 240 Hemiplegia SpastiCity 243 16 7 1 Dorsiflexion of the hemiplegic fOOt sees teennt tenentes tense AEAEE EEEE EAEan 244 s dale NR RR m nee 245 16 0 3 The hemiplegic Rand ERI 250 TS The tte neta ease heart 252 16 12 Treatment of venous isla dea ei desde spass qu 255 16121 VENOUS insufficiency without oedema esent tte ttttntttte tent tte ttti ttes ttes totes tittestie 255 16 12 2 Venous insufficiency with OCMEMAQ cccssssssssssssssessssessssesssseccsssessssecsssccsssescstscssssscsssecassecsssscessueesuisessueesstscasssessstecasuesssnes 257 16 13 Treatment of arterial insufficiency in the lower limbs sse 260 1613 1 Stage Baciaca ga 261 1513 2 Stage lI arterial InsuffIelelli cynical arret ibt rit iioc ee Saba ua 263 QN WEIT 264 REHAB THETA PHYSIO CONTENTS WEARI RENE ru 265 16 14 2 Stress INCONTINENCE 266 1614 34 Mix din ontinence urge and Stress TY COREIFTGTAC OS ARR ernie mtr erate et Ea 268 16 144 Postpartum PSV ACUI bc uude
103. adiation in the common peroneal or tibial nerves Two large electrodes are therefore placed longitudinally on the calf tibial or laterally common peroneal on the lower leg and are connected by a channel f the patient does not like endorphinic stimulation in the lumbar region two large electrodes placed to the lumbar region and are connected by a channel 16 10 4 4 Patient position The patient is placed in the position he she finds the most comfortable in the prone position with a cushion or on a specially designed table to prevent lordosis or in the side lying position 242 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 10 4 5 Stimulation energy The energy is gradually increased on the second channel TENS in order to cause a distinctive tingling sensation along the painful irradiation of the sciatic nerve The gradual energy increase on the first channel must be sufficient to obtain visible or at least palpable muscle twitches of the muscles of the lumbar region which cause hyperaemia Note When TENS is used in combination with an endorphinic programme such as the Low back pain programme in this case the mi TENS function is inactive 243 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 11 Hemiplegia Spasticity This chapter examines the treatment of problems specific to the hemiplegic patient including spasticity whic
104. adjust the width of the pulse to the intensity used so as to keep the ramp constant see graph below These ramped pulses must be balanced in order to have a zero electrical mean so as to avoid chemical burns gt Physio device proposes manual or automatic partial denervation programs Depending on the circumstances It may also be worthwhile working on the innervated part of the muscle using the rectangular biphasic micro pulses in the neurostimulation programmes 192 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS D Summary outside the within the re innervation time re innervation time TOTAL DENERVATION Stimulation is pointless Long rectangular pulses 100 ms with automatic PARTIAL DENERVATION Rectangular biphasic Long triangular pulses pulses of short duration 200 to 400 us Possibly on innervated fibres More information is detailed in Specific indications chapter 193 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 1 Overview Indication Page Disuse atrophy rehabilitation standard protocol 195 Rehabilitation of the peroneus muscles following an ankle sprain 197 Rehabilitation of low back muscles 200 Treatment of patellofemoral syndrome 203 1 Lateral tracking 203 2 Post traumatic condition 205 ACL ligamentoplast 207 Rehabilitation of the gluteal muscles following total hip repla
105. al chapter 2 Safety Information prior to using your stimulator 5 1 Select a neurostimulation program To start the stimulator press the On Off button To choose a programme you must first choose a type of treatment and a programme category NOTE There is a table summarising the different programmes and their functions at the end of this manual 5 2 Choosing a type of treatment MRIN MENU SPECIFIC TREATMENT CONDITIONING CUSTOM PROGRAMS PROGRAMMING CG m m ms Fig 30 3e Fig 3a Press the On Off button to turn off the unit Fig 3b Use the channel 1 button to choose another type of treatment i e Specific Treatment or Conditioning Fig 3e Press the channel 4 button to confirm your choice and access the programme category selection screen Press the i button to access the Top 5 menu 5 3 Choosing a programme category COMMON TRERTMENT REHABILITATION FAIN RELIEF Nc EB LL Fig 4a 4b 4e 28 REHAB THETA PHYSIO 5 HOW TO PERFORM A TREATMENT NEUROSTIMULATION PROGRAMS Fig 4a Press the On Off button to return to the previous screen Fig 4b Use the channel 1 button to choose a category Fig 4e Press the channel 4 button to confirm your choice and access the programme selection screen Press the i button to access the Top 5 menu 5 4 Choosing a programme NOTE Consult our Practical Guide for help in choosing a programme Once you choose a category th
106. alent to the chronaxies of the motor nerves of the quadriceps and hamstring muscles The mi SCAN function can be used to determine the pulse widths suitable for the patient s muscles ELECTRODES Electrodes positioned on the gluteal muscles must correspond to the specific indication INTENSITY The maximum tolerable stimulation energy on the 4 channels which is one of the key factors determining the effectiveness of the treatment The higher the stimulation energy the higher the number of muscle fibres motor units being used Progressively increase the level of energy during the course of a treatment session OPTION 2 2 No The 2 2 function is not available on this program since all four channels are in use NOTE Take care to properly observe the correct position of the stimulation channels 125 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS ACL 30 MIN 2ND CONTRACTION 1ST CONTRACTION CH 1224 344 ACTIVE REST CH 1 2 HAMSTRINGS HAMSTRINGS QUADRICEPS FREQUENCY 40 Hz 40 Hz 4 Hz DURATION OF 15S 3S 055 RAMP UP DURATION OF 35 65 85 PHASE DURATION OF OS 0 75 S 055 RAMP DOWN 126 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY REHABILITATION II PROGRAM ROTATOR CUFF WaN In addition to the rehabilitation of rotator cuff tendinopathies after sedation of acute i pain and manual correction of joint misalignment
107. amme is 180 US Electrodes must be placed after a thorough palpatory examination to locate the most painful point where a small electrode preferably connected to the positive pole of the cable will be placed The other electrode is placed at the end of muscle or muscle group being stimulated INTENSITY An essential factor in the therapeutic efficacy is to cause visible muscle twitching which may in certain cases require higher stimulation energies to be used OPTION 2 2 Yes BURST TENS FREQUENCY PULSE WIDTH TREATMENT TIME 2 Hz 2 pulse trains per second with an internal frequency of 180 15 20 min 80 Hz 104 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY PAIN RELIEF PROGRAM MIXED BURST TENS ALTERNATED Described by Han modulated stimulation Burst TENS successively activates every 3 BERE seconds the Gate control mechanism and releases endogenous opioid substances This l is a therapeutic option which may be worth considering for poorly classified pain with multiple causes T To improve the patient s comfort and to enable the therapist to start the process more easily Burst modulated TENS is based on the Gate control theory TENS effect and on the release of morphine like substances produced the body endorphins Endorphinic effect The stimulation frequencies vary every 3 seconds producing a combined stimulation of 80 Hz and 2 H
108. ased until significant values are obtained 16 15 3 4 Results No muscular contraction of the extensors of the wrist and fingers is observed either visually or by palpating It can be concluded therefore that denervation is total CONCLUSION Our patient has paralysis of the radialis nerve with complete denervation of the extensor muscles of wrist and fingers There is hope of re innervation PRACTICAL THERAPEUTIC APPROACH In this case the purpose of rehabilitation is going to be to prevent atrophy as much as possible and limit the phenomenon of sclerosis pending possible re innervation Here the preferred technique is going to be stimulation of the extensor muscles of wrist and fingers by means of Denervated programmes To stimulate a fully denervated muscle wide rectangular pulses will be used between 50 and 200 ms as the denervated fibre can only be slightly excited It therefore needs a large amount of electrical charge to reach its excitation threshold 16 15 3 5 Protocol 2 Total automatic or Total manual Unless the exact stimulation parameters are known for that one would have to have the precise results of a recent electromyograph it is recommended that the Total automatic programme be used Physio will work with default figures 276 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 15 3 6 Choice and position of the electrodes Self adhesive electrodes are not very suitable for st
109. atient use pulse widths equivalent to the PULSE WIDTH chronaxies of the motor nerves of the abdominal and lumbar muscles The mi SCAN function can be used to determine the pulse widths suitable for the patient s muscles Electrodes positioned depending on the muscle to be stimulated in accordance with ELECTRODES the instructions The maximum tolerable stimulation energy which is one of the key factors determining the effectiveness of the treatment The higher the stimulation energy the higher the number of muscle fibres motor units being used Very gradually increase the level of energy during the course of a treatment session OPTION 2 2 NO HAEMOPHILIA DISUSE ATROPHY LEVEL 1 25 MIN CONTRACTION REST FREQUENCY 40 Hz o Hz DURATION OF 6s OS RAMP UP DURATION OF 35 105 PHASE DURATION OF 1 55 OS RAMP DOWN 136 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS HAEMOPHILIA DISUSE ATROPHY LEVEL 2 32 MIN CONTRACTION REST FREQUENCY 45 Hz o Hz DURATION OF 6S Os RAMP UP DURATION OF 55 95 PHASE DURATION OF 1 55 5 RAMP DOWN HAEMOPHILIA REINFORCEMENT LEVEL 1 15 MIN CONTRACTION REST FREQUENCY 70 Hz o Hz DURATION OF T T RAMP UP DURATION OF 5 3 DURATION OF em RAMP DOWN gt HAEMOPHILIA REINFORCEMENT LEVEL 2 20 MIN RAMP DOWN CONTRACTION REST FREQUENCY 80 Hz o HZ DURATION OF
110. atient must have their own set of electrodes Do not use the same electrodes on different patients Some patients with very sensitive skin may experience redness under the electrodes after a session Generally this redness is completely harmless and usually disappears after 10 to 20 minutes Never start another stimulation session in the same area however if the redness is still visible Before each use clean and disinfect the motor point pen tip that is in contact with the skin When using the REHAB THETA PHYSIO to customize programs take special care that the parameters customized and applied by you to the patient are as you wanted them to be REHAB THETA PHYSIO 2 SAFETY INFORMATION Caution A Equipment damage Check that the voltage and frequency ratings of your local power line are those indicated on the type plate of the power supply Do not expose the Rehab Theta Physio to direct sunlight because some of the components may reach unacceptably high temperatures The presence of children pets and vermin does not normally affect the proper functioning However make sure that these sources do not contaminate the physiotherapy unit and keep them away from it Also keep the unit clean and protect it from dust and lint The safety rules and regulations set forth apply in any case It is recommended to use the transport bag that comes with the unit for transport of the device and to use a proper transport bo
111. atients HEROES The electrodes must be positioned where the pain is located Four large electrodes surrounding the joint produce a significant analgesic effect on all shoulder pain The intensity must be increased gradually until the patient feels a tingling sensation INTENSITY that is pronounced without being painful OPTION 2 2 Yes SHOULDER PAIN FREQUENCY PULSE WIDTH MODULATION TIME TREATMENT TIME 80 Hz 75 180 uS 35 min 146 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY PAIN RELIEF II PROGRAM FRACTURE PAIN In addition to other analgesic treatments during the first few days after a simple WHEN immobilisation or osteosynthetic surgery on a fracture Extended use for rib fractures where strict immobilisation is not possible resulting in severe pain over several weeks WHY For the relief of pain Using the Gate control principle This involves causing high levels of sensitivity impulses HOW in order to limit the input of pain impulses when they return to the posterior horn of the spinal cord PULSE WIDTH The pulse width for the programme is 170 us Depending on the means of restraint and or the size of the dressing used access to the painful area may be awkward It is important to surround the painful area as much as possible Another possible strategy is to directly stimulate the large nerve trunks superior to the point of pain ELECTRODES
112. ation of the test it is important to stay still and be relaxed When the test is complete the programme can be started by increasing the intensity levels of the channels 30 REHAB THETA PHYSIO 5 HOW TO PERFORM A TREATMENT NEUROSTIMULATION PROGRAMS 5 5 2 Activate the warm up session If the warm up session is activated heating radiator Fig 7C the program should start during the first 5 minutes with very clear muscle twitches to increase local blood flow and prepare muscle for stimulation 5 5 3 Choosing the 2 2 function You have the possibility to choose the 2 2 function which means that you can choose one programme for channels 1 and 2 then select one programme from the 2 2 programme list for channels 3 and 4 So you can treat two different body parts at the same time or combine two different programmes on the same body part NOTE The timer for channel 1 2 will control the total session time This means that the total time for channel 3 4 not exceed the session time for channel 1 2 The programme for channel 3 4 is always in one phase If a preset programme uses more than two channels this will not be available for the 2 2 mode 5 5 4 Level progression Generally speaking it is not advisable to progress through the levels too quickly and to aim to reach the maximum level too quickly The different levels correspond to progression in rehabilitation using electrostimulation Furthermore and without exception
113. ausing high levels of sensitivity impulses HOW in order to limit the input of pain impulses when they return to the posterior horn of the spinal cord The pulse width varies continuously with this programme This avoids habituation by PULSE WIDTH j using a system of stimulation that is perceived as more pleasant by some patients The electrodes must be placed on the painful area preferably on the points of ELECTRODES sensitivity The intensity must be increased gradually until the patient feels a tingling sensation INTENSITY y 8 y 8118 that is pronounced without being painful OPTION 2 2 Yes TRAPEZIUS PAIN FREQUENCY PULSE WIDTH MODULATION TIME TREATMENT TIME 60 HZ 80 200 US 35 min 145 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY PAIN RELIEF II PROGRAM SHOULDER PAIN To relieve shoulder pain following a mechanical conflict an inflammatory disorder WHEN shoulder surgery or inflammatory tendinopathy WHY For the relief of pain Using the Gate control principle This involves causing high levels of sensitivity impulses HOW in order to limit the input of pain impulses when they return to the posterior horn of the spinal cord The pulse width varies continuously with this programme This avoids habituation by PULSE WIDTH using a system of stimulation that is perceived as more pleasant some p
114. cant stimulation energy the number of fibres engaged in the stimulated muscle is too low to considerably improve the quality of the muscles The maximum energy will not be reached during the first session but after at least 3 sessions during which the energy to produce strong muscle contractions will be increased gradually so that the patient becomes accustomed to electrostimulation After the warm up which should produce clear muscle twitching the stimulation energies must be increased progressively contraction by contraction throughout the work sequence If your device emits a beeping sound and the symbols under the active channels begin to flash the stimulator is suggesting you increase the level of the stimulation energies If you are working at the patients maximum tolerance level simply ignore this message The energies used should also be increased session by session For TENS treatments stimulation is only sensory The intensity must therefore be increased until the patient has a pins and needles sensation tingling that is not considered painful For neuromuscular electrostimulation programmes which do not cause tetanic muscle contractions frequencies lt 10Hz the energies must be increased gradually until muscle twitching is produced that can be clearly seen or felt 3 REHAB THETA PHYSIO 5 HOW PERFORM A TREATMENT NEUROSTIMULATION PROGRAMS 5 9 Stimulation mode When you start a programme you will be pro
115. cement 211 Rehabilitation of the shoulder 213 1 Rotator cuff tendinopathy 214 2 Shoulder instability 217 3 Adhesive capsulitis 220 Cardiac rehabilitation 223 Reflex sympathetic dystrophy or Complex regional pain syndrome 226 Endorphinic treatment of Rachialgia and Radiculalgia 231 1 Endorphinic treatment of neck pain 233 2 Endorphinic treatment of thoracic back pain 235 3 Endorphinic treatment of low back pain 237 4 Treatment of lumbosciatic pain 240 Hemiplegia Spasticity 243 1 Dorsiflexion of the hemiplegic foot 244 2 Spasticity 245 3 The hemiplegic hand 250 4 The hemiplegic shoulder 252 194 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS Indication Page Treatment of venous insufficiency 255 1 Venous insufficiency without oedema 255 2 Venous insufficiency with oedema 257 Treatment of arterial insufficiency in the lower limbs 260 1 Stage arterial insufficiency 261 2 Stage III arterial insufficiency 263 Urinary Incontinence 264 1 Urge incontinence 265 2 Stress incontienence 266 3 Mixed incontinence urge and stress incontinence 268 4 Post Partum prevention 270 Denervated muscle electrostimulation 271 Situation 1 Total denervation outside the time 2n 2 Situation 2 Partial denervation outside the time 272 3 Situation 3 Total denervation within the time 274 4 Situation 4 Partial d
116. connected to a standard cable receives the same data as a channel connected to a mi SENSOR cable see Fig 13 1 e 3 4 2g dee 39 REHAB THETA PHYSIO 6 TREATMENT OPTIONS Before a programme is executed the sensor scans the muscle briefly During this time a horizontal bar will move up and down the figure on the left of the screen It is essential that the patient remains completely still and relaxed while these measurements are being taken The mi SENSOR system is very sensitive and the slightest contraction or movement could interfere with its results Note that certain people might feel an unpleasant tingling sensation during the test Once the test is complete a symbol will appear on the screen indicating that the programme can be started 6 1 2 Energy management mi RANGE amp mi TENS mi RANGE This function indicates the minimum energy threshold for programmes whose effectiveness requires obtaining vigorous muscular twitches The mi RANGE function is therefore only available for programmes using low stimulation frequencies below 10 Hz For programmes that allow the mi RANGE function the stimulator first prompts you to increase the energy level beep will accompany the flashing symbols e When a muscle pumping is first detected the symbols stop flashing You are at the minimum energy level to provide therapeutic results If you set the stimulation
117. d PC usse it aste oct od a 195 16 3 Rehabilitation of the peroneus muscles following an ankle Sprain sse 197 16 4 Rehabilitation of low back etude Stetit tbe 200 165 Ireapnentor parellofemoral By censendus anh te anes a ee este aea iacit dut cute ux 203 15 51 Lateral tracking 203 165 2 205 Dorem rca MP PC 207 16 7 Rehabilitation of the gluteal muscles following total hip replacement 21 16 8 Rehabilitation of the soulager abere n tttm obest ettet 213 I5 8 Rotator cuff Ny aderenti tret eee nett cnn Mears ene buds toc 214 16 8 2 Shoulder instabilities s str ereire LI 217 RE UE ERE EREE 220 16 294 Cardiac Ss 10 2 T ENERO 223 16 9 Reflex sympathetic dystrophy or Complex regional pain syndrome see 226 16 10 Endorphinic treatment or Rachialgia and Rag BIB BIB aote beant esaet 231 16101 Endorphiume treatment Of cervical tact head ll eh ca ead ga hd on dies 233 1610 2 Endorphinic treatment of thoracic back pain sette tttnttenettentennes 235 16 10 3 Endorphinic treatment of low b
118. d alter the currents generated by the stimulator If you are in any doubt as to the use of the stimulator in close proximity to another medical device seek advice from the manufacturer of the latter or from your doctor Exercise caution when using electrotherapy while the patient is connected to monitoring equipment with electrodes attached to the body Stimulation could disrupt the signals sent to the monitoring equipment Refer repair and maintenance to authorized persons Persons are authorized after training by a specialist trained and commissioned by the manufacturer Inspect the Rehab Theta Physio and it s accessories for damage and loose connections at least once a year Damaged and worn parts must be immediately replaced with original spare parts by authorized staff REHAB THETA PHYSIO 2 SAFETY INFORMATION Caution Patient hazard these cautions need to be observed to avoid the risk of electrical shock or other negative effects to the patient Do not apply stimulation close to metal Remove jewellery piercings belt buckles or any other metallic product or device in the area of stimulation Be careful if the patient has sensitivity problems or is not able to communicate that he or she feels discomfort however light Never begin an initial stimulation session on a person who is standing The first five minutes of stimulation must always be performed on a person who is sitting or lying down In rare instances peo
119. d with direct current Other forms of electric current have never demonstrated any efficacy for iontophoresis and their use in this application is insubstantial Direct current applied via surface electrodes on part of the body sets up an electric field through the tissues that is responsible for mobilizing ionized medicines In addition to this however the galvanic current has several effects It produces slight heating of the tissues vasodilation in the skin which is evident as erythema under the two electrodes and disappears spontaneously 20 to 60 minutes after treatment a slight pricking sensation or irritation under the electrodes at the cathode alkaline reaction NaOH increased excitability of the nerves reduced protein density sclerolytic at the anode acidic reaction reduced excitability of the nerves increased protein density sclerotic D Density of the current With regard to the efficacy or the safety of the treatment electric density must be discussed The degree of ionic transfer depends on the intensity of the current as well as on the size of the skin electrode contact area i e it depends on density How well the skin tolerates the galvanic current for the same intensity depends on dispersion of the current over a surface area that can vary in size Likewise the accumulation of sodium hydroxide at the cathode and its concentration on the skin depends on the intensity as
120. de Muscle Intelligence Technology with Mi Action Mi Range Mi Tens and Mi Scan functions Physio 4 Mi sensors are included in the kit Theta 2 Mi Sensors are included in the kit By purchasing more cables with Mi sensors it is possible to take advantage of the Mi technology on the 4 channels Rehab This device is Mi ready By purchasing one or more cables with Mi sensors it is possible to take advantage of the Mi technology 38 REHAB THETA PHYSIO 6 TREATMENT OPTIONS 6 1 1 Personalized impulse mi SCAN mi SCAN Just before starting a session of neuro muscular electrostimulation mi SCAN analyses the characteristics of excitability in the muscle subjected to stimulation mi SCAN detects the chronaxy of the muscle in approximately 10 seconds by detecting when and how strong a mucle contracts while getting different intensitys applied It allows the stimulator to adjust the width duration of the pulse to the measured chronaxy value Using a width duration of the pulse corresponding to the chronaxy of the stimulated muscle allows the use of the minimum power to obtain the same muscle response As soon as the mi SCAN function is activated each active channel performs the chronaxy measurement As many as 4 different chronaxy measurements corresponding to 4 different muscle groups can be taken per session The number of measurements depends on how many sensors are connected to the stimulator Each channel that is
121. describes the practical method established on the basis of the following publications Fall M Lindstr m S Electrical Stimulation A Physiologic Approach to the Treatment of Urinary Incontinence Urologic Clinics of North America 18 393 407 1991 Plevnik S Vodusek DB Vracnik P Optimization of pulse duration for electrical stimulation in treatment of urinary incontinence World J Urol 4 22 23 1986 Lindstr m S Fall M Carlsson CA The neurophysiological basis of bladder inhibition in response to intravaginal electrical stimulation Urol 129 405 410 1983 Fall M Erlandson BE Sundin T Intravaginal electrical stimulation Clinical experiments on bladder inhibition Scand Urol Nephrol Suppl 44 41 1978 Amaro JL Gameiro MOO Padovani CR Treatment of urinary stress incontinence by intravaginal electrical stimulation and pelvic floor physiotherapy Int Urogynecol Journal 14 204 208 2003 Two types of urinary phase are recognized short voluntary micturition phases separated by long collecting phases during which the bladder gradually fills Continence i e the absence of urine loss during the collecting phase requires firstly a relaxed bladder and secondly a permanent closure of the sphincter urethrae Impairment of one of these two elements results in urinary incontinence Clinically a distinction is made between three types of incontinence 1 Urge incontinence The bladder contracts abnormally detrusor overact
122. drome A distinction must be made between two types of patellofemoral syndrome 1 With patellar mal tracking which means the patella is not running centrally in the trochlear groove commonly being pulled laterally 2 Without patellar mal tracking i e with a centred patellofemoral syndrome as in post traumatic chondropathy The proposed protocols are based mostly on the studies carried out by Dr Gobelet University Hospital of Lausanne Switzerland Physical Medicine Department and by Dr Drhezen College of Physiotherapy Li ge Belgium 16 5 1 Lateral tracking An essential cause of the mal tracking of the patella is determined by an imbalance between the different heads of the quadriceps muscle A particularly significant weakness of the vastus medialis in comparison with the vastus lateralis creates a lateral displacement of the patella with hyperpressure between the lateral condyle and the adjacent retropatella surface Specific reinforcement of the vastus medialis is the ideal way to treat this pathology It can be enhanced effectively with electrostimulation 16 5 1 1 Protocol Weeks 1 2 Patellofemoral syndrome Level 2 Weeks 3 4 Patellofemoral syndrome Level If the patient is experiencing associated pain symptoms TENS stimulation can be performed in addition on the other channels In this case the specific practical rules for TENS electrode placement regulation of intensity should be followed for each
123. duction of edema under negative electrode Reduction of muscle spasm Influencing local blood circulation under negative electrode Retarding or prevention of disuse atrophy Facilitation of voluntary motor function Maintenance of increase of range of motion 1 4 Contraindications Do NOT use the Rehab Theta Physio on patients with Implanted electronic devices Do not use the device if you have a cardiac stimulator implanted defibrillator or other implanted electronic electrical device Epilepsy Pregnancy do not use on abdominal region Serious arterial circulation problems in lower limbs Abdominal or inguinal hernia Do not use chest stimulation on patients with cardiac arrhythmia This could cause an electrical shock burns electrical interference or death REHAB THETA PHYSIO 1 HOW TO USE THE MEDICAL EQUIPMENT INTENDED USE Heart disease If you have suspected or diagnosed cardiopathy you should follow the precautions for use recommended by your doctor Note Fixation metalwork and or prosthesis equipment The presence of Fixation metalwork and or prosthesis equipment metallic equipment in contact with the bone pins screws plates prostheses etc is not a contraindication for NMES TENS and Denervated muscle stimulation The electrical currents of the Rehab Theta Physio are specially designed to have no harmful effect on osteosynthesis equipment Never use direct currents lontophoresi
124. e screen will display a list of available programmes REHRBILITRTION DISUSE ATROFHY FREU OF DISUSE ATROPHY REINFORCEMENT NEURO REHAB SLOW START ERCK TRUNK STABIL rca mm mum Fig 5a 5b 5e Fig 5a Press the On Off button to return to the previous screen Fig 5b Use the channel 1 button to choose the programme you want Fig 5e Press the channel 4 button to confirm your choice Certain programmes start right away while others allow you to specify additional options TOP 5 To access the Top 5 menu press the i button before selecting a programme The menu can be accessed from the type of treatment screen Fig 3 the programme category screen Fig 4 or the programme list screen Fig 5 TOP5 PARTIAL MANUAL 8 me Fig 6b 6 6a Press the On Off button to return to the previous screen Fig 6b Use the channel 1 button to choose the programme you want Fig 6d Use the channel 3 button to personalize the programme Fig 6e Press the channel 4 button to start the programme 29 REHAB THETA PHYSIO 5 HOW TO PERFORM A TREATMENT NEUROSTIMULATION PROGRAMS 5 5 Personalising a programme Not all programmes have an option screen In certain programmes you will need to choose the muscle group you want to stimulate The target area is shown in black on the figure above channel 1 117 g in OFF EX Fig 7a 7b 7 7d 7e Fig 7a Press
125. e and their high volume of muscle mass Two channels are needed per thigh for quadriceps stimulation Two small electrodes are placed on the motor points of the vastus medialis and the vastus lateralis Two large electrodes are positioned at the top of the thigh For optimum effectiveness the positive pole should preferably be positioned on the motor point 16 8 4 4 Patient position The patient should preferably be placed in a sitting position with his her knees bent at approximately 90 the ankles must be restrained to avoid the knees from being extended which can induce contractions If the patient is not able to stay seated the session can be carried out in a lying position taking care to place a large cushion under the popliteal fossae so that the knees are flexed 225 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 8 4 5 Stimulation energy In NMES the stimulation energy is directly responsible for spatial recruitment the higher the stimulation energy the higher the percentage of motor units recruited and the greater the impact of the progress The general rule is to always try to increase the energy to the maximum level tolerated by the patient The therapist plays a fundamental role by encouraging and reassuring the patient who can then tolerate levels of energy that produce powerful contractions The levels of energy reached must increase throughout the session and also
126. e connected when in automatic mode 8 1 1 Total automatic Full denervation with fixed parameters Pulse width 100 ms Period 2000 ms Programme duration 8 min NOTE These are the default values recommended in the Total manual mode 54 REHAB THETA PHYSIO 8 DENERVATED PROGRAMS PHYSIO DEVICE ONLY 8 1 2 Partial automatic Partial denervation with automatic calculation of initial current ramp The width of the pulse before validation of the ramp is 100 ms How it works When you start the programme stimulation will automatically begin through the first channel you are using As soon as you perceive a muscle response confirm the ramp by pressing the corresponding button under the MEMO symbol The stimulator will display the value for this channel see Figure 30 below and automatically begin the search for the next channel The Physio can calculate and manage 4 different initial current ramps ET CLO Cm E06 OOo 0h Fig 30a 30b displayed above channel where ramp search is being performed 1 displayed above inactive channels channels that not connected displayed once intensity value for corresponding channel has been validated Fig 30a Press the On Off button to stop the programme and return to the previous screen Fig 3ob Press the button under the memo symbol to confirm the current intensity calculated during the ramp search pr
127. e disuse atrophy HONG Progressive incrementation of the frequency 25 40Hz at the beginning of each l contraction may improve the comfort of the stimulation in hypersensitive patients To make it as comfortable as possible for the patient use pulse widths equivalent to the PULSE WIDTH chronaxies of the motor nerves of the abdominal and lumbar muscles The mi SCAN function can be used to determine the pulse widths suitable for the patient s muscles Electrodes iti imul in rdance with EUECTHOBEE positioned depending on the muscle to be stimulated in accordance wit the instructions The maximum tolerable stimulation energy on the 4 channels which is one of the key INTENSIE factors determining the effectiveness of the treatment The higher the stimulation energy the higher the number of muscle fibres motor units being used Progressively increase the level of energy during the course of a treatment session OPTION 2 2 Yes ATROPHY MODULATED FREQUENCY 30 MIN FINAL RECOVERY WARM UP CONTRACTION ACTIVE REST PHASE FREQUENCY 6 Hz 25 40 Hz 4 Hz 3Hz DURATION OF 155 ove ORS 155 RAMP UP gt 5 DURATION OF 2min 45 85 3 min PHASE DURATION OF 2S 15 0 5 5 35 RAMP DOWN 131 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY REHABILITATION II PROGRAM REINFORCEMENT MODULATED FREQUENCY For use either on previously atrophied muscles
128. e first and second sessions help the patient become accustomed to the method by gradually increasing the stimulation energy INTENSITY every 3 or 4 contractions In the following sessions it is important to support the patient s progress by setting targets which go beyond the energy levels reached in the previous session OPTION 2 2 Yes MUSCLE LESION 30 MIN FINAL RECOVERY WARM UP CONTRACTION ACTIVE REST PHASE FREQUENCY 6 Hz 40 Hz 4 Hz 3 Hz DURATION OF 1 55 65 1 55 1 55 RAMP UP DURATION OF 2 min 35 105 3min PHASE DURATION OF 25 15 155 25 RAMP DOWN 98 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY REHABILITATION PROGRAM MOTOR POINT It is advisable to use this programme before all initial muscle electrostimulation sessions in order to precisely locate the motor points for each person Locating the WHEN NP motor points is recommended especially for long muscles such as those in the lower limbs quadriceps etc WHY In order to guarantee optimum effectiveness of the programmes A motor point pen must be used to locate the motor points See the example on the section on specific indications OPTION 2 2 NO MOTOR POINT 15 MIN CONTINUOUS STIMULATION FREQUENCY az 99 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS 15 1 2 Program category PAIN RELIEF CATEGORY PAIN RELIEF PROGRAM 100 Hz TENS OR FREQUENCY MODULATED TENS
129. e is uncomfortable and quickly becomes painful due to the sensation of cramp that results from this position Consequently this position must be avoided and the patient should be placed in a position in which the stimulated muscle is in a mid range position The end of the stimulated limb must be securely tied down so that the electrically induced contraction does not cause any movement The stimulation will therefore be carried out using isometric contractions 197 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 2 5 Stimulation energy In NMES the stimulation energy is directly responsible for spatial recruitment the higher the stimulation energy the higher the percentage of motor units recruited and the greater the impact of the progress The general rule is to always try to increase the energy to the maximum level tolerated by the patient The therapist plays a fundamental role by encouraging and reassuring the patient who can then tolerate levels of energy that produce powerful contractions The levels of energy reached must increase throughout the session and also from session to session because the patients quickly get used to the technique When the patient has difficulty in reaching satisfactory levels of stimulation energy it can be useful to ask the patient to add voluntary co contractions which improves mediocre spatial recruitment and also makes the stimulation more comfortable The
130. e key factors determining INTENSITY the effectiveness of the treatment The higher the stimulation energy the higher the number of muscle fibres motor units being used OPTION 2 2 Yes 166 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS LOWER BACK REINFORCEMENT LEVEL 1 33 MIN FINAL RECOVERY RAMP DOWN WARM UP CONTRACTION ACTIVE REST PHASE FREQUENCY 5 Hz 40 Hz 4 Hz 3 HZ DURATION fm IES mex 15 5 RAMP UP 5 gt E DURATION OF oe PHASE gt gt DURATION OF T e 4 RAMP DOWN 75 gt 3 LOWER BACK REINFORCEMENT LEVEL 2 35 MIN FINAL RECOVERY WARM UP CONTRACTION ACTIVE REST PHASE FREQUENCY 5 Hz 45 Hz 4 Hz 3 2 DURATION OF D nee ss ex RAMP UP P S DURATION OF 5 min 65 95 min PHASE DURATION OF 3 Sis 5 RAMP DOWN uS B 3 LOWER BACK REINFORCEMENT LEVEL 3 36 MIN FINAL RECOVERY WARM UP CONTRACTION ACTIVE REST PHASE FREQUENCY 5 Hz 50 HZ 4 Hz 3 Hz DURATION OF Tn T T wee RAMP UP 2 DURATION OF 5 min 75 85 10 min PHASE DURATION OF 2S 0 75 S 055 35 167 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY CONDITIONING II PROGRAM CORE STABILISATION The abdominal muscles and the muscles in the low back area are very important for BERE all sporting activities Good neuromuscular control and stabilisation of the tru
131. e neck Counter laterally i e do not use two poles connected to the same channel on opposite sides of the body On or near skin lesions of any kind wounds swelling burns irritation eczema cancerous lesion etc f the person is pregnant or menstruating do not place electrodes directly on the uterus area or connect pairs of electrodes on either side of the abdomen to avoid any risk for the mother and or the baby Never allow muscular contraction during a stimulation session to result in movement You should always stimulate isometrically this means that the extremities of the limb in which a muscle is being stimulated must be firmly fixed so as to prevent any movement that results from contraction REHAB THETA PHYSIO 2 SAFETY INFORMATION Warning IN Extreme caution should be taken when in use around small children and babies Sufficient distance to the device and its accessories is mandatory for their safety Never leave the device unattended when it is switched on After use store the device in a safe place to avoid other people not informed to use the device This device is not a toy but a medical device Misunderstanding its use can cause damage Warning Shock hazard Strictly observe the following warnings Failure to do so could endanger the lives of the patient the user and other persons involved Note Before use allow the Rehab Theta Physio to reach room temperature If the unit has been tran
132. e pectoralis major muscle 16 11 4 3 Electrode position Two channels are used to stimulate the abductor muscles of the arm One channel for the deltoid and the other for the supraspinatus e A small electrode is placed on the lateral aspect of the shoulder in the middle of the deltoid muscle another small electrode is placed on the outer part of the supraspinatous fossa For optimum effectiveness the positive pole should preferably be positioned on the small electrodes which correspond to motor points The negatives poles are connected to the two outputs of a large electrode placed on the acromion like an epaulette If there is painful irradiation towards the hand and forearm TENS stimulation is available on channels 3 and 4 For TENS two large electrodes are used for each channel positioned to cover or follow the painful area or irradiation 16 11 4 4 Patient position The patient is seated beside a table with his her elbow and forearm resting on a cushion on the table 254 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 11 4 5 Stimulation energy The energy is gradually increased for each contraction until the maximum tolerable energy level is reached The therapist plays a fundamental role in encouraging and reassuring the patient who can then tolerate levels of energy that produce powerful contractions If the TENS programme is used on channels 3 and 4 the energy will be ad
133. e relationship between the intensity of the current and the time period in V which it must be applied to achieve stimulation Fig 3 J 75 REHAB THETA PHYSIO 14 ELECTROTHERAPY THEORY C Intensity duration curve 2Rh Rheobase S ET E Hyperbolic relationship between the current intensity and pulse duration demonstrated by Lapicque and given by the formula q t i derived from Weiss fundamental formula Fig 3 Lapicque s development also shows that even when the length of time that the current is applied is infinite the current must have a minimum intensity known as the rheobase Rh in order to produce stimulation if t co therefore q t O in this case is the rheobase Rh Rh i The rheobase which is the minimum intensity that must be achieved in order to produce stimulation even if the pulse duration is very long actually corresponds to the coefficient i of the Weiss formula which has dimensions of electrical intensity Lapicque gave the name chronaxy to the minimum length of time in which a current with double the intensity of the rheobase must be applied in order achieve stimulation In fact he realised that the chronaxy is a time constant which characterises the excitability of tissue and that its value is the ratio q i P This means that UN since Rh i when 2 Rh therefore 2i and t is the chronaxy t ch when 2Rh th
134. e to consult the number of contractions and total contraction time To access the screen simply hold down the i button Contraction time 2 CONTRACTION INFOS 2124 3 TOT TIME 42sec NUMBER 7 LI EIE Number of contractions Fig 15 43 REHAB THETA PHYSIO 6 TREATMENT OPTIONS 6 4 How to use the Motor Point Pen The Motor Point Pen supports in locating the optimal electrode position for the mucle stimulation e g locating the motor point of the vastus medialis of the quadriceps Background Muscular electrostimulation programmes are programmes which subject the muscles to work The progress achieved depends on the kind of work to which the muscles are subjected that is to say the programme chosen The electrical pulses generated by these programmes are transmitted to the muscles via the motor nerve through self adhesive electrodes The positioning of the electrodes is one of the determining factors in ensuring a comfortable electrostimulation session It is therefore essential to devote special care to this aspect The correct placement of the electrodes and the use of significant energy allow a large number of muscle fibres to work The greater the energy the greater the spatial recruitment that is to say the number of fibres working and therefore the greater the number of fibres that make progress The motor point The motor point is a point where the motor nerve enters the muscle which is an ex
135. e treatment of which is one of the primary objectives of the rehabilitation therapist However during the first 3 4 months of quadriceps rehabilitation there must be no open kinetic chain exercises due to the anterior drawer component of the tibia which can endanger the tendon graft during the avascularisation phase The method described in this chapter is intended to describe an NMES protocol suitable for this particular problem of ACL ligamentoplasty avoiding any risk of a secondary lesion to tissue This safety is ensured by using specific ACL programmes that consist of appropriate sequential stimulation of the quadriceps and hamstrings Note This particular stimulation mode does not allow for work with mi ACTION For ligamentoplasty using the patellar tendon as the graft the NMES can be started promptly When using doubled semitendinosus and gracilis tendons for ligamentoplasty NMES must not be used before the standard healing period of these tendons 208 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 6 1 Protocol Weeks 1 16 ACL During the first two weeks of treatment the following 3 objectives must be worked towards and achieved Eliminate muscle wastage Familiarise the patient with the NMES technique so that the patient can work with high levels of stimulation energy Obtain the first signs of regaining trophicity slight increase in volume improvement in tone etc
136. e wastage Familiarise the patient with the NMES technique so that the patient can work with high levels of stimulation energy Obtain the first signs of regain of trophicity slight increase in volume improvement in tone Weeks 6 Disuse atrophy Level 2 The objective is the restoration of near normal muscle volume Weeks 7 8 Reinforcement Level 1 The objective is to develop the maximum strength the muscle or muscle group can produce 16 2 2 Treatment frequency One to two sessions every day if two sessions are carried out every day enough time must be given to rest between the two sessions Minimum three sessions per week 196 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 2 3 Electrode position During neurostimulation for motor stimulation purposes the general rule is to position a small electrode on the motor point of the muscle and the other electrode at one end of the same muscle For optimum effectiveness the positive electrode should preferably be positioned on the motor point The precise location of the motor point s is easy to ascertain by following the instructions for the indication Locating a motor point in this manual This step ensures that the electrodes will be positioned to provide optimum comfort to the patient and optimum effectiveness of the therapy 16 2 4 Patient position The stimulation of a muscle when it is at its maximum inner rang
137. e widths equivalent to the PULSE WIDTH chronaxies of the motor nerves of the abdominal and lumbar muscles The mi SCAN function can be used to determine the pulse widths suitable for the patient s muscles Electrodes positioned depending on the muscle to be stimulated in accordance with ELECTRODES the instructions The maximum tolerable stimulation energy which is one of the key factors determining MERE the effectiveness of the treatment The higher the stimulation energy the higher the number of muscle fibres motor units being used Progressively increase the level of energy during the course of a treatment session OPTION 2 2 Yes 141 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS NEURO REHAB SLOW START LEVEL 1 20 MIN FINAL RECOVERY RAMP DOWN WARM UP CONTRACTION REST PHASE FREQUENCY 6 Hz 35 Hz 3 Hz DURATION OF T T RAMP UP gt 4 5 DURATION OF r TT a PHASE gt gt 3 DURATION OF M RAMP DOWN 3 NEURO REHAB SLOW START LEVEL 2 20 MIN FINAL RECOVERY WARM UP CONTRACTION REST PHASE FREQUENCY 6 Hz 45 Hz iHz DURATION OF n RAMP UP B B DURATION OF 2 min 5S 15 S 3 min PHASE DURATION OF 2S 2S 35 142 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS 15 2 5 PAIN RELIEF II CATEGORY PAIN RELIEF II PROGRAM TENS 80Hz Gate control which is activated during TENS stimulation
138. eans of pump P the stimulator current generator The flow of water corresponds to the intensity of the stimulation current and the water moved from A to B to the quantity of electrical charges The water level in tank B reaches a certain level representing the value of the membrane potential Vo at rest and V local potential The stimulation threshold is given by a point D on float C Stimulation occurs when level V in the tank B reaches point D by submerging the float When pump P injects liquid from A to B therefore increasing level V part of the liquid goes back to A through tap K representing the excitation constant k In the tank B float C is linked to piston E that works by means of the level of liquid in tank F This is linked to B by tap L representing the accommodation constant A 89 REHAB THETA PHYSIO 14 ELECTROTHERAPY THEORY TWO EXAMPLES A Currents of long duration and low intensity In order that level V reaches threshold D a certain volume of water is necessary likened to a certain quantity of electrical charges If this water is supplied slowly by the pump current of long duration and low intensity some of the water has time to go through L and raise piston E therefore increasing the threshold level accommodation The quantity of liquid the current will therefore have to be greater because level V has to reach point D higher up Moreover a large amount of liquid returns from Bto A through tap K It is eas
139. ecommended environment Immunity Test level Observance Electromagnetic environment test IEC 60601 level recommendations Portable and mobile RF communication devices must only be used relative to the device and its wiring at a distance which is not less than the spacing recommended and calculated using the appropriate equation for the transmitters frequency Recommended spacin Conducted BE EC d 1 2 VP 3 Vrms d 212 VP 80 MHz to 800 MHZ 61000 4 6 150 kHz to 80 MHz 3 Vrms d 2 3 VP 800 MHZ to 2 5 GHz where P is the maximum output power of the transmitter Radiated RE 3 V M 3 V M in watts W set by the manufacturer s specifications and IEC 80 MHz to where d is the recommended spacing in metres m 2 5 GHZ The field intensity of RF fixed transmitters as determined 61000 4 3 by an electromagnetic survey a must be less than the observance level to be found in each frequency range Interference may occur close to any appliance identified by the following symbol NOTE 1 At 80 MHz and at 800 MHz the high frequency amplitude is applied NOTE 2 These guidelines may not be appropriate for some situations Electromagnetic wave propagation is modified by absorption and reflection due to buildings objects and persons a The field intensity from fixed transmitters such as radio telephone base stations cellular wireless and a mobile radio amateur radios AM and FM radio transmissions and TV transm
140. ecovery plus 169 Lumbago 151 Toning massage 170 Epicondylitis 152 Relaxing massage 171 Torticollis 153 Anti stress massage 172 Arthralgia 154 120 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS 15 2 1 REHABILITATION II CATEGORY REHABILITATION II PROGRAM HIP PROSTHESIS Except where there are complications as soon as possible following the surgical i implantation of a total hip replacement A To restore the muscular qualities of the gluteus medius and gluteus maximus muscles to recover stability when standing on one foot and to prevent limping The three levels of the programme correspond to the Disuse atrophy level 1 and 2 and HOW Reinforcement level 1 programmes for which the low frequencies have been removed SO as not to cause vibration in the prosthesis To make it as comfortable as possible for the patient use pulse widths equivalent to the PULSE WIDTH chronaxies of the motor nerves of the gluteal muscles The mi SCAN function can be used to determine the pulse widths suitable for the patient s muscles ELECTRODES _ Electrodes positioned on the gluteal muscles must correspond to the specific indication The maximum tolerable stimulation energy which is one of the key factors determining the effectiveness of the treatment The higher the stimulation energy the higher the number of muscle fibres motor units being used Progressively increase the level of
141. ectrostimulation programme are different depending on whether there is or is not an oedema associated with varicose veins 16 12 1 Venous insufficiency without oedema On one hand electrical stimulation must allow for an increase in the general blood flow arterial as well as venous so as to improve the circulation of the interstitial fluid and increase oxygenation of the tissues and the intima of the veins On the other hand it is necessary to drain the veins as much as possible to combat stasis The increase in arterial flow and therefore capillary flow and therefore venous flow is achieved by means of the optimum low frequency for increase of flow i e 8 Hz The deep veins are drained by being compressed which is caused by tetanic contractions of the leg muscles The programme therefore consists of short tetanic contractions of the leg muscles separated by long active pauses to increase the flow 16 12 1 1 Protocol Venous insufficiency 1 256 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 12 1 2 Treatment frequency 3to 6 sessions per week for approximately 6 weeks to treat the acute episode It is then recommended to keep up treatment with few weekly sessions 16 12 1 3 Electrode position Two channels are required for each leg A small electrode is placed just under the head of the fibula on the common peroneal nerve and another small electrode in the upper part of the pop
142. ed with the solution of ionized medicine and the inactive electrode has to be soaked with a conductive substance of the therapist s choice a conducting gel physiological liquid or simply tap water d Attaching the electrodes 1 Place the active electrode on the area to be treated If the area to be treated is painful ind the chosen pain point by palpation and centre the active electrode on that point ATTENTION Avoid placing the active electrode over scarred areas Unless the lontophoresis treatment is intended to soften a scar or improve a keloid avoid placing the active electrode on an area of skin with scarring 184 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS ATTENTION Do not place electrodes over skin wounds however slight Apart from special forms of lontophoresis treatment such as antibiotic therapy for instance only place the electrodes over healthy intact skin with no lesions however slight 2 When attaching the electrodes it is important to make sure that their entire surface area is applied to the skin Just applying a strap passing through the centre of the electrode and leaving the outer edges unattached is inadmissible Use the widest possible strap use several straps or several turns of the same strap or even use adhesive tape to fix the sides of the electrodes properly ATTENTION Make sure there is never any contact between a metal component and the skin If the connector of an electrode comes into c
143. eing used OPTION 2 2 Yes POTENTIATION 3 MIN FINAL RECOVERY WARM UP CONTRACTION ACTIVE REST PHASE FREQUENCY 1Hz 7 peaks 1Hz 1Hz DURATION OF 155 os OS 1 55 RAMP UP DURATION OF 30S 78 105 205 PHASE DURATION OF 25 OS OS 35 RAMP DOWN Contraction peak Hz 1 2 10 2 2 15 3 2 20 4 2 25 5 2 35 6 2 45 7 2 55 8 2 65 9 2 75 156 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY CONDITIONING II PROGRAM ENDURANCE WaN For athletes who wish to improve their performance during long sporting trials disciplines dnas To improve the oxidative capacity of the stimulated muscles and to aid in developing the athlete s aerobic performance To make it as comfortable as possible for the patient use pulse widths equivalent to the PULSE WIDTH chronaxies of the motor nerves of the muscles being stimulated The mi SCAN function can be used to determine the pulse widths suitable for the patient s muscles Electrodes iti tioned depending the muscle to be stimulated in accordance with the instructions The maximum tolerable stimulation energy which is one of the key factors determining INTENSITY the effectiveness of the treatment The higher the stimulation energy the higher the number of muscle fibres motor units being used OPTION 2 2 Yes 157 REHAB THETA PHYSIO 15 AVAILABLE THE
144. energy below the ideal range of treatment the stimulator prompts you to raise them again by continuously flashing signs 40 REHAB THETA PHYSIO 6 TREATMENT OPTIONS mi TENS The mi TENS function can reduce the appearance of unwanted muscular contractions e g at TENS Gate Control programs thus providing maximum comfort and efficiency Short tests are performed regularly throughout the duration of the programme A testing phase takes place systematically after each increase in stimulation intensity In order to allow its smooth progress it is essential to remain perfectly still during this time According to the test results recorded by the device the level of stimulation intensities may be slightly decreased automatically 6 1 3 Triggering of contraction mi ACTION In default set up all trigger functions are deactivated but can be activated where available mi ACTION voluntary This is a way of working in which voluntary active muscle contraction triggers an electrical stimulation Contraction by electrostimulation is perfectly controlled by voluntary triggering of muscle contraction From the perspective of maximum efficiency the mi ACTION working mode requires good muscular qualities Underperforming muscles may in some cases impede the onset of electrically induced contraction Programmes used in the mi ACTION mode have undeniable advantages They require active participation and encourage the pati
145. energy tolerated by the patient in order to obtain the greatest possible spatial recruitment The current intensity is increased regularly every 3 or 4 contractions throughout the session The therapist plays a decisive role in reassuring the patient and obliging her to work with the most powerful possible contractions INTENSITY OPTION 2 2 NO STRESS INCONTINENCE 20 MIN CONTRACTION ACTIVE REST FREQUENCY 75 Hz o Hz DURATION OF T T RAMP UP gt DURATION OF B Ta PHASE DURATION OF Tus RAMP DOWN 174 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY INCONTINENCE PROGRAM URGE INCONTINENCE WaN The bladder contracts abnormally detrusor overactivity and presses on the urine l increasing the pressure within the bladder This treatment relies on the reduction of detrusor activity by stimulation of an inhibitory wi reflex from sensory nerve endings in the perineal region The electrical parameters must therefore be created so as to excite these myelinated afferent nerve fibres at the frequency that produces optimum activation of the inhibitory reflex ELECTRODES Use of an intravaginal probe INTEN ITY Gradually increase the energies until the patient feels the stimulation Then increase the energies again to a value equal to three times that of the perception threshold OPTION 2 2 No URGE INCONTINENCE 30 MIN FREQUENCY PULSE WIDTH 5
146. enervation within the time 277 195 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 2 Disuse atrophy rehabilitation standard protocol Example disuse atrophy of the quadriceps Traumas of the locomotive system can be extremely diverse fractures sprains dislocations etc and have varied functional repercussions Despite immense progress in orthopaedic medicine it is still common practice to have a period of immobilisation of the area concerned which can be total or partial The result is always a significant reduction in the normal activity of the muscles in the traumatised region The rapid disuse atrophy which occurs reduction in the muscle volume and the muscle tissue s ability to contract can sometimes compromise the functional future of the patient The physiological mechanisms involved in the alteration of the different muscle fibres under such circumstances are well known and therefore extremely specific treatments can be proposed which can produce optimum benefits on their own This standard protocol is recommended for the majority of cases of functional disuse atrophy However this protocol can be adapted depending on the pathology the treatment objectives and the speed of the patient s recovery 16 2 1 Protocol Weeks 1 2 Disuse atrophy Level 1 During the first two weeks of treatment the following 3 objectives must be worked towards and achieved Eliminate muscl
147. ent to engage fully in his or her treatment They give the patient the free choice of triggering a contraction making the practice of electrostimulation more comfortable They ensure even more effective work as they combine voluntary exercises and electrostimulation that together allow for greater recruitment of muscle fibres They promote the restoration of the body map and motor relearning in patients with impaired neuromuscular control They allow the stimulation of stabilising muscles to be integrated during an overall functional movement 41 REHAB THETA PHYSIO 6 TREATMENT OPTIONS How it works The mi ACTION mode is active during muscle work sequences it is not operational during sequences of warm up and relaxation The first muscle contraction of the work sequence starts automatically At the end of the first contraction an active rest phase begins characterised by muscular twitches The voluntary triggering of a new contraction is only possible after a minimum rest period which varies depending on the programme As soon as the voluntary triggering of a contraction is possible the device emits a beep to inform the user Once the user hears the first sound signal composed of a beep the triggering of voluntary contraction is possible If no voluntary contraction has occurred after a certain period of time the unit will automatically pause To work properly the mi ACTION needs a good muscular twitches during t
148. er mobilisations massages and all techniques likely to cause or accentuate the pain must be ruled Out as they could potentially aggravate the RSD Few therapeutic methods meet these criteria which makes transcutaneous electrical nerve stimulation TENS the first treatment of choice available to physiotherapists for treating RSD However it is essential here to limit the stimulation to the myelinated nerve fibres of the tactile sensory system only the type fibres as these are the only fibres which have an inhibiting affect on the orthosympathetic system This is not the case for the other nerve fibres A6 B C as these activate this orthosympathetic nervous system This selective targeting of the fibres which are the most excitable nerve fibres tactile sensory system is possible if very short pulse widths s 50 Us are used i e the TENS programme 16 9 1 Protocol TENS 1 for very sensitive or hyperalgesic patients TENS 2 for all other patients 16 9 2 Treatment frequency A minimum of 20 to 40 minutes of treatment every day 228 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 9 3 Electrode position Use three channels Two channels are used with four large electrodes to cover the painful area The third channel uses small electrodes to excite the nerve path s supplying the extremity of the limb concerned Upper limb Distal RSD of the upper limb Four lar
149. er of muscle fibres motor units being used OPTION 2 2 Yes RESISTANCE LEVEL 1 27 MIN FINAL RECOVERY WARM UP CONTRACTION ACTIVE REST PHASE FREQUENCY 5 Hz 50 Hz 5 Hz 3 2 DURATION OF oe TF RAMP UP gt DURATION OF 5 min 75 75 1o min PHASE DURATION OF 25 O 75 S 0 5 5 35 RAMP DOWN 114 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS RESISTANCE LEVEL 2 28 MIN FINAL RECOVERY WARM UP CONTRACTION ACTIVE REST PHASE FREQUENCY 5 Hz 55 Hz 6 Hz 3 HZ DURATION OF T ES B 155 RAMP UP gt 5 x DURATION OF domin 5 5 DURATION OF ds ane RAMP DOWN 7 gt 3 RESISTANCE LEVEL 3 28 MIN FINAL RECOVERY WARM UP CONTRACTION ACTIVE REST PHASE FREQUENCY 5 Hz 60 Hz 7 Hz 3 Hz DURATION OF T TT usd 155 RAMP UP B DURATION OF 5 min 85 65 10 PHASE DURATION OF 2S O 75 S 0 5 5 35 RAMP DOWN 115 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY CONDITIONING I PROGRAM STRENGTH WHEN For athletes practising a discipline which requires strength and speed WHY An increase in maximum strength and muscle contraction speed To make it as comfortable as possible for the patient use pulse widths equivalent to the PULSE WIDTH of the motor nerves of the muscles being stimulated The mi
150. erefore from the equation q t i the result is 2i q tch i V therefore i q tch tch q i J 76 REHAB THETA PHYSIO 14 ELECTROTHERAPY THEORY We can note that the chronaxy can be calculated mathematically from Weiss fundamental formula as shown in Figure 4 UN gt t tch The chronaxy corresponds to the time value when 0 0 i e Q q it if Q O therefore q it O therefore it q and t q i Fig 4 14 1 2 Summary Electrical stimulation i e reducing resting potential to the stimulation threshold using an electric current is a phenomenon that fulfils a fundamental physiological law This shows us that e 1 The factor determining stimulation is the quantity of electrical A charges created by the current Stimulation must be considered in terms of the amount of current which is the product x t of the intensity times the duration of the pulse t 2 This amount of current fulfils a fundamental formula Q qtit where Q is a linear function of time Lapicque expresses this formula in another way by the intensity pulse duration ratio q t i and he deduced that a the rheobase Rh minimum intensity that must be reached in order to produce stimulation using an infinite pulse duration Rh i b the chronaxy tch minimum time in which a current with double the intensity of that of the rheobase must be applied in order to produce stimu
151. ernating current input on AC power supply Direct current output from power supply Protection class Il equipment The AC Power Supply device has double insulation Indoor use only The Gepr fte Sicherheit Tested Safety or GS mark indicates that the equipment meets German and if available European safety requirement for electrical devices Here approved by T V 23 REHAB THETA PHYSIO 3 DESCRIPTION OF THE REHAB THETA PHYSIO 3 3 Description of the device chattanooga A On Off button button This is used to Increase stimulation energies in several channels simultaneously Access the Top 5 menu showing 5 most recently used programmes Access parameters info menu for personalised programmes C buttons for 4 stimulation channels D Sockets for 4 stimulation cables E Battery charger socket F Stimulation cables Channel 1 blue Channel 2 green Channel yellow Channel red G Stimulation cable fitted with pin connector H Rechargeable battery compartment Belt clip socket Note Emergency stop function By pressing the On Off button during stimulation the device pauses 24 REHAB THETA PHYSIO 4 DEVICE SETUP 4 1 Connecting the cables The stimulator cables plug into the 4 sockets on the base of the device All 4 cables can be connected simultaneously Both the buttons and the cables are colour coded to simplify
152. ers with specific information on different muscles and allows them to adapt each stimulation session to the needs of their patients The corresponding data is transferred automatically from the sensor to the stimulator mi SENSOR This is a small sensor that links the stimulator to the electrodes It performs a key function in that it measures certain physiological characteristics of the muscle to be stimulated and transfers this data to the stimulator which in turn analyses the data and adapts its parameters accordingly This tailoring of each programme to the changing condition of the muscle clearly enhances both patient comfort and therapeutic efficacy To access the mi functions make sure that the stimulation cable fitted with the mi SENSOR is connected to the stimulator before this is turned on Do not connect the mi SENSOR cable if the stimulator is already on The mi SENSOR system may not work properly if restrained or subject to pressure in any way The mi SENSOR must be connected to an adhesive electrode at all times during a stimulation session Combination of the 2 2 function and the Mi Technology Please note that when you use the 2 2 function the Mi Scan function can still be used on channels 1 and 2 but is only available for the programs Endorphinic Reinforcement and Disuse atrophy on channels 3 and 4 The functions Mi Range Mi Tens and Mi Action can not be used in this state All Rehab Theta Physio devices are able to provi
153. es It is preferable to use soft carbon electrodes the sizes of which should be chosen so that the electrodes cover all the fibres of the muscle you need to stimulate In the Denervated programme we work in bipolar mode i e the positive and negative poles are immaterial After being coated with gel the two electrodes will be positioned crosswise on the fleshy part of the muscle therefore avoiding the tendinous parts their size will previously have been determined so that they cover the muscle fibres as much as possible They must therefore cover the full width of the muscle 279 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 15 4 6 Automatic ramp search Place the electrodes on the muscle to be stimulated and validate the choice of the Partial automatic or manual programme by pressing START The programme begins with an automatic ramp search on each stimulation channel in turn The automatic ramp search works as follows every half second 500 ms the stimulator creates a 100 ms wide pulse the ramp of which increased progressively As soon as the start of muscle response is observed press the or key located under the icon The stimulator then memorizes the slope The ramp search then begins on the following channel It is thus possible to work with 4 channels and each stimulation channel will have the ramp appropriate to the state of the stimulated muscle 16 15
154. es with loss of strength in the active stability of the hip when standing on one foot and walking In addition to active physiotherapy exercises neuromuscular electrical stimulation of the gluteus maximus and medius is a technique particularly indicated for the effective treatment of weakness in these muscles It is recommended to start treatment as soon as possible after the operation The very low frequency sequences such as the warm up active rest between tetanic contractions and final recovery phase at the end of the treatment sequences generate individualized muscle twitches producing vibration in the prosthetic material The three levels of the Hip prosthesis programme correspond respectively to the programmes Disuse atrophy Level 1 Disuse atrophy Level 2 and Reinforcement Level 1 from which the very low frequencies are removed The three levels of the Hip prosthesis programme therefore induce only tetanic contraction phases separated by complete rest phases 16 7 1 Protocol Week 1 Hip prosthesis Level 1 Weeks 2 3 Hip prosthesis Level 2 Week 4 Hip prosthesis Level 3 If the patient is experiencing associated pain symptoms TENS stimulation can be performed in addition on the other channels In this case the specific practical rules for TENS electrode placement regulation of intensity should be followed for each channel used for this purpose 16 7 2 Treatment frequency Once daily 5 days per week
155. esssscsessssesssseccssssecsssssscsessesessenseees 62 104 EPG All Sracemenr CS tale stata duse ll ah detent deena 62 Ti Technical Data Standards Guarantee 63 ma Tecnica Data RENE RTT 63 REO Irae 22 ORRRRNEERRPE A mATmK 63 111 2 Neuro Stimulation Parameters uo ccceecsesssesssesssesssssssessesssessessssessesssessesssesuscsussusssusssssessssisesseesscsussssssuessuessseasseseeesecseeseeseeeseeens 63 11 3 Denervated currents TPDVSID acct etc stain le hash li cea ee uae 64 11 1 4 Direct currents Physio device only ettet tentat tte t teta HANE 64 11 1 5 Information on electromagnetic compatibility 64 65 REHAB THETA PHYSIO CONTENTS MES SERIES e t MM M n E LU ee 65 1 3 GUALPANTOC CRRRRRRRRRRRRRRRMRMMMMMMMMMMMMMMMMMMMMMMMMMME 66 TEAM eT meter eee rx TP NE 66 NUR I c s 67 AVOUT sod ts PREMO 67 122 Electromagnetic DUREE che nc enamine ert need end ddr 68 12 3 Recommended separation 7 LESKE o g MP 71 T eiie c ILLE 72 RR nn OR En PERE
156. eurons of the spastic muscle via the reciprocal inhibition reflex This phenomenon of inhibiting a motor neurons through NMES of the antagonist muscle is clearly demonstrated by electromyography In fact Hoffmann s reflex in a muscle produced by a stimulus is reduced in amplitude when the motor nerve of the antagonist muscle is stimulated NMES is an effective technique in the treatment of spasticity not only because it reduces hypertonia but also because it allows strengthening of the antagonist muscle as well preventive curative stretching of the retraction of the spastic muscles this is much more effective than the conventional passive methods However care must be taken in the treatment of spasticity to ensure that NMES is used correctly toachieve a positive effect It is particularly necessary to avoid stimulating spastic muscle by diffusion which can occur when the electrical energy is too high It is also necessary that the antagonist muscle is tensed extremely gradually to avoid over stretching the spastic muscle and thereby increasing its spasticity This is achieved through the gradual rate of contraction specific to the Spasticity programme Another particularity of this programme is the absence of all low frequencies which can also increase spasticity by generating repeated micro stretches of the spastic muscle Spasticity mainly affects the antigravity muscles of the lower limbs and the flexor muscles of the upper limbs bu
157. f muscle tendon structures and a reduction in the range of articular movement which can lead to stiffening and misalignment of the joints Use of neuromuscular electrical stimulation NMES Starting in the neuromuscular bundles are afferent proprioceptive nerve fibres which are directly associated with the a motor neurons of the same muscle and which are indirectly associated via interneurons with the a motor neurons of the antagonist muscle Stretching a muscle therefore stimulates the afferent proprioceptive nerve fibres of the neuromuscular bundles and they monosynaptically activate the a motor neurons of the muscle being stretched myotatic stretch reflex and inhibit via an interneuron the a motor neurons of the antagonist muscle reciprocal inhibition reflex 246 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS NMES of a muscle excites not only the a motor neurons of that muscle but also and even more readily the afferent proprioceptive nerve fibres which are contained in the neuromuscular bundle of the muscle and which have a lower stimulation threshold Stimulating these activates the a motor neurons of this muscle and also inhibits the a motor neurons of the antagonist muscle reciprocal inhibition reflex It is this last action that NMES uses in the treatment of spasticity NMES of a muscle antagonist to a spastic muscle makes it possible to reduce the spasticity by inhibiting the a motor n
158. f the oedema Encourage venous blood return using a sequenced stimulation starting in the leg HOW muscles and continuing to the thigh muscles supporting the distal tetanic contraction to prevent regurgitation To make it as comfortable as possible for the patient use pulse widths equivalent to the PULSE WIDTH chronaxies of the motor nerves of the muscles being stimulated The mi SCAN function can be used to determine the pulse widths suitable for the patient s muscles ELECTRODES Electrodes positioned according to the specific indication Adjust the stimulation energy in order to produce pronounced but comfortable muscle INTENSITY contractions The stimulation energies must be greater on channels 1 and 2 than on channels 3 and 4 OPTION 2 2 No VENOUS INSUFFICIENCY 2 21 MIN 1ST CONTRACTION 2ND CONTRACTION DURATION OF PHASE 25 REST CH 1 2 CH 1 2 3 4 FREQUENCY 50 Hz 50 Hz o Hz DURATION OF RAMP UP 1 55 1 55 OS 195 DURATION OF RAMP DOWN OS OS 109 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY VASCULAR PROGRAM ARTERIAL INSUFFICIENCY 1 Arterial insufficiency in the lower limbs is conventionally divided into four clinical stages These four stages I II Ill IV depend on the approximate severity of the loss of blood WHEN flow and the tissue related consequences The arterial ins
159. f the stimulation gradually deteriorates For information on use and storage please consult the instructions found on the electrodes packaging Note Biocompatibility Those parts of the Rehab Theta Physio unit that come into contact with the patient when used as intended are designed to fulfil the biocompatibility requirements of the applicable standards 18 REHAB THETA PHYSIO 3 DESCRIPTION OF THE REHAB THETA PHYSIO 3 1 Device components and accessories Model Rehab Part number 253311 Your kit contains included in delivery QUANTITY DESCRIPTION PART NUMBER 1 Rehab device 1551000 1 Fast charger 683010 1 Battery pack 941213 1 Set of 4 pin cables 601132 1 Snap adaptor kit 6111944 1 Protecting cover 690001 Bags of small electrodes mE 5x5 cm 1 snap connection 2 bags of large electrodes A563 5x10 cm 2 snap connections 1 User manual and practical guide on CD USB 45264 1 Quick start guide warning leaflet 885932 1 Electrode placement leaflet 4526645 1 Bottle of gel 602047 1 Motor point pen 980020 1 Transportation pouch 6680033 1 Belt clip 949000 19 REHAB THETA PHYSIO 3 DESCRIPTION OF THE REHAB THETA PHYSIO Model Theta Part number 253481x Your kit contains included in delivery QUANTITY DESCRIPTION PART NUMBER 1 Theta device 1552200 1 Fast charger 683010 1 Battery pack 941213 1 Set of 4 pi
160. factor in the effectiveness of electrotherapy is the ability to cause visible INTENSITY muscle twitches The mi RANGE function can be used to determine the minimum level of energy required to produce an appropriate muscle response OPTION 2 2 Yes ANTI STRESS MASSAGE 21 MIN 1ST SEQUENCE 2ND SEQUENCE 3RD SEQUENCE Freg mod FREQUENCY 3Hz 2Hz 1Hz 1 6 Hz 2 min 1min 3OS 405 mod mod FREQUENCY q 1 HZ q 1 HZ 1 3 HZ 1 6 Hz TIME 305 305 905 305 TITH SEQUENCE 12TH SEQUENCE Freq mod 1 Hz intensit FREQUENCY q 1 HZ 1 HZ y 1 3Hz decrease TIME 905 305 305 aM These 3 sequences loop 5 times These 4 sequences loop 2 times 173 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS 15 3 Optimum Version Programs and their usage Physio device only 15 3 1Incontinence CATEGORY INCONTINENCE PROGRAM STRESS INCONTINENCE wain The sphincter urethra is deficient and cannot remain closed in the event of a sudden and significant increase in abdominal pressure exertion coughing etc The aim of this programme is to strengthen the sphincter muscle of the bladder The wiw objective is therefore to produce tetanic contractions of the paraurethral components of the striated muscle of the pelvic floor using the optimum tetanization frequencies of the fast fibres ELECTRODES Use of an intravaginal probe Use of the maximum
161. fluence not only the polarity of the ionized medicinal substance but also the charge of the pores of the skin Some medicinal substances are called amphoteric because their molecules have both an acidic and a basic function and consequently their ionization varies according to the pH of the medium In an acidic medium pH 7 the basic function fixes an H and the medicine has positive polarity whereas in a basic medium pH gt 7 the acidic function releases an H and the medicine has negative polarity The charge of the pores of the skin is also influenced by the pH when the pH is less than 3 the charge of the pores is positive and when it is greater than 4 the charge becomes negative As most solutions have a pH 4 the pores are negatively charged and a positively charged medicine interacts with the pores in the form of attraction whereas a negatively charged medicine is repelled by the pores 5 THE SOLUTION BEING PLACED ON THE CORRECT ELECTRODE The solution must be placed on the cathode or anode depending on the polarity of the ionized medicine Positively charged medicines must be placed on the positive electrode anode and negatively charged medicines on the negative electrode cathode The ionized medicine is therefore placed on the electrode of the same polarity so that it is repelled by that electrode and attracted towards the other A table in the practical section gives the charges of various medicines 6 ABSENCE OF GREASE ON TH
162. from session to session because the patients quickly get used to the technique 226 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 9 Reflex sympathetic dystrophy or Complex regional pain syndrome Reflex sympathetic dystrophy RSD is a disease that physiotherapists frequently see and which they must be able to diagnose and treat at an early stage The protocols proposed have been developed on the basis of the following publications 1 Abram S Asiddao C Reynolds A Increased Skin Temperature during Transcutaneous Electrical Stimulation Anesthesia and Analgesia 59 22 25 1980 2 Owens S Atkinson R Lees DE Thermographic Evidence of Reduced Sympathetic Tone with Transcutaneous Nerve Stimulation Anesthesiology 50 62 65 1979 3 Owens S Atkinson R Lees DE Thermographic Evidence of Reduced Sympathetic Tone with Transcutaneous Nerve Stimulation Anesthesiology 50 62 65 1979 4 Abram S Increased Sympathetic Tone Associated with Transcutaneous Electrical Stimulation Anesthesiology 45 575 577 1976 5 Meyer GA Fields HL Causalgia treated by selective large fibre stimulation of peripheral nerve Brain 9 163 168 1972 Diagnostic definition RSD is a complication which most often occurs following a trauma In most cases this trauma is to the bone or joints of the limbs The type of trauma is generally a fracture or operation but may also involve dislocations wound
163. g exercises on classic balance boards such as Freeman boards a sufficient number of times number of sessions 198 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 2 Muscle reinforcement Allows the peroneus muscles to contract with enough strength to oppose the stress applied to the ankle joint This aspect of rehabilitation consists of producing peroneus muscle contractions using electro stimulation and using programmes designed for developing explosive force Only this method is really capable of developing the strength of these muscles effectively given the impossibility of feasibly being able to carry Out active methods with this level of load 16 3 1 Protocol Treatment at an early stage e Weeks 1 2 Reinforcement Level 1 Weeks 3 4 Reinforcement Level 2 Treatment at a late stage e Weeks 1 2 Disuse atrophy Level 2 Weeks 3 4 Reinforcement Level 1 Weeks 5 6 Reinforcement Level 2 If the patient is experiencing associated pain symptoms TENS stimulation can be performed in addition on the other channels In this case the specific practical rules for TENS electrode placement regulation of intensity should be followed for each channel used for this purpose 16 3 2 Treatment frequency Three sessions per week right after the proprioceptive session or alternating one day on one day off 199 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA
164. ge electrodes are used to cover the palms and backs of the hand and fingers Two small electrodes a finger s width apart are placed as high as possible on the inner side of the arm the upper electrode is thus positioned at the level of the brachial wall of the axilla RSD of the shoulder Four large electrodes are used to cover the whole shoulder A small electrode is placed at the level of the supraclavicular cavity and another small electrode is positioned on the bony protrusion of the acromion 229 REHAB THETA PEYSIO 16 HOW USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS Lower limb Distal RSD of the lower limb Four large electrodes are used to surround the ankle and foot A small electrode is placed in the middle of the popliteal fossa another small electrode is placed similarly one finger s breadth above RSD of the knee Four large electrodes are used to cover the knee and surround the kneecap A small electrode is placed at the level of the inguinal fossa just beside the femoral artery and another small electrode is placed similarly one finger s breadth above it 16 9 4 Patient position The most comfortable position for the patient To improve the irradiation of the tingling sensation caused by neural stimulation it is recommended to exert a slight pressure on the small electrodes placed on the nerve being targeted bag of sand weighing 1 or 2 kg cushion placed
165. ginal Rehab Theta Physio shipping box 2 Turn the device and it s accessories off 3 Disconnect and dismount the device and it s accessories by following the guidelines 4 Place the accessories within the box as shown in the pictures below 5 Store the user manual in the CD pocket of the transport bag Caution Equipment damage Only use the original transport bag for carrying the device around Caution A Equipment damage Only use the original shipping box for shipping the device DJO cannot be held liable for transport samage if the device is not packed in its original shipping box 10 4 Enviromental Statement Expected Life The Rehab Theta Physio device is electronic equipment and may include substances that can damage the environment It must not be dispose of with unsorted household or municipal waste It requires separate disposal at a suitable collection point for recycling of electronic equipment By doing so you will be contributing to the safeguarding of natural resources and health Please contact DJO GLOBAL for information about the possible recycling of the product When the electrodes no longer stick well to your skin dispose of them in a receptacle out of reach of children and pets The product as well as the parts and accessories supplied with it are designed for a minimum service life of 6 years of normal usage 63 REHAB THETA PHYSIO 11 TECHNICAL DATA STANDARDS GUARANTEE PATENTS 11 1 Technical Dat
166. h is found not only in hemiplegic patients but also in most disorders of the central nervous system tetraplegia paraplegia multiple sclerosis etc The practical methods of treatment described in this chapter are based on the following reference publications 1 Wal J B Modulation of Spasticity Prolonged Suppression of a Spinal Reflex by Electrical Stimulation Science 216 203 204 1982 2 Baker L L Yeh C Wilson D Waters R L Electrical Stimulation of Wrist and Fingers for Hemiplegic Patients Physical Therapy 59 1495 1499 1979 3 Alfieri V Electrical Treatment of Spasticity Scand Rehab Med 14 177 182 4 Carnstan B Larsson L Prevec T Improvement of Gait Following Electrical Stimulation Scand J Rehab Med 9 7 13 1977 5 Waters R McNeal D Perry J Experimental Correction of Foot Drop by Electrical Stimulation of the Peroneal Nerve J Bone Joint Surg Am 57 1047 54 1975 6 Liberson WT Holmquest HJ Scot D Functional Electrotherapy Stimulation of the Peroneal Nerve Synchronized with the Swing Phase of the Gait Hemiplegic Patient Arch Phys Med Rehabil 42 101 105 1961 7 Levin MG Knott M Kabat H Relaxation of Spasticity by Electrical Stimulation of Antagonist Muscles Arch Phys Med 33 668 673 1952 The treatments discussed in this chapter are applicable through the programmes in the Neurological Rehabilitation category and some of these programmes require each contraction to be manua
167. hase 3 Continuation of the stimulation of the supraspinous and infraspinous muscles The electrodes are positioned in the same way as for phase 2 16 8 1 4 Patient position The patient is seated with the arm against his her body the forearm and the hand resting on an armrest the upper limb is placed in the reference position with neutral rotation In phases 2 and 3 and on the condition that the position remains painless the arm can gradually be placed in slight abduction not exceeding 30 16 8 1 5 Stimulation energy Phase 1 The stimulation energy must be gradually increased to obtain a clear tingling sensation Phase 2 and 3 The stimulation energy must be gradually increased to the patient s maximum sub painful threshold for the stimulation of the infraspinous and supraspinatus muscles channel 1 and until they experience a tingling sensation for the channels using TENS phase 2 in case of associated pain 217 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 8 2 Shoulder instabilities Shoulder instabilities are one of the most common pathologies and their treatment remains a difficult challenge Trauma repeated microtraumas or a constitutional laxity can compromise the stability of the shoulder either by injuring the passive structures distension or tear of the inferior glenohumeral ligament detachment of the labrum progressive stretching of the capsule etc or by disturbing
168. he active rest phase If the twitches are not significant enough the unit beeps and a sign appears on channels you must increase the stimulation energy to get good twitching Similarly in order to make these twitches possible it is imperative that the muscles are properly relaxed during the resting phase Care should be taken at the end of each contraction phase to get back into a position allowing the best muscle relaxation 42 REHAB THETA PHYSIO 6 TREATMENT OPTIONS 6 2 SKIP Function Move on to the next phase Fig 14a 14d 14e In certain programmes the skip function allows you to end the current programme phase and move on to the next one For SKIP function to work the unit must be in Pause mode Fig 14a Press the On Off button to return to the list of programmes in the category you are working with Fig 14d Use the channel 3 button to skip a particular sequence of a programme When you do this the unit will beep and the cursor under the progress bar will move to the beginning of the next sequence Fig 14e Use the channel 4 button to resume the programme at the chosen sequence NOTE The skip function is not available for all programmes It should also be noted that this function can reduce the effectiveness of a programme if used to shorten the work sequence excessively 6 3 Contractions information When working with a muscle contraction programme you can access the contraction info screen at any tim
169. he mi SCAN function ELECTRODES Electrodes must be placed after a thorough palpatory examination to locate the most painful point where a small electrode preferably connected to the positive pole of the cable will be placed The other electrode is placed at the end of muscle or muscle group being stimulated INTENSITY An essential factor in the therapeutic efficacy is to cause visible muscle twitching which may in certain cases require higher stimulation energies to be used The mi RANGE function can be used to determine the minimum level of energy required to produce an appropriate muscle response OPTION 2 2 Yes ENDORPHINIC FREQUENCY PULSE WIDTH TREATMENT TIME 5 Hz 200 US 20 min 103 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY PAIN RELIEF PROGRAM BURST The Burst programme is an type of endorphinic programme which has a less WHEN pronounced vascular effect than endorphinic It may be used in the same way to relieve pain following a chronic contracture WHY To relieve chronic muscle pain The Burst mode involves replacing the emission of an isolated electric pulse by an How emission of a very short burst of 8 pulses In this way the Burst programme emits 2 burst per second which can produce the same endorphinic results as for a standard frequency of 2 Hz PULSE WIDTH pulse width for the progr
170. he patient s muscles Electrodes iti jointly on th minal and lumbar muscles in rdance with EUECTRODES pos t oned jointly on the abdominal and lumbar muscles in accordance wit the specific indication The maximum tolerable stimulation energy on the 4 channels which is one of the key factors determining the effectiveness of the treatment The higher the stimulation energy the higher the number of muscle fibres motor units being used Progressively increase the level of energy during the course of a treatment session OPTION 2 2 NO BACK TRUNK STABILISATION 30 MIN FINAL RECOVERY WARM UP CONTRACTION ACTIVE REST PHASE FREQUENCY 6 Hz 40 Hz 4 Hz 3 HZ DURATION OF ee be T TT RAMP UP gt DURATION OF 2min 65 125 3 MIN PHASE DURATION OF 25 15 0 55 35 RAMP DOWN 1291 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY REHABILITATION II PROGRAM CARDIAC REHABILITATION WHEN In addition to the aerobic exercises suggested during cardiac rehabilitation Heart failure limits the capacity for exertion linked in part to changes in the peripheral muscles Electrostimulation allows muscle qualities to be improved in particular aerobic capacity which contributes to improving tolerance of exertion and the quality of life in patients suffering from severe cardiac failure The work regime imposed by the cardiac rehabilitation programme uses the oxidative HOW
171. his situation which is why prophylactic pelvic re training treatment by neuromuscular electrostimulation is indicated 16 14 4 1 Protocol Postpartum prevention weeks 1 3 The treatment can start 6 to 8 weeks after delivery 16 14 4 2 Treatment frequency Three times per week 16 14 4 3 Electrode position Use of an intravaginal probe 16 14 4 4 Patient position The patient reclines on her back on a couch with a cushion under the buttocks and the knees flexed at 90 feet flat on the couch 16 14 4 5 Stimulation energy It is necessary to work with the maximum tolerable energy at all times It is therefore important to regularly increase the energy level during the session every 3 or 4 contractions The therapist plays a decisive role in reassuring the patient and encouraging him her to work with the strongest possible contractions 271 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 15 Denervated muscle electrostimulation 16 15 1 Situation 1 Total denervation outside the time Example PARALYSIS OF THE AXILLARIS NERVE Questioning the patient gives us the following information e The level of the injury This is a complication of a complex fracture of the shoulder The date of the injury The accident occurred 9 months ago Question n 1 Are you outside or within the re innervation time The distance between the injury and the motor point of the deltoid can be assessed
172. hould not however lead to premature termination of treatment Indeed in order to restore the atrophic capillary network the treatment must be continued for a minimum of ten sessions or so 233 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 10 1 Endorphinic treatment of cervical pain Chronic contractures of the levator scapulae and or superior trapezius are often responsible for the painful symptoms in patients with neck pain The use of endorphinic treatment on these contractured muscles is thus the treatment of choice for this condition However it must be ensured that the stimulation energy levels are sufficient to obtain clearly visible muscle twitches leading to a marked hyperaemic effect so that the acid metabolites swamping the capillary bed of the contractured muscle can be drained away This treatment should be continued for at least ten sessions in order to restore the capillary network which is usually atrophic in chronically contractured muscles 16 10 1 1 Protocol Cervical pain 10 to 12 weeks 16 10 1 2 Treatment frequency Three to five sessions per week for two to three weeks 10 to 12 sessions in total Each session should last at least 20 minutes Ideally it may be beneficial to carry out two successive stimulation sessions with the Neck pain programme ensuring a ten minute rest period is taken between the two sessions to allow the stimulated muscles to recover 16 1
173. ic approach can be used This clinical presentation is the result of the compensatory mechanisms established during the acute phase Phase 2 Disuse atrophy Level 1 then Disuse atrophy Level 2 16 8 3 2 Treatment frequency Three to five sessions per week 221 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 8 3 3 Electrode position Phase 1 Four large electrodes are placed in such a way as to cover the whole shoulder as well as possible Phase 2 One stimulation channel for the infraspinous and supraspinous muscles One small electrode is placed on the fleshiest part of the infraspinous fossa The other small electrode is positioned on the external part of the supraspinous fossa For optimum effectiveness the positive pole should preferably be positioned on the infraspinous muscle Phases 2 16 8 3 4 Patient position Phase 1 The patient is placed in the most comfortable position for him or her Phase 2 The patient is seated with the arm against his her body the forearm and the hand resting on an armrest the upper limb is placed in the reference position with neutral rotation In phase 2 and on the condition that the position remains painless the arm can gradually be placed in slight abduction not exceeding 30 222 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 8 3 5 Stimulation energy Phase 1 The stimulatio
174. ich may appear spontaneously at rest during the WHEN night or following prolonged muscular effort These cramps can be partially due to an imbalance in the flow of blood through the muscles WHY To improve the circulatory system to prevent the occurrence of cramps This programme consists of two different phases an 8 Hz sequence to improve blood HOW flow and develop blood capillaries A 3 Hz sequence to relax muscular tonus and increase the well being of the patient To make it as comfortable as possible for the patient use pulse widths equivalent to the PULSE WIDTH chronaxies of the motor nerves of the muscles being stimulated The mi SCAN function can be used to determine the pulse widths suitable for the patient s muscles Electrodes positioned depending on the muscle to be stimulated in accordance with ELECTRODES the instructions An essential factor in the effectiveness of electrotherapy is the ability to cause visible INTENSITY muscle twitches The mi RANGE function can be used to determine the minimum level of energy required to produce an appropriate muscle response OPTION 2 2 Yes CRAMP PREVENTION 40 MIN 1ST SEQUENCE 2ND SEQUENCE FREQUENCY 8 Hz 3 Hz DURATION OF RAMP UP 1 55 1 55 DURATION OF PHASE 8 min 2min DURATION OF RAMP DOWN 1 55 1 55 1st and 2nd sequence loop 4 times 112 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY VASCULAR PROGRAM
175. ideis rnnt ea dtu encom itinere r A AE 270 16 15 Denervated muscle electrostimulation sestertia 271 1535 1 Situation t Total denervation 271 16 15 2 Situation 2 Partial denervation outside the 272 16 15 3 Situation 3 Total denervation within the 274 16 15 4 Situation 4 Partial denervation within 277 REHAB THETA PHYSIO 1 HOW TO USE THE MEDICAL EQUIPMENT INTENDED USE Note This manual is considered as accessory of the therapy unit and therefore it should accompany it at all times The specific instructions provided given here are conditions for the intended use and correct operation of the equipment as well as the safety of the patient and the operator using it Please read the entire manual carefully and section 2 in particular since information concerning several chapters is only given once before using your device 1 1 Fields of application The Rehab Theta Physio is a stimulator designed for use by health professionals to ensure electric stimulation treatments in pain management TENS neuro muscular stimulation EMS NMES The Physio device also allows Direct applications lontophoresis Hyperhidrosis Oedema and Denervated muscles stimulation The Rehab Theta Physio unit is an important supplement to medical and therapeutic treatment for use in hospitals clinics general practices a
176. ient position The patient with bare feet is placed in a standing position his weight is on the inside of the foot to combat the movement caused by the electrically induced contraction 16 15 3 Situation Total denervation within the time Example PARALYSIS OF THE RADIALIS NERVE Questioning the patient gives us the following information e The level of the injury This paralysis is the result of a fracture of the humerus The date of the injury The fracture occurred 4 months ago Question n 1 Are we outside or within the reinnervation time The distance between the injury and the motor points of the extensor muscles of the wrist and fingers can be estimated at about twenty centimetres the reinnervation time will therefore be around 7 months 9 months at most as the trauma only goes back 4 months we are within the re innervation time Question n 2 Is the denervation total or partial Testing for total or partial denervation of the extensor muscles of the wrist and fingers 16 15 3 1 Protocol 1 Disuse atrophy level 1 16 15 3 2 Electrode position Use one stimulation channel The small positive electrode is placed on the fleshy part of the epicondylus muscles a small negative electrode is placed a few centimetres below on the dorsal side of the forearm 275 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 15 3 3 Stimulation energy The energy level will be gradually incre
177. ies of the motor nerves of the abdominal and lumbar muscles The mi SCAN function can be used to determine the pulse widths suitable for the patient s muscles ELECTRODES _ Electrodes positioned according to the specific indication Use the necessary energy to effect strong contractions of the deltoid and the supraspinatus to elevate the shoulder stump whilst ensuring that this electrically induced activation does not spread to the adductor and depressor muscles of the shoulder OPTION 2 2 NO SHOULDER SUBLUXATION 25 MIN CONTRACTION REST FREQUENCY 40 Hz o Hz DURATION OF E P RAMP UP 3 DURATION OF 85 85 PHASE DURATION OF 1 55 OS RAMP DOWN 140 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY NEUROLOGICAL PROGRAM SLOW START NEURO REHABILITATION Electrostimulation is an excellent complement to traditional kinesiotherapy for WEHEN many central neurological diseases such as hemiplegia Treatment must be used in conjunction with passive mobilisation but should also preferably be combined with active movement as soon as the patient s recovery permits WHY To help facilitate motor control and motor relearning Howi The programme has a very gradual rate of tensioning followed by a long period of rest Mobilisation must be synchronised with the contraction induced by the stimulation To make it as comfortable as possible for the patient use puls
178. ies to be used The mi INTENSITY y rin 8 8 RANGE function can be used to determine the minimum level of energy required to produce an appropriate muscle response OPTION 2 2 Yes LUMBAGO FREQUENCY PULSE WIDTH TREATMENT TIME 1Hz 250 US 20 min 152 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY PAIN RELIEF II PROGRAM EPICONDYLITIS Epicondylitis is manifested by acute pain located at the point of insertion of the extensor muscles for the wrist and fingers onto the lateral epicondyle The Epicondylitis WHEN programme is used during the acute and inflammatory phase of the complaint It can also be used for localised pain at the medial epicondyle which results from functional overwork of the flexor muscles epicondylitis or medial epicondylitis WHY To relieve pain during the acute and inflammatory phase of the complaint Using the Gate control principle This involves causing high levels of tactile sensitivity HOw impulses in order to limit the input of pain impulses when they return to the posterior horn of the spinal cord For this programme the frequency is modulated 50 150 Hz to avoid habituation This programme uses very short duration impulses 50 45 suitable for the higher level PULSE WIDTH pi 8 P 5 of excitability of the sensitive AB fibres Due to the small extent of the painful area 2 small electrodes are usually sufficient to ELE
179. ifting the foot produces a spasm reflex in the muscles of the lower limb this technique should no longer be used this phenomenon is rare in hemiplegics but more common in paraplegics 2 If the spasticity of the soleus muscle is considerable to the point where satisfactory dorsiflexion cannot be achieved programmes for the treatment of spasticity in the lower limb must be used initially before resuming work on the gait with FES when spasticity of the triceps surae has been sufficiently reduced 16 11 1 1 Protocol The hemiplegic foot USE CHANNEL 1 other channels are inactive for this programme 16 11 1 2 Treatment frequency Minimum of three sessions per week the length of treatment varies greatly depending on progress 16 11 1 3 Electrode position A single channel is sufficient to stimulate the levator muscles of the foot A small electrode is placed on the motor point of the tibialis anterior For optimum effectiveness the positive pole should preferably be positioned on the lower electrode which corresponds to the motor point of the tibialis anterior 245 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 11 1 4 Stimulation energy Use the energy necessary to achieve slight dorsiflexion that is enough to prevent the foot from dropping while walking In this application there is nothing to be gained from producing a more powerful contraction that might diffuse into the antagonis
180. il remission of the symptoms generally between 5 and 10 sessions C Electrode position Use channel 1 connecting the and outputs to the large red iontophoresis electrodes then place the electrodes in the bottom of a nonmetal basin two thirds full of tap water D Patient position The patient is seated with the feet or hands immersed in the basin with the palms or soles resting on the electrodes E Stimulation intensities For these programmes the intensity increases automatically after validation or key on the fourth channel of the the desired electrical density selection 187 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS 15 3 2 3 Oedema A Introduction This chapter addresses the electrotherapeutic treatment of traumatic oedema The practical method presented has been developed on the basis of the following publications Bettany JA Fish DR Mendel FC High Voltage pulsed direct current effect on oedema formation after hyperflexion injury Arch Phys Med Rehabil 71 9 677 81 1990 Karnes JL Mendel FC Fish DR Burton HW High voltage pulsed direct current its influence on diameters of histamine dilated arterioles in hamster cheek pouches Arch Phys Med Rehabil 76 4 381 6 1995 Fish DR Mendel FC Schultz AM Gottstein Yerke LM Effect of anodal high voltage pulsed current on oedema formation in frog hind limbs Phys Ther 71 10 677 81 1991132 Taylor K Fish DR Mendel FC Burt
181. improved The protocols proposed have been developed on the basis of the following publications 1 Karavidas A Arapi SM Pyrgakis V Adamopoulos S Functional electrical stimulation of lower limbs in patients with chronic heart failure Heart Fail Rev 2010 Nov 15 6 563 79 Review 2 Banerjee P Clark A Witte K Crowe L Caulfield B Electrical stimulation of unloaded muscles causes cardiovascular exercise by increasing oxygen demand Eur J Cardiovasc Prev Rehabil 2005 12 503 508 3 Quittan M Wiesinger G Sturm B et al Improvement of thigh muscles by neuromuscular electrical stimulation in patients with refractory heart failure Am J Phys Med Rehabil 2001 80 3 206 214 4 Maillefert JF Eicher JC Walker P et al Effects of low frequency electrical stimulation of quadriceps and calf muscles in patients with chronic heart failure Cardiopulm Rehabil 1998 18 4 277 282 5 Deley G Kervio G Verges B et al Comparison of low frequency electrical myostimulation and conventional aerobic exercise training in patients with chronic heart failure Eur J Cardiovasc Prev Rehabil 2005 12 3 226 233 224 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 8 4 1 Protocol Cardiac rehabilitation 16 8 4 2 Treatment frequency Three to six sessions a week for four to eight weeks 16 8 4 3 Electrode position The quadriceps are the priority muscles due to their functional importanc
182. imulating denervated muscles It is preferable to use soft carbon electrodes the size of which should be chosen so that the electrodes can cover all the fibres of the muscle you need to stimulate In the Denervated programme we work in bipolar mode i e the positive and negative poles are immaterial After being coated with gel the two electrodes will be positioned crosswise on the fleshy part of the muscle thus avoiding the tendinous parts the size of the electrodes will have been previously determined so that they cover the muscle fibres as much as possible they must therefore cover the full width of the muscle 16 15 3 7 Stimulation intensities The maximum tolerable intensity should always be used in order to obtain the greatest spatial recruitment possible For safety reasons in the Denervated programme the maximum intensity strength is limited to 3O mA 16 15 3 8 Stimulation frequency In automatic mode the pulses are 100 ms wide and are repeated every two seconds frequency o 5 Hz The muscle fibres respond to each pulse with a single twitch 16 15 3 9 Duration and frequency The treatment lasts for 8 minutes and must be repeated 5 times a week until possible re innervation is achieved It will be abandoned as soon as the re innervation time has elapsed During rehabilitation it is desirable to test the denervated muscles regularly with the Disuse atrophy programme in order to check for the possible start of reinnervation
183. inful area e Sufficient stimulation energy to produce a clear tingling sensation Take care to properly observe the correct order of the channels LUMBOSCIATICA FREQUENCY PULSE WIDTH TREATMENT TIME 5 Hz 250 US 20 min 1531 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY PAIN RELIEF II PROGRAM LUMBAGO This type of treatment is indicated to relieve pain following acute muscle contractures WHEN in the low back region It will also reduce tension in the contracted muscles to facilitate manual handling techniques WHY To reduce muscular tension and to provide a relaxing effect Highly individualised muscular twitching that is induced by a very low frequency 1 Hz HOW has a relaxing effect To make it as comfortable as possible for the patient use pulse widths equivalent to PULSE WIDTH the chronaxies of the motor nerves of the muscles in the lumbar region The mi SCAN function can be used to determine the pulse widths suitable for the patient s muscles A small electrode preferably connected to the positive pole is placed on the most painful area of the paravertebral muscles which can be detected by palpation The ELECTRODES other electrode is placed on the same muscles 2 or 3 finger widths away from the first one An essential factor in the therapeutic efficacy is to cause visible muscle twitching which may in certain cases require higher stimulation energ
184. ing condition The cables and connectors in particular must be checked for signs of damage Damaged parts must be replaced immediately before use Stop therapy immediately if you have doubts about the device settings and or the therapy protocol Patients must be fully conscious while being instructed in the use of the therapy unit and during therapy The choice of the therapy parameters to program and of the therapy protocols to use is restricted to the responsible physician or therapist It is the physician s or therapist s decision whether or not to use the unit on a specific patient The patient must be familiar with the functions of the Rehab Theta Physio device allowing them to stop therapy if needed Patients unable to operate the emergency stop function e g paralytic patients must never be left unattended during therapy Any accessories used with Rehab Theta Physio must first be approved by the manufacturer The utmost caution is advised under the following conditions Depending on the judgement of the responsible physician the unit may only be applied under supervision and with the parameters defined by the responsible physician Otherwise the exercise may be too strenuous for the patients with 1 hypertension stage 2 ischemic heart disease and cerebrovascular diseases 2 cardiovascular diseases 3 pregnancy 4 under 16 years of age Never apply the electrodes Near the head On the front and side of th
185. ing more muscles during a session An essential factor in the effectiveness of electrotherapy is the ability to cause visible INTENSITY muscle twitches The mi RANGE function can be used to determine the minimum level of energy required to produce an appropriate muscle response OPTION 2 2 Yes RECOVERY PLUS 25 MIN 1ST SEQUENCE 2ND SEQUENCE 3RD SEQUENCE 4TH SEQUENCE FREQUENCY 2Hz 4 Hz 6 Hz 5 Hz TIME 2 min 2 min 4 min 4 min 5TH SEQUENCE 6TH SEQUENCE 7TH SEQUENCE 8TH SEQUENCE FREQUENCY 4 Hz 3 HZ 2 2 1Hz TIME 4 min 3min 3 3 min 170 REHA B THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY CONDITIONING II PROGRAM TONING MASSAGE Specific massage programme that includes some short muscle contractions This WHEN programme can supplement traditional heating or even replace it if traditional heating is difficult to use WHY Activates circulation and revives of the contractile properties of the muscles To make it as comfortable as possible for the patient use pulse widths equivalent to the PULSE WIDTH chronaxies of the motor nerves of the muscles being stimulated The mi SCAN function can be used to determine the pulse widths suitable for the patient s muscles Electrodes position nding on the m tioned depending the muscle be stimulated in accordance with the instructions Gradually increase the stimulation energy until there is clear visible muscle twitching INT
186. ions 268 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 14 3 Mixed incontinence urge and stress incontinence Many patients do not exhibit well defined urge or stress incontinence Often a mixture of the two forms is present in varying proportions it is difficult in these situations to establish which is the predominant symptom Electrical stimulation treatment is particularly advantageous in this type of incontinence particularly with Compex equipment The stimulator is able to provide combined treatment to inhibit the detrusor and strengthen urethral closure in the same session and using the same stimulation programme The sphincter urethrae is strengthened by means of tetanic contractions with the optimum fast fibre tetanization frequency Between the tetanic contractions during the resting phase a very low frequency pulse 5 Hz allows for detrusor inhibition 16 14 3 1 Protocol Mixed incontinence weeks 1 3 16 14 3 2 Treatment frequency Five times per week 16 14 3 3 Electrode position Use of an intravaginal probe 16 14 3 4 Patient position The patient reclines on her back on a couch with a cushion under the buttocks and the knees flexed at 90 feet flat on the couch 269 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 14 3 5 Stimulation energy The energy levels are set separately starting with the energy level of
187. is the ability to cause visible INTENSITY muscle twitches The mi RANGE function can be used to determine the minimum level of energy required to produce an appropriate muscle response OPTION 2 2 Yes CERVICAL PAIN LO FREQUENCY PULSE WIDTH TREATMENT TIME 5 Hz 250 15 20 min 148 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY PAIN RELIEF II PROGRAM THORACIC BACK PAIN Thoracic back pain is most commonly a result of chronic contractures of the paravertebral back muscles erector spinae and is for example due to spinal WHEN Wu osteoarthritis or postures where the spinal muscles remain tense for long periods of time WHY For pain relief and relaxation of muscle contractures Endorphin stimulation aids pain relief by increasing production of endogenous opioids HOW The associated vascular effect results in effective drainage of acidic metabolites and enables the elimination of muscular acidosis Endorphin stimulation first targets the sensitive nerve fibres which are best stimulated with a larger pulse of 200us However the vascular effect is secondary to the co activation of the motor units which have a slightly higher chronaxy that is measured at the start of the session using the mi SCAN function PULSE WIDTH ELECTRODES _ Electrodes positioned according to the specific indication An essential factor in the effectiveness of electrotherapy is the ability to cause visible INT
188. ise by a doctor always follow the positions specified on the images 5 7 Body position To determine the stimulation position to be used based on the position of the electrodes and the programme chosen please refer to the images of where the electrodes are positioned The position of the person to be stimulated depends on the muscle group that requires stimulation and on the programme chosen For programmes requiring muscle contractions tetanic contractions working the muscle isometrically is always recommended to prevent cramps and muscle soreness after the session For example when the quadriceps are stimulated the patient will be placed in a seated position with the ankles fixed with straps to prevent the knees extending For other types of programmes for example analgesic programmes which do not cause muscle contractions position the patient as comfortably as possible 32 REHAB THETA PHYSIO 5 HOW TO PERFORM A TREATMENT NEUROSTIMULATION PROGRAMS 5 8 Adjusting stimulation energies Stimulation energy settings intensity level For programmes which cause muscle contractions it is important to use the maximum stimulation energies i e always at the limit of what the patient is able to tolerate This means that in a stimulated muscle the number of fibres working depends on the stimulation energies The maximum stimulation energies must therefore be used in order to engage as many fibres as possible Below a signifi
189. issions cannot be predicted with any accuracy It may therefore be necessary to consider an analysis of the electromagnetic environment of the site to calculate the electromagnetic environment coming from fixed RF transmitters If the field intensity measured in the environment where the device is located exceeds the appropriate RF observance level above the device should be monitored to ensure it is operating properly In the event of abnormal operation new measures may then be imposed such as realignment or movement of the device b Above the frequency amplitude from 150 kHz to 80 MHz the field intensity must be 3 V m 70 REHAB THETA PHYSIO 12 EMC TABLES 12 3 Recommended separation distances RECOMMENDED SPACING BETWEEN A PORTABLE AND MOBILE COMMUNICATION DEVICE AND THE DEVICE The device is designed for use in an electromagnetic environment in which radiated RF waves are controlled The buyer or user of the device can contribute to preventing electromagnetic interference by maintaining a minimum distance between portable and mobile RF communication devices transmitters and the device according to the table of recommendations below and according to the maximum output power of the telecommunication device Maximum Spacing according to the frequency of the transmitter m transmitter 150 kHz From 80 From 800 MHZ output power to 80 MHz to 800 MHz 2 5 GHz W d 1 2 VP d 1 2 VP d 2 3 VP 0 01 0 1
190. ive humidity 75 Atmospheric pressure 700 hPa to 1 060 hPa Conditions of use Temperature O Cto 40 C Maximum relative humidity 30 to 7596 Atmospheric pressure 700 hPa to 1 060 hPa 11 2 Standards To guarantee your safety the Rehab Theta Physio has been designed manufactured and distributed in compliance with the requirements of European Directive 93 42 EEC as amended on medical devices The Rehab Theta Physio also complies with the IEC 60601 1 standard on general safety requirements for electro medical devices the IEC 60601 1 2 standard on electromagnetic compatibility and the IEC 60601 2 10 Standard on particular safety requirements for nerve and muscle stimulators Current international standards require that a warning be given concerning the application of electrodes to the thorax increased risk of cardiac fibrillation The Rehab Theta Physio also complies with Directive 2012 19 EU on waste electrical and electronic equipment WEEE 66 REHAB THETA PHYSIO 11 TECHNICAL DATA STANDARDS GUARANTEE PATENTS 11 3 Guarantee This guarantee is valid only if it is accompanied by proof of purchase Your statutory rights are not affected by this guarantee Your Rehab Theta Physio stimulator is guaranteed for a period of 3 years from the date of purchase The guarantee covers the device and the AC adaptor hardware and labour but not the cables batteries electrodes or the motor point pen All defects resulti
191. ivity and presses on the urine increasing the pressure within the bladder 2 Stress incontinence The sphincter urethrae is deficient and cannot remain closed in the event of a sudden and significant increase in abdominal pressure exertion coughing etc 3 Mixed incontinence urge and stress incontinence Combination of urge and stress incontinence in greater or lesser proportions 265 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 14 1 Urge incontinence Since this type of incontinence is due to detrusor smooth muscle of the bladder overactivity the treatment is concerned with reducing the activity of this muscle The detrusor is controlled by the parasympathetic nervous system which increases its activity and by the orthosympathetic system which reduces it Various mechanisms act to inhibit detrusor activity These include an inhibitory reflex originating in the sensitive nerve fibres of the vaginal area Excitation of these afferent fibres originating in branches of the internal pudendal nerve has a dual inhibitory effect on the detrusor 1 By activating the inhibitory orthosympathetic neurons 2 By central inhibition of activation of parasympathetic motor neurons Electrical excitation of these afferent fibres produces an optimum inhibitory effect with A frequency of 5 Hz by the orthosympathetic route A frequency of 5 to 10 Hz by the central route 16 14 1 1 Protocol
192. justed on these channels so that the patient clearly feels moving tingling However care must be taken to ensure that the energy is low enough to avoid any muscle contraction 255 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 12 Treatment of venous insufficiency Unlike occasionally experiencing heavy legs venous insufficiency is a result of organic damage to the vein walls which clinically manifests as large or small varicose veins These are the result of a permanent dilation secondary to the hyperpressure and stasis of the venous blood to which is added progressive hypoxia of the intima inner layer of the wall The deficiency of the valves of the deep veins and the perforating veins is behind this process Their role in preventing the regurgitation of venous blood is no longer guaranteed Hydrostatic pressure is accentuated and muscle contractions are no longer sufficient to evacuate the venous blood The blood stagnates and causes hyperpressure in the superficial veins until varicose distensions are produced Stasis oedema is often associated with venous insufficiency but not always Moreover this oedema may be present or absent in the same patient depending on the time of day and how much time the patient has spent standing up We must therefore distinguish between e Venous insufficiency without oedema f Venous insufficiency with oedema The implications for the type of the el
193. laced after a thorough palpatory examination to locate the most painful point where a small electrode preferably connected to the positive pole of the cable will be placed The other electrode is placed at the end of muscle or muscle ELECTRODES group being stimulated If a contracture affects all the muscle fibres the electrodes suitable for neuromuscular stimulation can also be applied please refer to the positions recommended for the muscle being stimulated An essential factor in the therapeutic efficacy is to cause visible muscle twitching which may in certain cases require higher stimulation energies to be used The mi INTENSITY y 8 8 RANGE function can be used to determine the minimum level of energy required to produce an appropriate muscle response OPTION 2 2 Yes DECONTRACTION FREQUENCY TREATMENT TIME 1Hz 20 min 106 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS 15 1 3 Program category VASCULAR CATEGORY VASCULAR PROGRAM HEAVY LEGS The problem of heavy legs occurs when venous blood return sometimes does not take place but does not cause any damage to the body Heat certain stages of the WHEN menstrual cycle prolonged standing and long continuous periods sitting down may l cause swelling stasis oedema with a considerable feeling of heaviness in the lower limbs A certain degree of muscle tension is often as
194. lation tch q i J 77 REHAB THETA PHYSIO 14 ELECTROTHERAPY THEORY 14 1 3 References 1 Physiologie Volume II Le Systeme nerveux et Muscle Charles Kayser ed Flammarion 2 Lapicque L D finition exp rimentale de l excitabilit Soc Biologie 77 1909 280 283 3 Lapicque L La Chronaxie et ses applications physiologiques Hermann amp Cie Paris 1938 4 Weiss G Sur la possibilit de rendre comparable entre eux les appareils servant l excitation lectrique 5 Arch itali Biol 35 1901 413 446 6 Irnich W The chronaxy time and its practical importance Pace 3 1980 292 301 7 Cours de Physiologie Humaine Volume I Prof Colin F Universit Libre de Bruxelles 8 Trait de Physiologie M dicale Arthur C Guyton ed Doin 9 Physiologie Humaine Philippe Meyer 2nd edition Flammarion M decine Science 14 2 The Optimum Current 14 2 1 Introduction The reminders and ideas developed in the previous chapter The fundamental law of electrostimulation must be read before starting this chapter which describes the qualities of the optimum electrostimulation current The optimum current can be defined as being able to reduce the resting potential to the stimulation threshold value under Weiss law while also keeping the patient as comfortable as possible The second requirement is met by minimising the electrical parameters of the stimulation current i e by using a minimum amount of electrical intensity
195. lation techniques since in this position the patient very often feels the contraction as being uncomfortable and even painful cramp sensation The use of high stimulation energies that ensure significant spatial recruitment can be difficult to achieve in some patients The third stimulation channel overcomes this disadvantage by optimising spatial recruitment and therefore the effectiveness of the treatment Three small electrodes are placed respectively on the motor points of the vastus medialis the vastus lateralis and the rectus femoris A large two way electrode is placed at the top of the thigh and a further small electrode is positioned just above For optimum effectiveness the positive pole should preferably be positioned on the motor point 16 5 2 4 Patient position For this indication it is recommended to carry out the session with the patient s knee extended 16 5 2 5 Stimulation energy In NMES the stimulation energy is directly responsible for spatial recruitment the higher the stimulation energy the higher the percentage of motor units recruited and the greater the impact of the progress The general rule is to always try to increase the energy to the maximum level tolerated by the patient The therapist plays a fundamental role by encouraging and reassuring the patient who can then tolerate levels of energy that produce powerful contractions The levels of energy reached must increase throughout the sessio
196. le current must obviously be used one which can reduce the resting potential to the threshold value but keep the patient as comfortable as possible In other words the electrical parameters of this current must be kept to a minimum and its stimulation energy and duration must be as low as possible i 40 B 30 Action potential 20 10 0 0 10 20 30 40 50 Threshold 60 70 Rest potential 80 C 2 P Fig 1 73 REHAB THETA PHYSIO 14 ELECTROTHERAPY THEORY We will therefore need to understand the fundamental law that it must observe in order to find the optimum qualities of this current This first chapter aims to provide a reminder and explanation of this law This is followed by a second chapter which on the basis of this fundamental law and ideas surrounding it determines the qualities of the optimum current At the turn of the last century well known physiologists such as Weiss Hoorweg Du Bois Reymond and Lapicque managed to discover the fundamental law of electrostimulation and its mathematical expression Based on Hoorweg s work Weiss a Parisian doctor and physiologist emphasised the importance of the quantity of electrical charges created by the stimulation current His experiments led to the fundamental observation that to achieve stimulation it is not the type of current that is significant but the quantity of current in a specified period of time In other words if the stimulation threshold
197. level 1 is the starting point and should be used until the therapeutic targets have been reached One of these targets is for the patient to be able to tolerate a significant amount of stimulation energy Stimulation energies should therefore be given priority in order to have a many fibres working as possible before changing the level 31 REHAB THETA PHYSIO 5 HOW TO PERFORM A TREATMENT NEUROSTIMULATION PROGRAMS 5 6 Placement of electrodes The placement of the electrodes belongs to the indication that is supposed to be treated Depending on the characteristics of the current used for each programme the electrode connected to the positive pole may benefit from a prime location that is likely to increase the efficacy of the treatment This is the case particularly for muscular electrostimulation programmes requiring strong muscular contractions for which it is recommended that the electrode with positive polarity is placed on the motor point of the muscle These recommended positions are also the optimal positions for the mi sensor system and as such should be followed closely detailed in Muscle Intelligence part Chapter 6 The choice of electrode size large or small and the correct positioning of the electrodes on the muscle group that needs to be stimulated are determining factors and are essential for stimulation to be effective As a result always use the size of the electrodes shown on the images Unless advised otherw
198. levels of energy can then be gradually increased over time For this the mi ACTION is a useful tool because it requires the patient to contract his her muscle voluntarily to initiate and or accompany the electrically induced contraction depending on the given set point 16 3 Rehabilitation of the peroneus muscles following an ankle sprain The purpose of the peroneus muscles is to maintain the stability of the talocrural joint and prevent the ankle from rotating inwards Following a sprain due to the functional disability reflex inhibition phenomena and immobilisation these muscles can undergo partial disuse atrophy a loss of proprioceptive reflexes and a considerable loss of strength Rehabilitation following such an accident must therefore focus essentially on the peroneus muscles in order to prevent recurrences To fulfil their function optimally the peroneus muscles must effectively put up resistance to brief and powerful stresses They must therefore be capable of responding with a powerful short contraction at that very moment when the stress being applied to the foot risks making the ankle tilt inwards There are therefore two main aspects of the rehabilitation of these muscles 1 The proprioceptive reflex Allows the peroneus muscles to sense the lower limb position relative to neighbouring parts and to contract at the right moment with an appropriate strength effort This aspect of rehabilitation consists of properly performin
199. liteal fossa over the tibial nerve For optimum effectiveness the positive poles should preferably be positioned on these two small electrodes The two other negative poles are connected to the two outputs of a large electrode placed on the upper part of the calf just below the popliteal fossa 16 12 1 4 Patient position The patient must be in a supine position with his her legs inclined so that gravity encourages venous return 16 12 1 5 Stimulation energy For the draining stage contraction the energy must be gradually increased until a significant and balanced contraction is being caused for all stimulated muscles For the activation stage of blood circulation the energy must be increased until clearly visible muscle twitches are obtained 257 REHAB THETA PEYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 12 2 Venous insufficiency with oedema The presence of oedema particularly when it does not go upon wakening completely changes the electrical stimulation programme Oedema is caused by blood plasma leaking through the venous membranes due to hyperpressure in the distal veins In this case it is not possible to use the low arterial flow increase frequencies because they reduce peripheral vascular resistance increase the perfusion pressure of the capillaries and risk aggravating the oedema On the other hand tetanic contractions encourage drainage of the deep veins and drainage of the
200. ll always end up atrophying and sclerosing Rehabilitation can then be solely palliative 16 15 2 Situation 2 Partial denervation outside the time Example PARALYZED SCIATIC Questioning the patient gives us the following information e The level of the injury Radicular compression L4 Ls following a discal hernia The date of the injury The patient has had a steppage gait for at least 3 years Question n 1 Are we outside or within the re innervation time The distance between the injury and the motor points of the muscles of the anteroexternal part of the leg can be estimated at 65 or 70 cm The re innervation time is therefore around 24 months here as our patient s injury goes back more than three years there is no longer any hope of reinnervation Question n 2 Is the denervation total or partial Testing for total or partial denervation of the muscles of the antero external part of the leg 16 15 2 1 Protocol 1 Disuse atrophy level 1 273 5 16 HOW USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 15 2 2 Electrode position Use one stimulation channel The small positive electrode is placed under the head of peroneous where the lateral popliteal nerve passes through The negative electrode large is placed crosswise at mid height of the outside of the leg 16 15 2 3 Results By increasing the current strength gradually an incomplete dorsal bending movement of the a
201. ll electrode is placed on the middle bundle a large two way electrode is placed on the shoulder above the acromion For optimum effectiveness the positive poles should preferably be positioned on the small electrodes For the spinal muscles a small electrode is placed on the fleshiest part of the infraspinous fossa connected to the positive pole a small electrode is positioned at the external part of the supraspinous fossa connected to the negative pole but not over the rear deltoid For optimum effectiveness the positive pole should preferably be positioned on the infraspinous muscle Phase 3 A small electrode is placed on the fleshiest part of the infraspinous fossa and The other small electrode is positioned on the external part of the supraspinous fossa For optimum effectiveness the positive pole should preferably be positioned on the infraspinous muscle Phases 2 amp 3 219 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 8 2 4 Patient position Phases 1 and 2 The first stimulation sessions are conducted on a patient seated with the upper limb in the reference position the forearm resting on an armrest In subsequent sessions the arm will gradually be placed in increasing abduction to 60 The patient s position during stimulation should prevent any stress on the scar tissue and should always remain painless Phase 3 The stimulation of the infra and s
202. lly triggered All programmes used reduce spasticity as long as they are applied correctly to the muscles antagonistic to the spastic muscles Some of these programmes are intended solely for the treatment of spasticity while others are intended to treat situations or complications specific to the hemiplegic patient namely functional neuromuscular electrical stimulation of the foot and subluxation of the shoulder 244 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 11 1 Dorsiflexion of the hemiplegic foot One of the problems in hemiplegic patients is the greater or lesser degree of difficulty that they encounter when raising the foot voluntarily or even the total inability to do so For this reason the foot drops when walking during heel strike Neuromuscular electrical stimulation NMES in the area of the flexor muscles of the foot tibialis anterior extensors of the toe allows for dorsiflexion to be achieved This NMES is functional FES if the dorsiflexion achieved is synchronised with the gait so as to stop the foot from dropping when lifted from the ground The aim of FES is to teach the hemiplegic patient to walk again by creating a functional gait pattern that the patient is then able to reproduce more easily However this method of gait rehabilitation using FES is not suitable for all hemiplegic patients Two types of case must be considered 1 If the stimulation of the muscles l
203. m the stimulation screen or the end of programme screen to access the programme parameters 7 2 Hyperhidrosis Read the chapter Hyperhidrosis in the Practical Guide to become fully familiar with this programme before using it NOTE The Hyperhidrosis programme should always be run on channel 1 with the large red lontophoresis electrodes supplied with the stimulator The Hyperhidrosis programme is in the Direct Current category of the Specific Treatment type DIRECT CURRENT IONTOFHORESIS HYFERHIDROSIS OEDEMA EN lt 12 Fig 24a 24b 24e Fig 24a Press the On Off button to return to the previous screen Fig 24b Use the channel 1 button to choose a programme Fig 24e Press the channel 4 button to confirm your choice 5 REHAB THETA PHYSIO 7 DIRECT CURRENTS PHYSIO DEVICE ONLY HYPERHIDROSIS DENSITY 21 EE mm LL Fig 25a 25 25e Fig 25a Press the On Off button to return to the previous screen Fig 25c Use the channel 2 button to change the default electrical density value Fig 25e Press the channel 4 button to confirm your choices and access a confirmation screen Use the i button to access the electrodes placement pictogram The Hyperhidrosis programme lasts for 12 minutes and can only be run on channel 1 Only use the red electrodes with this programme Other electrodes will cause current intensity calculation errors 12 1 ELECTRO
204. me ensuring however a ten minute rest period between the two sessions to allow the stimulated muscles to recover 16 10 2 3 Electrode position The points of maximum contraction are usually bilateral but not always symmetrical therefore two stimulation channels are used Two small electrodes are placed on the most painful points which can be easily located by palpatory examination of the painful area For optimum effectiveness the positive pole should preferably be positioned on the painful area Two other electrodes also small ones are placed on the top of the erector spinae muscles a few centimetres above or below the electrodes placed on the painful points depending on whether the pain radiates towards the neck or the lumbar region 236 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 10 2 4 Patient position The patient is placed in a position he she finds the most comfortable in the prone or side lying position or seated 16 10 2 5 Stimulation energy The energy must be increased gradually until it causes clearly visible muscle twitches which are required to induce hyperaemia The mi RANGE function makes it possible to work with certainty within a therapeutically effective range The stimulator prompts you to firstly increase the level of energy beep sound accompanies the flashing symbols When it detects that the muscles have started to pump the
205. med in addition on the other channels In this case the specific practical rules for TENS electrode placement regulation of intensity should be followed for each channel used for this purpose 16 11 2 2 Treatment frequency One or two 20 to 30 minute sessions per day 16 11 2 3 Electrode position Place the electrodes on the muscle antagonist to the spastic muscle to be treated The stimulation does not act on the spastic muscle but on its antagonist 248 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 11 2 4 Patient position The patient and body part being treated are positioned in such a way as to achieve the maximum range of motion In fact unlike the conventional rules for using NMES it is worthwhile for these treatments to allow for isotonic contraction of the antagonist muscle causing movement to the maximum range of motion thus causing maximum stretching of the spastic muscle Lower limb leg patient seated thigh prone position Pelvic girdle supine position Shoulder girdle patient seated arm abducted at 30 to the body elbow resting on an armrest Upper limb patient seated triceps elbow in supination Extensors of the fingers and wrist wrist in pronation 16 11 2 5 Stimulation energy Always work with an energy that is too low to produce muscle fibre stimulation in the spastic muscles The stimulation energy must however be adjusted manually so that the
206. metabolism through contractions which are of low power but very long and repeated over a long period 1 hour To make it as comfortable as possible for the patient use pulse widths equivalent to the PULSE WIDTH chronaxies of the motor nerves of the abdominal and lumbar muscles The mi SCAN function can be used to determine the pulse widths suitable for the patient s muscles Epp MEE The quadriceps muscles are a priority because of their volume and their functional importance Electrodes must be positioned according to the specific indication The maximum tolerable stimulation energy on the 4 channels which is one of the key factors determining the effectiveness of the treatment The higher the stimulation energy the higher the number of muscle fibres motor units being used Progressively increase the level of energy during the course of a treatment session OPTION 2 2 NO CARDIO TRAINING 60 MIN FINAL RECOVERY WARM UP CONTRACTION REST PHASE FREQUENCY 10 Hz DURATION OF RAMP UP DURATION OF 205 205 5 DURATION OF RAMP DOWN 130 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY REHABILITATION II PROGRAM ATROPHY MODULATED FREQUENCY WHEN Use on weakened muscles following immobilisation or restricted activity Waw The programme imposes a work regime adapted to the physiology of the type I fibres where the qualities have been altered during muscl
207. mpted to increase the stimulation energies This is the key to the success of any treatment lt lt 25 0 DISUSE ATROPHY Fig 8a 8b 8c 8 Fig 8a Press the On Off button to interrupt the programme momentarily Fig 8b cde The unit will beep and the symbols for the 4 channels will alternate between and ooo The energy level for the 4 channels is at o To start the programme you will need to increase the energy levels in the channels you are going to use To do this use the corresponding buttons The different energies reached during the contraction phase are shown by a series of black bar graphs Active rest phase energies are shown by hatched bar graphs NOTE If you want to increase the energy levels in all 4 channels simultaneously press the i button Press it twice to increase the levels in the first 3 channels and 3 times to increase the levels in the first 2 channels Interdependent channels will be highlighted in white against a black background NOTE Active rest phase stimulation energies are automatically set at 50 of contraction intensities but can be modified during the rest phase Once modified they will be totally independent of the contraction intensities NOTE If your device emits a beeping sound and the symbols under the active channels begin to flash the stimulator is suggesting you increase the level of the stimulation energies If you are working at the patient s maximum tolerance
208. n and also from session to session because the patients quickly get used to the technique With this programme the stimulation starts directly with a tetanic contraction because the warm up phase has been eliminated so as not to produce muscle twitches that are likely to cause unwanted microtraumas to the kneecap 207 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 6 ACL ligamentoplasty Ruptures of the Anterior Cruciate Ligament ACL of the knee are among the most common accidents in sports trauma Reconstructive surgery of the ACL has been subject to continuous developments in recent decades with considerable progress in particular owing to the use of arthroscopic techniques Associated with the improvement in the rehabilitation treatment of injured athletes the return time to athletic activity continues to decrease significantly and today is practically half what it was around ten years ago The return to athletic activity requires both satisfactory solidity of the tendon graft which must be capable of supporting significant mechanical stresses and more importantly good active joint stability This active joint stability requires muscles capable of opposing sometimes phenomenal stresses in the shortest time periods possible by activating the proprioceptive reflex One of the potential consequences of the operative procedure is significant disuse atrophy of the quadriceps muscles th
209. n the patient must Breathe out slowly Pull in the stomach Elongate the body along its axis The patient then returns to the starting position during the rest phase and slowly breathes in For the following two weeks The basis of the exercises stays the same combine an electrically induced contraction with breathing out pulling in the stomach and elongating the body Depending on the patient s progress the following can gradually be added to the exercises Additional movement of an upper limb lifting up an arm Additional movement of a lower limb taking one foot off the floor Quick movements of two upper limbs throwing and catching a ball etc 16 4 6 Stimulation energy In NMES the stimulation energy is directly responsible for spatial recruitment the higher the stimulation energy the higher the percentage of motor units recruited and the greater the impact of the progress The general rule is to always try to increase the energy to the maximum level tolerated by the patient The therapist plays a fundamental role by encouraging and reassuring the patient who can then tolerate levels of energy that produce powerful contractions The levels of energy reached must increase throughout the session and also from session to session because the patients quickly get used to the technique 203 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 5 Treatment of patellofemoral syn
210. n cables 601132 1 Snap adaptor kit 6111944 2 Mi cables 601160 1 Protecting cover 690001 Bags of small electrodes 2 l 42204 5x5 cm 1 snap connection 2 bags of large electrodes 2 42203 5x10 cm 2 snap connections 1 User manual and practical guide on CD USB 45264XX 1 Quick start guide warning leaflet 885932 1 Electrode placement leaflet 4526645 1 Bottle of gel 602047 1 Motor point pen 980020 1 Transportation pouch 6680033 1 Belt clip 949000 20 REHAB THETA PHYSIO 3 DESCRIPTION OF THE REHAB THETA PHYSIO Model Physio Part number 253511x Your kit contains included in delivery QUANTITY DESCRIPTION PART NUMBER 1 Physio device 1553300 1 Fast charger 683010 1 Battery pack 941213 1 Set of 4 pin cables 601132 1 Snap adaptor kit 6111944 4 Mi cables 601160 1 Protecting cover 690001 Bags of small electrodes 5x5 cm 1 snap connection E 2 bags of large electrodes 5x10 cm 2 snap connections 1 Set of ultra flexible electrode for Denervated 602110 1 Set of lontophoresis electrodes 642110 1 User manual and practical guide on CD USB 45264 1 Quick Start Guide warning leaflet 885932 1 Electrode placement leaflet 4526645 1 Bottle of gel 602047 1 Motor point pen 980020 1 Transportation case 680031 1 Belt clip 949000 21 REHAB THETA PHYSIO 3 DESCRIPTION OF THE REHA
211. n completed by applying gentle and gradual pressure 252 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 11 4 The hemiplegic shoulder Reminder One of the specific problems commonly encountered in hemiplegic patients is subluxation of the paretic or paralysed shoulder Atrophy with loss of strength which affects the abductor muscles of the arms deltoid and supraspinatus muscles results in an inability to provide satisfactory support for the head of the humerus In addition more or less pronounced spasticity of the depressor muscles of the shoulder pectoralis major and latissimus dorsi causes a downward pull on the head of the humerus which adds to the pull caused by the weight of the limb This situation commonly leads to the displacement of the head of the humerus from the glenoid cavity Radiologically it is clear that the axis of the anatomical neck of the humerus no longer passes through the centre of the glenoid cavity This is inferior subluxation This subluxated shoulder can often cause pain The pain can remain localised around the shoulder but can also radiate into the upper limb towards the hand through stretching of branches of the brachial plexus Vasomotor and trophic disorders of the hand such as those seen in algoneurodystrophy complex regional pain syndrome may be combined resulting in classic shoulder hand syndrome Use of neuromuscular electrical stimulation NMES
212. n energy must be gradually increased to obtain a clear tingling sensation Phase 2 The stimulation energy must be gradually increased to the maximum threshold the patient can tolerate 223 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 8 4 Cardiac Rehabilitation Chronic heart failure causes functional impairment associated with the intricate physiopathological mechanisms involved between the cardiac dysfunction and the peripheral changes associated with a deconditioning syndrome The skeletal muscle abnormalities are morphological and functional They include a reduction in muscle mass a reduction in slow twitch type 1 fibres and a reduction in capillary density Metabolically the muscle changes are characterised by a reduction in the density of the mitochondria and a reduction in the mitochondrial oxidative capacity Appropriate physical exercise which improves one s capacity for exertion is known to be one of the essential components in the treatment of chronic heart failure However some patients are excluded from the cardiac rehabilitation programmes due to the severity of their cardiac condition or due to co morbidities limiting the practice of physical exercise It is because of this that neuromuscular electrostimulation has been proposed as an alternative or complementary treatment to physical exercise for heart failure as it enables muscular performance and capacity for exertion to be
213. n the approximate severity of the loss of blood WHEN flow and the tissue related consequences The Arterial insufficiency 2 programme is used to treat Stage 11 At Stage III the severity of the arterial occlusion causes constant pain which occurs even at rest SUE To improve oxygen uptake by the muscles to reduce muscular pain at rest and partially restore muscular tolerance to exertion To avoid further reducing the supply of oxygen to the muscle fibres the contractions HOW remain infra tetanising 7 Hz and are separated by long periods of active rest 2 Hz in order to avoid muscular fatigue To make it as comfortable as possible for the patient use pulse widths equivalent to the PULSE WIDTH chronaxies of the motor nerves of the muscles being stimulated The mi SCAN function can be used to determine the pulse widths suitable for the patient s muscles ELECTRODES _ Electrodes positioned according to the specific indication NERY Stimulation energies must be increased as high as possible whilst still remaining comfortable for the patient OPTION 2 2 No ARTERIAL INSUFFICIENCY 2 14 MIN CONTRACTION ACTIVE REST FREQUENCY 7 Hz 2 HZ DURATION OF RAMP UP 1S 1S DURATION OF PHASE 155 155 DURATION OF RAMP DOWN 1S 1S 11 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY VASCULAR PROGRAM CRAMP PREVENTION For people suffering from cramps wh
214. n the muscle to be stimulated in accordance wit the instructions RTENSITY The stimulation energies must be adjusted successively for each muscle group to obtain joint mobility in the desired range OPTION 242 No The 2 2 function is not available in this program since all four channels are in use For 2 channel configuration channels 1 and 2 alternate Take care to properly position channel 1 on the agonist and channel 2 on the antagonist NOTE For 4 channel configuration channels 1 2 alternate with channels 3 4 Take care to properly position channels 1 and 2 on the agonist and channels 3 and 4 on the antagonist 133 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS ATROPHY 1 21 MIN SEQUENCE 1 SEQUENCE 1 SEQUENCE 2 SEQUENCE 2 AGONIST ANTAGONIST AGONIST ANTAGONIST FREQUENCY 35 Hz o Hz o Hz 35 Hz DURATION OF vers s ae 155 RAMP UP gt E DURATION OF Bs 6s Bs 6s PHASE DURATION OF ne oe EE RAMP DOWN 75 75 ATROPHY 2 21 MIN SEQUENCE 1 SEQUENCE 1 SEQUENCE 2 SEQUENCE 2 AGONIST ANTAGONIST AGONIST ANTAGONIST FREQUENCY 35 Hz o Hz o Hz 35 HZ DURATION OF 15S OS OS 15S RAMP UP DURATION OF 8s 8s 4S 8s PHASE DURATION OF 0 75 S OS OS 0 75 S RAMP DOWN 134 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS REINFORCEMENT 1 16 MIN RAMP DOWN SEQUENCE 1 SEQUENCE 1 SEQUENCE 2 S
215. nate muscle wastage can be performed with the lower limb extended with a small cushion placed under the popliteal fossa For the subsequent sessions the patient will be placed in a sitting position with the knee bent at a comfortable angle After satisfactory recovery of joint mobility the knee is ideally bent between 60 and 909 210 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 6 5 Stimulation energy As always in NMES the objective of the rehabilitation therapist is to motivate the patient to tolerate the highest possible stimulation energy level With the ACL programmes and taking into account the particular sequential stimulation mode it is not possible to adjust the energy levels of channels 3 and 4 without having previously increased levels on channels 1 and 2 This is an additional safety feature that prevents contraction of the quadriceps if it is not preceded by contraction of the hamstrings As usual a patient who tries to work with the maximum energies he she is capable of tolerating will reach higher energy levels for channels 3 and 4 quadriceps than for channels 1 and 2 hamstrings 211 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 7 Rehabilitation of the gluteal muscles following total hip replacement Orthopaedic surgery to the hip and in particular the fitting of a prosthesis results in disuse atrophy of the gluteus muscl
216. ncrease the amplitude intensity if required Stimulation is uncomfortable Amplitude intensity is too high Decrease amplitude intensity Electrodes are too close together Reposition the electrodes Electrodes must be a minimum of 2 inches apart Damaged or worn electrodes Replace Ensure proper program is being used A Refer to section 6 1 and 7 for a description of the Programs B Contact clinician if discomfort persists Stimulation is ineffective Improper electrode placement Reposition electrodes Electrodes must be a minimum of 2 inches apart Unknown Contact clinician 5o REHAB THETA PHYSIO 9 TROUBLESHOOTING Problem Possible cause Solution Stimulation only felt on one electrode Improper electrode placement A Reposition electrodes Electrodes must be a minimum of 2 inches apart B Replace electrodes Stimulation on one channel side only Electrodes a Worn or damaged b Improper placement A Replace B Reposition electrode Electrodes must be a minimum of 2 inches apart Replace Intermittent Output Intermittent program in use Some programs will seem intermittent This is expected Refer to section 6 1 for a description of the Programs Stimulation is not producing the usual sensation Settings and Electrodes positioning A Check that all the settings are correct and ensure the elec
217. nd at patient s home by a therapist 1 2 Therapy objectives The Rehab Theta Physio is a multifunctional electrotherapy unit for the post surgical and conservative treatment of muscular dysbalance as well as pain management The following therapy forms are provided by the unit TENS transkutane electrical Nervenstimulation for painmanagement NMES neuromuscular electronical stimulation also EMS FES functional electrical stimulation The Physio also provides the following functions Direct current lontophoresis Hyperidrosis Oedema Denervated muscles REHAB THETA PHYSIO 1 HOW TO USE THE MEDICAL EQUIPMENT INTENDED USE 1 3 Indications The physiotherapy unit is indicated in the treatment of most musculoskeletal injuries and diseases as well as in postoperative treatment after joint surgeries and in the treatment of several pain indications Examples As an NMES device indications are for the following conditions Retarding or preventing disuse atrophy Maintaining or increasing range of motion Re educating muscles Relaxation of muscle spasms Increasing local blood circulation As a TENS device indications are for the following conditions Symptomatic relief and management of chronic intractable pain Adjunctive treatment for post surgical and post trauma acute pain Relief of pain associated with arthritis As a pulsed current device indications are for the following conditions Re
218. ng a certain distance the shorter the distance the more severe the condition in the end this pain makes the patient stop then after a recovery period the pain lessons and the person can resume walking until the cycle starts again Stage III is characterised by constant pain including when at rest Blood flow is so reduced that the tissues constantly suffer from hypoxia with a continual presence of acid metabolites Stage IV corresponds to suffering that is so advanced that tissue necrosis with gangrene occurs This is then called critical ischaemia a condition which often leads to amputation Only Stages II and can benefit from treatment by electrostimulation Stage IV is an emergency situation and requires surgical treatment Stage is asymptomatic and the patient has no complaint 261 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 13 1 Stage Il arterial insufficiency With intermittent claudication Stage 11 the muscle fibres suffer from an oxygen shortage during physical activity The narrowed arteries cannot meet the fibres need for oxygen which increases with walking With a chronic reduction in blood flow and a lack of oxygen the capillary network degenerates and the fibres lose their oxidative power They use the little oxygen that they still receive increasingly badly Therefore the problem becomes twofold very little oxygen provided and poor use of what oxygen there
219. ng from poor quality material or workmanship are covered This guarantee does not cover damage resulting from impact accidents misuse inadequate protection against moisture immersion in water or repairs made by unauthorized personnel 11 4 Patents The Rehab Theta Physio incorporates several innovations with patents pending or already issued 67 REHAB THETA PHYSIO 12 EMC TABLES The Rehab Theta Physio needs special EMC precautions and must be installed and started according to the EMC information supplied in this manual The use of accessories sensors and cables other than those recommended by the manufacturer may result in stronger emissions or reduce the immunity of the Rehab Theta Physio The Rehab Theta Physio should not be used beside or stacked on top of any other equipment If you must use it side by side or on top of another system you should check that the Rehab Theta Physio works properly in the chosen configuration The product designation of the Rehab Theta Physio used in the text below includes all product variants 12 1 Electromagnetic emissions RECOMMENDATIONS AND DECLARATION BY THE MANUFACTURER CONCERNING ELECTROMAGNETIC EMISSIONS The device is intended for use in the electromagnetic environment specified below The customer or user of the device should ensure that it is used in this environment Emissions test Compliance Electromagnetic environment Guide The device uses RF energy only for its in
220. nk are l essential for the optimal positioning of the lumbar spine and to ensure the effective transmission of strength in any complex movement T Increase postural control of the trunk muscles May be combined with or supplement active dynamic exercises To make it as comfortable as possible for the patient use pulse widths equivalent to the PULSE WIDTH chronaxies of the motor nerves of the muscles being stimulated The mi SCAN function can be used to determine the pulse widths suitable for the patient s muscles Place the electrodes on the paravertebral E EGTBISHES paravertebral muscles of the low back region and on the abdominal muscles The maximum tolerable stimulation energy which is one of the key factors determining INTENSITY the effectiveness of the treatment The higher the stimulation energy the higher the number of muscle fibres motor units being used OPTION 2 2 Yes 168 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CORE STABILISATION LEVEL 1 33 MIN FINAL RECOVERY RAMP DOWN WARM UP CONTRACTION ACTIVE REST PHASE FREQUENCY 5 Hz 40 Hz 4 Hz 3 HZ DURATION fm mee 15 5 RAMP UP 5 E DURATION OF oe PHASE gt gt DURATION OF T e Bs 4 RAMP DOWN 75 gt 3 CORE STABILISATION LEVEL 2 35 MIN FINAL RECOVERY WARM UP CONTRACTION ACTIVE REST PHASE FREQUENCY 5 Hz 45
221. nkle can be seen as well as a hint of an eversion movement of the foot CONCLUSION Our patient has paresis of the sciatic nerve with partial denervation of the muscles of the antero external part of the leg there is no hope of re innervation for the denervated fibres PRACTICAL THERAPEUTIC APPROACH Electrostimulation of the muscles of the antero external part of the leg using Denervated programmes is of no value In fact denervated fibres with no hope of re innervation will always end up atrophying and sclerosing On the other hand it might be worthwhile to work on the innervated part of the paretic muscles by means of neurostimulation with rectangular biphasic pulses in order to achieve hypertrophy of the innervated fibres to compensate for the denervated ones compensating hypertrophy 16 15 2 4 Protocol 2 Disuse atrophy level 1 weeks 1 and 2 Disuse atrophy level 2 weeks 3 to 6 8 16 15 2 5 Electrode position Use one stimulation channel The live electrode the smallest one is placed under the head of peroneous where the lateral popliteal nerve passes through The negative electrode large is placed crosswise at mid height on the outside of the leg 274 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 15 2 6 Treatment frequency Three times a week for six to eight weeks Then maintenance of what has been achieved at a rate of one session every two weeks 16 15 2 7 Pat
222. ntil the patient feels a tingling sensation TENSY that is pronounced without being painful The mi TENS function prevents any kind of muscle contraction If the sensor detects a muscle response the stimulator automatically reduces the stimulation energy in order to stop the muscle response OPTION 2 2 Yes ARTHRALGIA FREQUENCY PULSE WIDTH MODULATION TIME TREATMENT TIME 50 150 HZ 50 US 25 20 155 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS 15 2 6 CONDITIONING CATEGORY CONDITIONING II PROGRAM POTENTIATION For optimal muscle preparation immediately before a competition The session should i be carried out 10 minutes prior to the start dv To increase the speed of contraction and increase power Reduces nervous control to attain or maintain a specified level of exertion To make it as comfortable as possible for the patient use pulse widths equivalent to the PULSE WIDTH of the motor nerves of the muscles being stimulated The mi SCAN function can be used to determine the pulse widths suitable for the patient s muscles Electrodes positioned depending on the muscle to be stimulated in accordance with ELECTRODES the instructions The maximum tolerable stimulation energy which is one of the key factors determining INTENSITY the effectiveness of the treatment The higher the stimulation energy the higher the number of muscle fibres motor units b
223. o find out the state of denervation of a muscle Biphase rectangular micro pulses lasting between 0 15 and 0 35 ms are only capable of exciting the nerves but not of directly exciting the denervated muscle fibres It is sufficient therefore to test by means of a disuse atrophy treatment If no response is observed in spite of significant current strengths the muscle can then be considered as completely denervated if on the other hand a contraction even of low intensity is achieved then the muscle is partly denervated C Practical therapeutic approach It is therefore actually easy to find out the two fundamental factors that will guide our therapeutic approach There is hope of re innervation or on the contrary denervation is final muscle is partly or totally denervated Four situations can thus arise We are OUTSIDE the re innervation time p e Denervation is total Denervation is partial We are WITHIN the re innervation time 2 Denervation is total Denervation is partial 191 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS The practical therapeutic approach must be adapted to each situation Situation 1 Total denervation outside the time Electrostimulation by means of the Denervated programmes is pointless since a muscle definitively without any innervation will always end up atrophying and sclerosing Situation 2 Partial denervation outside the time It is not possible to avoid at
224. ocess The width of the current pulse length does not change during this search In the above example the search is being performed in channel 1 Once the ramp is validated the V symbol will replace the memo symbol and where applicable the search will begin in the other channels Fig cde the buttons for the other channels remain inactive while a search is being performed 55 REHAB THETA PHYSIO 8 DENERVATED PROGRAMS PHYSIO DEVICE ONLY When all the ramps for the active channels have been calculated the programme will start automatically When you increase the stimulation intensity the pulse width will automatically be modified to maintain the appropriate initial ramp 8 1 3 Total manual Full denervation programme This programme works with rectangular pulses and allows the following parameters to be modified Pulse width Period Programme duration Fig 31a 31b 31C 31e Fig 31a Press the On Off button to return to the previous screen Fig 31b Use the channel 1 button to select the parameter you wish to edit pulse width for each channel period or programme duration 31c Use the channel 2 button to edit the value of the parameter you have selected Fig 31e Press the channel 4 button to confirm your choice and start the treatment NOTE The default values of the Total manual programme are the same as the default values of the Total automatic programme 56 REHAB THETA PHYSIO
225. oduce powerful contractions The levels of energy reached must increase throughout the session and also from session to session because the patients quickly get used to the technique 200 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 4 Rehabilitation of low back muscles Muscular insufficiency of the muscles that provide stability of the lumbar region is often the cause of common low back pain or identified as a contributing factor which increases the risk of recurrence The particular benefit of electrostimulation is three fold t enables treatment to be started at an early stage because unlike voluntary exercises the stress applied to the stabilising muscles in the lumbar region through electrostimulation is initially carried out in isometric mode which considerably reduces the mechanical stresses exerted on the vertebral and periarticular structures t enables an appropriate work regime to be created to restore the quality of the postural muscles i e the muscles that are essentially made up of type high endurance fibres t promotes motor re learning and postural control by combining synchronised electrically induced contractions of the abdominal and lumbar muscles with voluntary proprioception exercises 16 4 1 Protocol Weeks 1 2 Lumbar stabilisation Level 1 Weeks 3 4 Lumbar stabilisation Level 2 16 4 2 Treatment frequency Three to five sessions a week f
226. of charged particles electrophoresis is produced in the tissues crossed by an electric field This migration is significant provided the electric current is kept stable at an adequate intensity and for a sufficiently long time Direct current also referred to as galvanic current at a constant intensity over time enables charged particles to be mobilized through tissues If the charged particles are medicines the direct current acts as a vector allowing for the introduction and penetration of medicinal substances This technique is internationally known as iontophoresis Direct current applied via surface electrodes on part of the body sets up an electric field through the tissues that is responsible for mobilizing ionized medicines B Electrolysis Passing a direct current through an aqueous solution containing dissolved mineral salts leads to a number of reactions and changes that are referred to as electrolysis This phenomenon of electrolysis involves the chemical decomposition of certain substances in solution owing to the passing of an electric current Studying electrolysis helps to explain the reactions that occur under electrodes placed on the skin given that the skin is always in contact with an aqueous saline solution namely the product of perspiration When the two terminals of a source of electric current are immersed in a vessel containing absolutely pure water i e without any dissolved substances distilled water the
227. on HW Effect of a single 30 minute treatment of high voltage pulsed current on edema formation in frog hind limbs Phys Ther 72 1 63 8 1992 The use of interrupted direct current can reduce post traumatic oedema in 3 to 4 days Although Taylor has shown that a single 30 minute session can successfully reduce oedema the effects are short lived lasting only about 6 hours To achieve long lasting results the current must be applied 3 times daily For optimum results other methods designed to reduce oedema formation cold therapy compression bandaging elevation etc should be used between sessions The mechanisms by which interrupted direct currents act consisting of monophasic pulses are still unclear Karnes has ruled out a vasoconstrictor mechanism and the most plausible hypothesis is that the currents reduce local protein substrate density by reducing vascular membrane permeability also preventing the arrangement of protein molecules or by combining both mechanisms B Parameters Consequently it is important to A Work with monophasic rectangular pulses delivered at a continuous frequency of 120 Hz B Place one or more negative electrodes cathodes on the swelling and positive electrodes above the swelling C Set pulse duration to 150 us optimum level determined in tests D Set current intensity to 90 of the motor evoked potential MEP threshold session 0 9 MEP threshold E Ensure that each treatment lasts
228. on for the rectangular pulse Every time stimulation needs to be produced a rectangular pulse current is sent out which has the same duration as the chronaxy of the nerve structure that needs to be stimulated Repetition of stimulation is obtained by repeating the electrical impulse Whether this is with analgesic or motor stimulation electrotherapy the stimulations correspond to a series of stimulations set by streams of pulses Repeating the pulses if they are not compensated for will result in polarisation because the electrical mean is not zero Fig 7 Non compensated series of pulses The electrical mean is not zero which causes polarisation Electrical Mean Fig 7 The polarised current equates to a continuous current with a value equal to the mean intensity Applying this kind of polarised current to the skin has the same disadvantages as a galvanic current i e risk of skin burns in all cases and sometimes ionisation if there is metal osteosynthetic material To resolve the issue of polarisation the positive wave must be compensated for by a negative wave with the same quantity of electrical charge i e the same area on the graph Fig 8 The electrical mean is therefore zero the current is completely compensated for and the risks of polarisation are eliminated N Compensated rectangular pulse S1 S2 therefore the electrical mean is zero Electrical mean O Fig 8 A P
229. ontact with the skin the current will flow preferentially through that point of low impedance As this contact has a very small surface area the density of the electricity will be very high resulting in an electric burn 3 If possible place the inactive electrode at right angles to the active electrode There has been no study on how the positioning of the two electrodes in relation to each other influences the efficacy of lontophoresis treatment However the depth of penetration should logically be greater if the direction of the electric field is perpendicular to the surface of the skin rather than oblique or longitudinal e During treatment ATTENTION Do not move or remove the electrodes without stopping the treatment first Physio is programmed so that the current increases gradually at the start of the treatment and decreases gradually at the end or when the treatment is stopped This means that there can be no excitation phenomenon and the patient will never be surprised by a shock or a painful electrical discharge If by contrast the electrodes are disconnected the sudden break in the circuit may give rise to an excitation phenomenon 1 Ask the patient to move as little as possible during the treatment and not to remove the electrodes For the same reasons as in the previous point 2 Warn the patient that a pricking sensation from the electrodes is normal and harmless This is a normal effect of the galvanic current which has nothing
230. or four weeks 201 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 4 3 Electrode position Two channels are needed for the stimulation of the abdominal muscles Four large electrodes are positioned on the abdomen one above one below and one either side of the belly button For optimum effectiveness the positive pole should preferably be positioned on the upper electrode Two further channels are needed for the simultaneous stimulation of the lumbar muscles one for the right side and the other for the left side Two small electrodes are placed on the muscle body at the level of the lowest lumbar vertebrae at one finger s breadth distance from the spinous processes on both sides Two small electrodes are placed 2 finger s breadths above the body of the paravertebral muscles For optimum effectiveness the positive pole should preferably be positioned on the lower electrodes 16 4 4 Patient position For the first two weeks The patient is seated on a firm seat with the forearms resting on armrests and a straight back without leaning against the back of the chair For the following two weeks The patient is seated on a balance ball feet resting on the ground pelvis width apart 202 REHAB THETA PHYSIO 16 HOW USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 4 5 Associated exercises For the first two weeks On each contraction induced by the stimulatio
231. orces pectoralis major biceps brachii coracobrachialis triceps brachii caput longum or extrinsic forces fall contact etc Owing to the numerous advances in the fields of biomechanics physiology and physiopathology the therapeutic approach to shoulder pathologies has evolved considerably in recent years In this chapter we will discuss three pathological conditions of the shoulder for which neuromuscular electrostimulation is a preferred treatment among the established rehabilitation techniques These three conditions are 1 Rotator cuff tendinopathy 2 Shoulder instability 3 Adhesive capsulitis The protocols proposed have been developed on the basis of the following publications Flatow EL Soslowsky LJ Ateshian GA Pawluk RJ Bigliani LU Mow VC Shoulder joint anatomy and the effect of subluxations and size mismatch on patterns of glenohumeral contact Orthop Trans 15 803 1991 Harryman DT Sidles JA Clark JM McQuade KJ Gibbs TD Matsen FA Translation of the humeral head on the glenoid with passive glenohumeral motion J Bone Joint Surg 72A 1334 1990 Matsen F Lippit S Iserin A M canismes patho anatomiques de l instabilit gl no hum rale Pathoanatomical mechanisms of glenohumeral instability Expansion scientifique francaise Paris Cahier d enseignement de la SOFCOT Teaching book of the French Society of Orthopaedic Surgery pp 27 13 Gibb TD Sidles JA Harryman DT McQuade KJ Matsen
232. ortable as possible for the patient use pulse widths equivalent to the chronaxies of the motor nerves of the muscles being stimulated The mi SCAN can be used to determine the pulse widths suitable for the patient s muscles ELECTRODES INTENSITY Electrodes positioned depending on the muscle to be stimulated in accordance with the instructions Use the maximum stimulation energies The first and second sessions help the patient become accustomed to the method by gradually increasing the stimulation energy every 3 or 4 contractions In the following sessions it is important to support the patient s progress by setting targets which go beyond the energy levels reached in the previous session OPTION 2 2 Yes 92 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS DISUSE ATROPHY LEVEL 1 25 MIN FINAL RECOVERY RAMP DOWN WARM UP CONTRACTION ACTIVE REST PHASE FREQUENCY 6 Hz 35 Hz 4 Hz 3 HZ DURATION OF fs mee 155 RAMP UP 5 5 DURATION OF 2 Es gifs PHASE 7 3 DURATION OF T e Ern 4 RAMP DOWN 75 5 3 DISUSE ATROPHY LEVEL 2 25 MIN FINAL RECOVERY WARM UP CONTRACTION ACTIVE REST PHASE FREQUENCY 6 Hz 45 Hz 4 Hz 3 Hz DURATION OF p T OES 155 RAMP UP 2 Y DURATION OF 2min 6S 55 3 MIN PHASE DURATION OF 25 0 75 5 0 5 5 35 93 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY PROGR
233. orter when the current is more intense Fig 3 1 1 0 2Rh lo With lo rheobase and k excitation constant Chronaxy This relationship applies to currents that are very short compared to the accommodation constant Accommodation can be disregarded and excitation appears when V So This is why in the intensity duration relationship only the excitation constant k occurs as the duration of currents used have values close to k from 0 2 ms to 3 ms 87 REHAB THETA PHYSIO 14 ELECTROTHERAPY THEORY If the durations of current applied were longer the threshold would increase and excitation would only occur if V became equal to S In these cases the intensity duration relationship must be reconsidered as the rheobase does not keep the value Io instead it increases to a value 1 o determined by the excitation and accommodation constants The actual rheobase Io is linked to the observed rheobase I1 by the relationship di i jk 14 3 3 Excitation by a current with any shape It is possible to determine the equation for the local potential V and to calculate its value at any given point in time with any given shape of current An equation can also be determined for the development of the threshold These equations required a solid understanding of mathematics and come under the field of specialist electrophysiology This is why we believe there is no purpose in e
234. passing through the skin and tissue is minimal for duration of the stimulation current i e for a pulse duration which is found by calculating the derivative of the energy curve at the minimum energy point Fig 6 N W minimum Fig 6 ES N The derivative of W q t 2 q i 2 t R is dw dt The derivative is the slope of the tangent at any point of a curve As at the minimum energy point this slope is at zero since it is parallel to the abscissa we can therefore state that for W minimum dw dt t i R O therefore 2 2 R R t q P t q i As we have seen above R does not influence the determination of the pulse duration corresponding to the minimum energy The electrical energy passing through the skin and tissue is therefore minimum when the rectangular pulse duration is equal to q i which is in fact as we have seen in the article on the fundamental law of electrostimulation the chronaxy value Furthermore this is why at the start of the century pioneers in electrophysiology chose the chronaxy as the value that characterises tissue excitability that is independent from variations in skin resistance To reduce electrical energy to its minimum the rectangular pulse duration will therefore have to equal the chronaxy of the nerve structure that needs to be excited 82 REHAB THETA PHYSIO 14 ELECTROTHERAPY THEORY 14 2 2 5 Compensati
235. ple of a nervous disposition may experience a vasovagal reaction This is of psychological origin and is connected with a fear of the muscle stimulation as well as surprise at seeing one of their muscles contract without having intentionally contracted it themselves A vasovagal reaction causes heart to slow down and blood pressure to drop which produces a feeling weakness and a tendency towards fainting If this does occur all that is required is to stop the stimulation and for the person to lie down with the legs raised until the feeling of weakness disappears 5 to 10 minutes Never allow muscular contraction during a stimulation session to result in movement You should always stimulate isometrically this means that the extremities of the limb in which a muscle is being stimulated must be firmly fixed so as to prevent any movement that results from contraction Do not disconnect any channel during the stimulation session Do not use the stimulator while driving or operating machinery Do not apply stimulation during sleep Do not use the stimulator at altitudes of over 3 000 meters Always turn off the stimulator before moving or removing any electrodes during a session to avoid electrical shock to the patient Do not try to place electrodes on a body part not directly visible without assistance Attach the electrodes in such a way that their entire surface is in contact with the skin For obvious reasons of hygiene each p
236. r surface of the thigh 3 Spread a thin but even layer of conductive gel over the inner surface of the thigh in the position indicated for the positive electrode position the motor point area spreading the gel a few extra centimetres in all directions 4 Connect the positive pole red of the cable to the snap connection of the motorpoint pen and bring the tip of the pen in contact with the conductive gel 5 Switch on the device select the Motor point programme program category Rehabilitation and start the programme 6 Very gradually increase the energy of channel 1 until a value between 5 and 25 is reached while continuously moving the pen tip over the gel layer but without ever losing contact with the gel to avoid triggering an electrode fault message 7 As soon as you observe a muscle response in form of twitching you have located the vastus medialis motor point Visually locate this motor point and apply a small electrode that should be centred over the motor point 8 Remove the pen from the positive output and connect the positive pole of the cable to the small electrode which should be correctly centred over the motor point of the vastus medialis Warning Patient hazard patient contamination Before each use of the Motor Point Pen clean and disincect the pen expecially the tip that comes into contact with the patients skin Note While using the pen it might lose contact with the skin coated in gel even if this is
237. ral rule is to always try to increase the energy to the maximum level tolerated by the patient The therapist plays a fundamental role by encouraging and reassuring the patient who can then tolerate levels of energy that produce powerful contractions The levels of energy reached must increase throughout the session and also from session to session because the patients quickly get used to the technique With this programme the stimulation starts directly with a tetanic contraction because the warm up phase has been eliminated so as not to produce muscle twitches that are likely to cause unwanted vibrations on the prosthesis 213 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 8 Rehabilitation of the shoulder The specific properties of the shoulder joint are complex and particularly demanding at a functional level The shoulder must be capable of providing significant mobility of the upper limb whilst providing a stable base The limited congruence of the joint surfaces the humeral head within the glenoid cavity although partially compensated by the labrum exposes the joint to misalignment that the passive capsular ligament elements cannot control Neuromuscular control must constantly compensate for the deficiencies in passive stability by maintaining coordinated forces capable of opposing the unstable component resulting from intrinsic forces contraction of muscles generating translational f
238. ramme you can choose the number of channels and size of electrodes you want to use There are 3 electrode sizes red green and yellow You can also edit the default parameters Duration Electrical density recommended by DJO Global 3 DENSITY ma cme O80 TIME min e mmm c Fig 22a 22b 22c 22e Fig 22a Press the On Off button to return to the previous screen Fig 22b Use the channel 1 button to select the parameters you wish to edit channel to use density and duration of session In the above example only channel 1 green electrodes is active The electrical density is 0 05 mA and the session duration is 6 minutes Fig 22c Use the channel 2 button to choose the electrode size colour you wish to use for each channel and or to modify the default values density duration Fig 22e Press the channel 4 button to confirm your choices and access a confirmation screen 50 REHAB THETA PHYSIO 7 DIRECT CURRENTS PHYSIO DEVICE ONLY 2 CHAN ELECTRODE GREEN 4 B lt Fig 23a 23e Fig 23a Press the On Off button to return to the previous screen Fig 23e Use the channel 4 button to confirm your choices and start the programme NOTE Current intensity is automatically calculated according to the size of electrode used Electrode size is determined by colour Make sure you choose the correct colour before running the programme Press the i button fro
239. rat plasma Naunyn Schmiedebergs Arch Pharmacol 1978 303 2 171 174 2 Viru A Tendzegolskis Z Plasma endorphin species during dynamic exercise in humans Clin Physiol 1995 15 1 73 79 3 Pierce E F Eastman N W Tripathi H T Olson K G Dewey W L Plasma beta endorphin immunoreactivity response to resistance exercise J Sports Sci 1993 11 6 499 452 4 Dzampaeva E T Hearing loss correction by endogenous opioid stimulation Vestn Otorinolaringol 1998 3 13 16 5 Ulett G A Han S Han J S Electroacupuncture mechanisms and clinical application Biol Psychiatry 1998 44 2 129 138 6 Wang H H Chang Y H Liu D M Ho YJ A clinical study on physiological response in electroacupuncture analgesia and meperidine analgesia for colonoscopy Am J Chin Med 1997 25 1 13 20 7 Chen B Y Yu J Relationship between blood radioimmunoreactive beta endorphin and hand skin temperature during the electroacupuncture induction of ovulation Acupunct Electrother Res 199 16 1 2 1 5 8 Boureau F Luu M Willer J C Electroacupuncture in the treatment of pain using peripheral electrostimulation J Belge Med Phys Rehabil 1980 3 3 220 230 9 Wu Zhu J Cao X Involvement of opioid peptides of the preoptic area during electroacupuncture analgesia Acupunct Electrother Res 1995 20 1 1 6 232 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS Spinal pain
240. rior misalignment while a limitation in abduction shows misalignment in medial rotation spin Recovery of range of motion is obtained after correction of the joint misalignment which must be performed using appropriate techniques Neuromuscular control work must be focused on the coordination muscles the muscles depressing the humeral head and the lateral rotators The priority given for many years to the latissimus dorsi and pectoralis major muscles is strongly disputed today due to the medial rotation component of these muscles In fact the only muscles enabling these mechanical requirements to be satisfied are the supraspinous and infraspinous muscles which neuromotor rehabilitation including electrostimulation will focus on as a primary objective 16 8 1 1 Protocol Phase 1 TENS and Decontracture if required Phase 2 Rotator cuff Level 1 TENS in case of persistent pain Phase 3 Rotator cuff Level 2 mi ACTION mode 215 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 8 1 2 Treatment frequency Phase 1 One to several consecutive TENS sessions for the first to third initial treatments before performing the manual joint realignment techniques In case of hypertonicity of the pectoralis major muscle a session can be carried out using the Decontracture programme on the pectoralis major muscle to reduce excessive muscular tension that could impede the medial spin correction techniques
241. rogramme or return to the previous screen Fig 28 bc de Press any of the active buttons to confirm the MEP threshold Once confirmed the programme will start automatically with the optimal stimulation energy NOTE If no channels are connected the electrode error symbol will be displayed 53 REHAB THETA PHYSIO 8 DENERVATED PROGRAMS PHYSIO DEVICE ONLY Denervated programs are provided by the Physio device only The Denervated programmes are part of the Specific Treatment Do not use these programmes in the chest region Physio Denervated programmes are not contraindicated in patients with osteosynthesis devices or other metal implants Denervated programmes should only be run with 2 1 mm pin connector cables and carbon electrodes black electrodes supplied with stimulator For optimal results apply conductor gel to the electrodes before use Do not use snap connector cables or selfadhesive electrodes for Denervated programmes There are 4 types of Denervated treatments TOTAL OR PARTIAL AUTOMATIC AND TOTAL OR PARTIAL MANUAL DENERVRTED TOTAL AUTOMATIC FARTIAL AUTOMATIC TOTAL MANUAL PARTIAL MANUAL EE Fig 29a 29b 29e Fig 29a Press the On Off button to return to the previous screen Fig 29b Use the channel 1 button to choose the programme you want Fig 29e Press the channel 4 button to confirm your choice 8 1 Automatic mode The stimulator will automatically detect which channels ar
242. rophy and sclerosis of muscle fibres that are definitively denervated Stimulation of these fibres by means of the Denervated programmes is therefore not indicated here It is possible however to work on the innervated part of the muscle by means of neurostimulation rectangular biphasic micropulses in order to achieve compensatory hypertrophy of the innervated fibres Situation 3 Total denervation within the time Pending possible re innervation it is important to prevent atrophy as much as possible and limit the sclerosis phenomenon Stimulation of muscles deprived of innervation by means of wide rectangular pulses in the Denervated programmes is the preferred technique here Physio device proposes manual or automatic total denervation programs Situation 4 Partial denervation within the time It is important to try and prevent atrophy and to limit the phenomenon of sclerosis of the denervated fibres to do this it is necessary to use the triangular gradient pulses in the Denervated programmes The ramp to be used to excite specifically the denervated fibres and not the innervated fibres or the motor neurons must be determined Ramp detection is therefore essential this will be carried out by the device s automatic system with a pulse of 100 ms or better still after establishing the accommodation curve that will make it possible to choose possibly a shorter pulse duration Once the ramp has been established the device will automatically
243. s burns phlebitis infections etc RSD does not start immediately after the trauma or the operation but appears some time later In general it starts when physiotherapy begins This is why the role of the physiotherapist is vital The main sign of RSD is pain The pain is most often located at the end of the traumatised limb It is described by the patient as a burning pain The intensity of the pain is high and often disproportionate to the initial trauma It increases with stress and activity and decreases when the patient is calm and resting Mobilisation and massage accentuate it simply touching the skin may be very painful 227 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS Depending on the stage of development other signs may appear The skin becomes cold with sweating oedema and cyanosis developing in the more advanced stages The muscles in the affected area become atrophied The underlying bone develops osteoporosis Sudeck s atrophy The precise mechanism of development of RSD is not yet exactly known However it is well established that the sympathetic nervous system plays a major role Indeed vasomotor disorders associated with hyperactivity of the orthosympathetic system innervating the region concerned have been observed Treatment There are two aspects to the treatment of RSD the relief of pain and the reduction in the activity of the orthosympathetic system Howev
244. s Hyperhidrosis Oedema provided by Physio device on patients with osteosynthesis devices or other metal implants 1 5 Secondary effects Currently there is no evidence of desired or undesired secondary effects caused by electrotherapy units 10 REHAB THETA PHYSIO 2 SAFETY INFORMATION Definitions It is mandatory to read the safety statements before using the physiotherapy unit The safety statements are classified as follows Danger IN This term indicates an imminent hazard If not avoided this hazard could result in death or serious injury Warning This term indicates a hazard If not avoided this hazard can result in death or serious injury Caution This term indicates a potential hazard If not avoided this hazard can result in minor personal injury and or product property damage Safety information Danger IN Explosion hazard Rehab Theta Physio is not designed for use in areas where an explosion hazard may occur An explosion hazard may result from the use of flammable anesthetics oxygen rich environments skin cleansing agents and disinfectants REHAB THETA PHYSIO 2 SAFETY INFORMATION Warning Only authorised individuals are allowed to operate the Rehab Theta Physio Individuals are authorised after receiving training in the operation of the unit and reading this operating on manual Before using the therapy unit the operator must ascertain that it is in correct working order and operat
245. s completely full The stimulator switches off automatically as soon as you disconnect the charger 26 REHAB THETA PHYSIO 4 DEVICE SETUP 4 4 Preliminary settings 4 4 1 Language contrast volume When you start the stimulator for the first time you will need to choose the interface language you wish to use from the options screen See below for instructions on how to proceed There are a range of settings that you can adjust to suit your needs interface language display contrast backlighting volume To change any of these settings bring up the options screen by holding the On Off button on the front of the stimulator for a few seconds FRANCAIS ESPAROL ITALIANO DEUTSCH exa cmm nre Fig 2a 2b 2c ad 2e Fig 2b Use the channel 1 button to choose the language you wish to use Fig 2c Use the channel 2 button to adjust the contrast of the screen Fig 2d Use the channel 3 button to adjust the volume Fig 2e Use the channel 4 button to adjust the backlighting On Backlighting always on Off Backlighting always off Auto Backlighting activated whenever a button is pressed 2a Use the On Off button to confirm and save your choices The settings will be applied immediately REHAB THETA PHYSIO 5 HOW TO PERFORM A TREATMENT NEUROSTIMULATION PROGRAMS You are strongly advised to read the countra indications and safety measures described at the beginning of this manu
246. s for the 4 channels and if possible at a higher level on channels 1 and 2 than on channels 3 and 4 260 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 13 Treatment of arterial insufficiency in the lower limbs We will limit this chapter to insufficiency of the arteries in the lower limbs High blood pressure smoking cholesterol and diabetes are among the main causes of progressive deterioration of the arterial walls arteriosclerosis This presents as narrowing of the arteries with consequently a reduction in the blood flow in the tissues downstream of the narrowed arteries The less well irrigated tissues suffer and become hypoxic all the more so because the width of the arteries has shrunk and more intense activity requires more oxygen Arterial insufficiency in the lower limbs is conventionally divided into four clinical stages These four stages I II 111 and IV depend on the approximate severity of the loss of blood flow and the tissue related consequences Stage is asymptomatic In a clinical examination an arterial murmur can be heard which is evidence of narrowing although the patient has no complaint In Stage II the reduction in the flow causes pain in the legs when walking At rest the flow is sufficient but it cannot meet tissue requirements during physical activity the patient suffers from intermittent claudication IC This means that pain occurs after walki
247. s must be used which are as a result even less comfortable for the patient 80 REHAB THETA PHYSIO 14 ELECTROTHERAPY THEORY 14 2 2 4 Duration of rectangular electrical pulse First of all it must be specified that this is in a specific pulse duration phase Weiss law is used for stimulation pulse durations close to the excitation constants k In the case of motor neurons this means a time period ranging from 100 to 3 000 microseconds C Chronaxy 0 693 The third electrical factor which should be minimised in order to produce the most comfortable possible stimulation is electrical energy W We know that electrical energy is given by the formula W I2 t R where I is the current intensity t its pulse duration R the skin resistance ia The Weiss or Lapicque relationship states N I q t i and we can replace I by its value in the energy equation We get W q t i t R by developing W q t 2 i q t i t R q t 2 q i t R When t 2 0 W gt When t gt W gt co i The shape of this curve is given in Figure 4 Fig 4 M ET Relationship between energy and the pulse duration W minimum Variations in electrical energy depending on skin resistance W q t 2 qi PE Rn where R1 R2 R3 Fig 5 V 81 REHAB THETA PHYSIO 14 ELECTROTHERAPY THEORY The electrical energy
248. s to develop this new concept for potential users and provide anyone already working with this equipment with explanations and data that will allow them based on current knowledge and scientific work carried out to optimise the use of their stimulators 14 1 1 The fundamental law of electrostimulation Electrostimulation is a technique which involves producing action potentials in the excitable cells nerve and muscle using an electric current Nerve cell membranes have a resting potential with an average value of 70mwv as the internal face of the membrane has negative polarity compared to the external face To excite the membrane of the nervous fibre i e causing an action potential to appear at its surface the resting potential simply has to be reduced to a certain threshold value which is 50 mV on average Fig 1 Once this threshold value has been reached the membrane changes from a state of rest to a state of activity An action potential appears which then moves along the nerve fibre The nerve impulse either goes towards the muscles to instruct them to contract or returns from the surrounding areas towards the brain to relay information regarding the senses Electrostimulating the nerve fibre essentially involves reducing the membrane s resting potential to the threshold value by applying an electric current to the skin The first question is of course which stimulating current to choose Which type of current will we use A sing
249. s with an intensity equal to 90 of that of the motor threshold 189 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS 15 3 3 Denervated A Introduction In the current state of knowledge there is nothing to indicate that electrostimulation is capable of influencing the re innervation process of a partly or fully denervated muscle Electrostimulation of denervated muscle fibres however is essential insofar as it is the only really effective means of retaining a certain trophicity and limiting the sclerosis phenomenon of these fibres throughout the duration of their possible re innervation period Indeed after many months of being patient nothing is more frustrating than to find functional trouble caused by muscles that are certainly re innervated but with a sclerosis condition that prevents them from being used satisfactorily If stimulation enables the amyotrophy to be limited and sclerosis of the denervated muscle to be avoided during its re innervation period it then becomes pointless if there is any hope of re innervation for the denervated fibres The choice of form and parameters of the electrical current depend on state of denervation of the muscle is it completely or partly denervated Therefore before undertaking any electrostimulation treatment on a denervated muscle the following two questions should be answered 1 Is there any hope of re innervation In other words have the re innervation times elapsed or no
250. s working normally The main treatment phases are carried out with conventional operational frequencies for slow fibres to compensate for their tendency towards disuse atrophy PULSE WIDTH To make it as comfortable as possible for the patient use pulse widths equivalent to the chronaxies of the motor nerves of the muscles being stimulated The mi SCAN function can be used to determine the pulse widths suitable for the patient s muscles ELECTRODES Electrodes positioned depending on the muscle to be stimulated in accordance with the instructions INTENSITY Use the maximum stimulation energies The first and second sessions help the patient become accustomed to the method by gradually increasing the stimulation energy every 3 or 4 contractions In the following sessions it is important to support the patient s progress by setting targets which go beyond the energy levels reached in the previous session OPTION 2 2 Yes 96 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS PREVENTION OF DISUSE ATROPHY LEVEL 1 54 MIN FINAL RECOVERY RAMP DOWN WARM UP CONTRACTION ACTIVE REST PHASE FREQUENCY 6 Hz 30 Hz 4 Hz 3 HZ DURATION OF fs 155 15 5 RAMP UP 5 3 gt 5 DURATION OF Stain T Mon PHASE gt 4 3 DURATION OF T TM ima 4 RAMP DOWN 5 3 PREVENTION OF DISUSE ATROPHY LEVEL 2 47 MIN FINAL RECOVERY WARM UP CONTRACTION AC
251. so makes it possible to work synchronously with the associated movements 16 11 2 7 Associated actions Passive mobilisation When the severity of spasticity causes a marked imbalance between the spastic muscle and its antagonist and there is a risk of joint stiffness the therapist can complete the movement induced by stimulation using passive mobilisation or gravity assisted posture 250 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 11 3 The hemiplegic hand In hemiplegic patients the hand and wrist show paresis or even paralysis with more or less pronounced spasticity of the flexor muscles and atrophy of the extensors This highly debilitating situation can develop into retraction stiffening and misalignment if regular treatment is not initiated This specific indication is an example of using the Spasticity programme for the area most commonly affected by debilitating spasticity 16 11 3 1 Protocol Spasticity If the patient is experiencing associated pain symptoms TENS stimulation can be performed in addition on the other channels In this case the specific practical rules for TENS electrode placement regulation of intensity should be followed for each channel used for this purpose 16 11 3 2 Treatment frequency One to two 20 minute sessions per day 16 11 3 3 Electrode position A single channel is sufficient to stimulate the extensor muscles of the fingers and the wrist
252. sociated with this and female patients can experience cramps in their calves Wiw To accelerate venous blood return re oxygenate the tissues and produce a relaxing l effect During the treatment session we move progressively and automatically through a series of clearly defined frequencies requiring a large increase in the flow to allow HOW acceleration of the venous blood return 7 Hz produce an analgesic effect by increasing the production of endorphins 5 Hz and end by relaxing the muscles 3 Hz while keeping the blood flow noticeably high To make it as comfortable as possible for the patient use pulse widths equivalent to the PULSE WIDTH chronaxies of the motor nerves of the calf muscles The mi SCAN function can be used to determine the pulse widths suitable for the patient s muscles EIBETHODES A large electrode is placed transversely under the popliteal fossa and two small electrodes are positioned on the contour of the gastrocnemius muscles An essential factor in the effectiveness of electrotherapy is the ability to cause visible INTENSITY muscle twitches The mi RANGE function can be used to determine the minimum level of energy required to produce an appropriate muscle response OPTION 2 2 NO TENS 1ST SEQUENCE 2ND SEQUENCE 3RD SEQUENCE FREQUENCY 7 Hz 5 Hz 3 Hz DURATION OF RAMP UP 155 15 15 DURATION OF PHASE 7 min 7 min 7 min DURATION OF RAMP DOWN O 5S O 5 S 6s 107 REHAB THETA PHYSIO 15 AVAILABLE THERAPY P
253. sported at temperatures below o C 32 F leave it to reach at room temperature for about 2 hours until any condensation has disappeared Electrosurgical equipment or defibrillators Disconnect the electrodes from the device before using electrosurgical equipment or a defibrillator to avoid cutaneous burns from the electrodes and destroying the device Electronic surveillance equipment Do not apply stimulation near electronic surveillance equipment e g cardiac monitors ECG alarms as there is a risk they may not work properly whilst the electrical stimulation device is being used Electromagnetic radiation Do not use the stimulator in areas in which unprotected devices are used to emit electromagnetic radiation Portablecommunications equipment can interfere with the device Cancer Do not apply stimulation if you have progressive cancer or near any cancerous tumour The increased metabolism caused by certain modes of stimulation is likely to encourage cancer cells to spread Muscle shortening During the muscular contraction phase it is recommended to hold the extremities of the stimulated limbs to avoid any shortening of the muscle during contraction which could cause cramps Contralateral stimulation Do not use two terminals connected to the same channel on opposite segments of the body for example a positive terminal on the left arm and a negative terminal on the right arm REHAB THETA PHYSIO 2 SAFETY INF
254. t 2 Isthe muscle completely or partly denervated B Factors guiding the therapeutic approach 1 Are we within the re innervation times To be able to answer this question it is essential to have the following three pieces of information A The date of the injury B The degree of the injury C The rate of nerve fibre regeneration Interviewing the patient usually establishes how old the injury is and where it is located The rate of regeneration of an injured nerve is approximately 1 millimetre per day i e 3 centimetres a month The following elementary calculation gives the re innervation times Distance in cm between nerve fibre injury and the motor point of the denervated muscle Re innervation time Rate of nerve fibre regeneration 23 cm per month 190 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS 2 Total or partial denervation How can we find out if the muscle is partly or totally denervated An electromyogram examination is of course preferable but it must be recent and the results must be passed on to the physiotherapist which does not always happen in day to day practice Muscular testing is often worthwhile However with certain muscles especially if there are only very few innervated fibres left the really analytical contraction of the muscle is difficult to obtain because of the inevitable activity of the agonist muscles Nevertheless there is a simple and easily reproducible way t
255. t links the pulse duration with the amount of electricity required to produce the stimulation Understandably he called this relationship the fundamental formula Q qtit UN Q the amount of current required to reach the threshold This is also the quantity of electrical charges provided by the stimulation current as the Q value is given by the product x t of the stimulation current intensity multiplied by its application time t length of time that the current is applied which is known as the pulse duration i a coefficient determined by experiment with the same quantity as an electric current intensity q acoefficient determined by experiment with the same dimensions as a quantity of electrical charges q corresponds to the intersection of the straight line with the V y axis and may be calculated as the Q value when t is equal to zero Lapicque an electrophysiologist who is more widely known than Weiss did not actually discover a new law of electrostimulation but he performed a number of experiments which confirmed the fundamental formula He defined it differently to mathematically deduce coefficients called the rheobase and chronaxy which he gave physiological meaning Lapicque developed the fundamental formula as follows Q qtit UN or Q It I stimulation current intensity t pulse duration therefore It it by dividing the two by t Lapicque obtained qftt i which is th
256. t out of these muscles the ones most affected and the severity of spasticity vary greatly depending on the type of disorder of the cerebro spinal tract hemiplegia tetraplegia paraplegia or multiple sclerosis Moreover for the same type of disorder of the cerebro spinal tract the severity of spasticity and the muscles in which it is most apparent varies from one patient to another For these reasons each case has to be considered individually It is therefore the task of the therapist to carry out an accurate clinical evaluation of each patient in order to select the muscles on which the treatment is to be concentrated In general spasticity mainly affects the following muscles In the lower limbs triceps surae quadriceps adductors gluteus maximus 247 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS In the shoulder pectoralis major latissimus dorsi In the upper limbs biceps brachii flexors of the fingers and wrist In the treatment of spasticity NMES is applied to one or more of the following muscles depending on the patient tibialis anterior extensor of the toes lateral peroneal hamstrings tensor fascia lata deltoid supraspinatus triceps brachii extensors of the fingers and wrist 16 11 2 1 Protocol Spasticity length of treatment to be adjusted depending on progress If the patient is experiencing associated pain symptoms TENS stimulation can be perfor
257. t passing through the excitable tissue comparable to a neuron returns to its initial value Vo when the current is stopped Returning to the resting conditions does not occur instantly but gradually in the same way as discharging a capacitor The mathematical law for the return of V to its initial rest value is dV dt V Vo k 1 Where has time dimensions and is the excitation time constant The excitation time constant characterises the tendency of the local potential to return to its initial value at a particular speed when the neuron is no longer subjected to the current While the current is being passed the local potential V does not increase instantly but exponentially in the same way as the charge of a capacitor with k as the time constant This constant therefore defines the tendency of the neuron to oppose or resist the variation in potential caused by electrical charges provided by the stimulation current which is identical to the charge of a capacitor 84 REHAB THETA PHYSIO 14 ELECTROTHERAPY THEORY It must be stated that k does not depend on the shape and qualities of the stimulation current it is a feature of the neuron itself which expresses the time factor of its tendency to return the membrane potential to the resting value The critical value that the local potential V must reach to trigger excitation i e the excitation threshold So is only a constant value if the pulse duration is extremely short
258. ted The mi SCAN function can be used to determine the pulse widths suitable for the patient s muscles Electrodes ition ndi tioned depending the muscle to be stimulated in accordance with the instructions The maximum tolerable stimulation energy which is one of the key factors determining INTENSITY the effectiveness of the treatment The higher the stimulation energy the higher the number of muscle fibres motor units being used OPTION 2 2 Yes 159 REHAB THETA PHY SIO 15 AVAILABLE THERAPY PROGRAMS EXPLOSIVE STRENGTH LEVEL 1 32 MIN FINAL RECOVERY RAMP DOWN WARM UP CONTRACTION ACTIVE REST PHASE FREQUENCY 5 Hz 104 Hz 1 Hz 3 Hz DURATION OF vers oes ss 155 RAMP UP i a DURATION OF 5 PHASE gt 3 DURATION OF ies RAMP DOWN gt 3 3 EXPLOSIVE STRENGTH LEVEL 2 32 MIN FINAL RECOVERY WARM UP CONTRACTION ACTIVE REST PHASE FREQUENCY 5 Hz 108 Hz 1Hz 3 Hz DURATION OF T eves 15 5 RAMP UP ue B s DURATION OF 5 min as 295 1o min PHASE DURATION OF 25 055 0 5 5 35 RAMP DOWN EXPLOSIVE STRENGTH LEVEL 3 34 MIN FINAL RECOVERY WARM UP CONTRACTION ACTIVE REST PHASE FREQUENCY 5 Hz 11 Hz 1Hz 3 Hz DURATION OF Kee Biss 155 RAMP UP 73 9 DURATION OF 5 min 38 2275 1o min PHASE DURATION OF 25 055 0 5 5 35 160 REHAB THETA PH
259. ternal RF emissions operation Consequently its RF emissions are Group 1 CISPR n unlikely to interfere with any adjacent electrical device radios computers telephones etc RF emissions Class B CISPR 11 The device is suitable for use in any establishment Harmonic emissions other than private dwelling or a place connected IEC 61000 3 2 directly to the low voltage mains supply which Voltage fluctuations emission powers residential buildings Wear Not applicable oscillations IEC 61000 3 3 pp 68 REHAB THETA PHYSIO 12 EMC TABLES 12 2 Electromagnetic immunity RECOMMENDATIONS AND DECLARATION BY THE MANUFACTURER CONCERNING ELECTROMAGNETIC IMMUNITY Device is designed for use in the electromagnetic environment stipulated below The buyer or user of the device must ensure it is used in this recommended environment Test level IEC Observance Electromagnetic environment Immunity test 60601 level Recommendations Floors must be wood concrete or ceramic Electrostatic 6 kV at the 6 kV at the tile discharge DES contact contact If floors are covered with synthetic material 61000 4 2 8 kV in air 8 kV in air the relative humidity must be maintained at a minimum of 30 Fast transient electrical bursts CEI 61000 4 4 Shock waves CEI 61000 4 5 2 kV for power supply lines 1 kV for input output lines 1 kV differential mode 2 kV joint mode Not applicable
260. the On Off button to return to the previous screen Fig 7b Use the channel 1 button to choose the desired treatment area You can choose from 7 areas Fig 7C Press the channel 2 button to delete the warming up sequence and 2 to choose if you want to combine with any of the 2 2 programmes on channel 3 and 4 see explanation hereunder Fig 7d Use the channel 3 button to choose the programme level Fig 7e Use the channel 4 button to confirm your choices and start the programme 5 5 1 Choosing a treatment area If the mode for the manual selection of the body area is activated Fig 7b the user must manually select the area to be treated An average chronaxy value is used based on the area selected by the user This choice is made after selecting the desired programme Note If mi SCAN has been activated by connecting Mi cable Body area representation will not appear on the unit display This function adjusts the electrostimulation session to the physiology of each patient Just before starting the work session mi SCAN tests the muscle group and automatically adjusts the settings of the stimulator to the excitability of this area of the body n order to ensure optimum efficiency and comfort of the session it is recommended to perform the mi SCAN measurement before each session This function is implemented at the beginning of the programme by a short sequence in which measurements are made Throughout the dur
261. the active electrode as it penetrates the tissue The quantity N of ionized medicine penetrating the tissues depends on all the factors described above Once the treatment conditions are established however penetration only depends on the current density and the duration of treatment The quantity N of ionized medicine penetrating the tissues is a function of density and duration N is proportional to the cube root of density D multiplied by time t 0 2 mA cm2 i 4 H 0 5 10 15 20 25 30 35 40 45 50 55 60 t Practice a Precautions prior to lontophoresis treatment ATTENTION Do not perform the treatment if the patient is suffering or has suffered from asthma hay fever food allergy eczema allergy to penicillin or aspirin Do not carry out the treatment on allergic patients whatever form their allergy may take hay fever eczema or food allergy The more likely the medicinal product is to cause strong reactions in an allergic subject e g aspirin the more vigilant one should be ATTENTION Make sure that the medicine is not contraindicated lontophoresis treatment must not be performed if the patient has a disease or is taking other treatments that are listed among the contraindications for the ionized medicine 183 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS ATTENTION Stop the treatment immediately and do not repeat it with the same medicine if a local allergic reaction is
262. the motor systems causing a reduction in the coordination component resulting from the action of the scapular and scapulohumeral muscles The supra and infraspinous muscles are the main coordination muscles of the glenohumeral joint however their efficacy is reinforced by the tone and muscle mass of the deltoid Unlike in the rehabilitation of rotator cuff tendinopathy in which the work of the deltoid must be prescribed due to the subacromial interference combined muscular electrostimulation of the deltoid and the supra and infraspinous muscles is beneficial in this case because it allows for the stabilising musculature of the shoulder to be optimised 16 8 2 1 Protocol Phase 1 Disuse atrophy Level 1 until full painless mobility is obtained Phase 2 Disuse atrophy Level 2 until there is no pain during physical examination Phase 3 Disuse atrophy Level 2 mi ACTION mode Stimulation of of the infra and supraspinous muscles combined with voluntary proprioception exercises until the recovery of strength and endurance corresponding to functional requirements 16 8 2 2 Treatment frequency Three to five sessions per week 218 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 8 2 3 Electrode position Phases 1 and 2 Three channels for stimulation of the deltoid and the spinal muscles For the deltoid one small electrode is placed on the anterior bundle of the deltoid and another sma
263. the problem persists replace the cable If for any reason your device seems to present a malfunction other than those presented above please contact DJO Global customer service Problem Possible cause Solution Electrode failure Poor electrode connection to the cable Poor electrode connection to the skin Check that the electrodes are properly connected to the cable Check if the electrodes are outdated worn and or the contact is poor try with new electrodes 9 2 Battery level Problem Possible cause Solution Device battery low During the stimulation the device may turn out to be discharged Stop the stimulation and recharge the device 58 REHAB THETA PHYSIO 9 TROUBLESHOOTING 9 3 Others Problem Possible cause Solution Display does not come on Low batteries Load batteries Weak stimulation with loaded batteries Electrodes dried out lost their adhesive power and have no adequate connection to th skin Replace electrode Electrode placement Make the electrodes at least 2 inches apart Stimulation stops with loaded batteries Stimulation weakens within minutes of starting treatment with loaded batteries Poor electrode contact Reapply electrodes secure firmly Electrodes must be a minimum of 2 inches apart Damaged or worn electrodes This is a normal body adaptive process Replace I
264. the programme momentarily To restart it simply press the button of any channel The session will resume at 80 of the energy levels that were being used prior to the interruption 5 12 End of program At the end of each session a small flag will be displayed on the screen and a short melody will be played 2 00oo E ISI 51 15 51515 51815 Fig Fig To turn off the stimulator press the ON OFF button 36 REHAB THETA PHYSIO 5 HOW TO PERFORM A TREATMENT NEUROSTIMULATION PROGRAMS 5 13 Performance Check If the unit can be operated as described above the therapy unit has passed the performance check successfully The device also runs performance checks regularly during operation This is what happens if a problem is identified at start or during operation If there is a risk in usage or a malfunction identified e the device will ask you to correct it see also Chapter Problems and Solutions or automatically shut down immediately In this situation you may attempt to restart the unit by turning it briefly off and on again With the unit Switched off check that all plugs are correctly connected If the error message persists when the unit is switched on again have the unit insprected by an authorised service technician before using it again 37 REHAB THETA PHYSIO 6 TREATMENT OPTIONS 6 1 Muscle Intelligence Technology Muscle Intelligence mi technology provides practition
265. the very low frequency inhibition of the detrusor at the beginning of the session Then between contractions the energy level of the tetanic reinforcement contractions is adjusted j During the very low frequency inhibition of the detrusor duration 24 at the beginning of the session and between the contractions it is necessary to use a energy equal to three times that of the perception threshold The energy will gradually be increased until the patient feels 5 pulses per second Once this threshold value has been determined the energy will gradually be increased until three times the initial energy is reached 2 During tetanic contractions duration of contraction 4 it is necessary to work with the maximum tolerable energy at all times Therefore it is important to regularly increase the energy during the session every 3 or 4 contractions The therapist plays a decisive role in reassuring the patient and encouraging her to work with the strongest possible contractions 270 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 14 4 Postpartum prevention Pregnancy and to an even greater extent delivery cause significant trauma to the pelvic region The consequences of this trauma are varied strained muscles torn muscles partial denervation loss of body image loss of strength and control of the striated muscles of the pelvic floor etc Urinary incontinence is a relatively common problem in t
266. their usage Rehab Theta Physio sse go 15141 Program BITE MON teat uta taxon Kata rx Te 91 15 1 2 PROP Tall categ ory PRIN RELIE Piinia 99 15 1 3 Program category VASCULAR 106 jx aee IMaee a 13 15 2 Full Version Programs and their usage Theta Physio devices only n8 REMAR ITA CU NM RTT 120 15 2 2 AGONIST ANTAGONIST EMEN 132 15 23 PROGRAMMES FOR AEMOPHILIA S usted cantatas ced asbl gena dtu attesa 135 i PAESE ML n ios ubinam boit aerarium uuu eb edad 137 REHAB THETA PHYSIO CONTENTS os 142 c aelteym 155 15 3 Optimum Version Programs and their usage Physio device Only 173 E 173 BISSA E E E T EE E 177 15 3 20 WOU OPIN FSS I sence sv NEE EE EAEE ANEA EEEN ENEE criam rtis teilte E EEES EE 177 AVDE NATOS 185 187 UR mc 189 16 How to use the Rehab Theta Physio specific indications essen 193 TOKOVNI eC MU U HM se 193 16 2 DISuSe atraphy rehabilitation standar
267. through electrostimulation of the quadriceps using the Patellofemoral syndrome programme the parameters of which are specially adapted to avoid any unwanted effects on the kneecap However for irreversible cartilaginous lesions it is always recommended that the benefits obtained should be maintained through maintenance treatments The protocol detailed below is also suitable for the rehabilitation of patello femoral athroposies 16 5 2 1 Protocol Week 1 Patellofemoral syndrome Level 1 e Weeks 2 3 Patellofemoral syndrome Level 2 Week 4 then maintenance Patellofemoral syndrome Level 3 If the patient is experiencing associated pain symptoms TENS stimulation can be performed in addition on the fourth channel In this case the specific practical rules for TENS electrode placement regulation of intensity should be followed for this channel 16 5 2 2 Treatment frequency Five sessions per week during the first four weeks Then one session per week to maintain the results after week four 206 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 5 2 3 Electrode position In this programme 3 stimulation channels are used for the quadriceps This is because of the need to work with the knee extended in order not to cause excessive pressure on the posterior side of the patella Indeed this position places the quadriceps in inner range which is not generally favourable to electrostimu
268. ting more muscles during a session An essential factor in the effectiveness of electrotherapy is the ability to cause visible INTENSITY muscle twitches The mi RANGE function can be used to determine the minimum level of energy required to produce an appropriate muscle response OPTION 2 2 Yes RELAXING MASSAGE 21 MIN 1ST SEQUENCE 2ND SEQUENCE 3RD SEQUENCE FREQUENCY 7 Hz 5 Hz 3 Hz TIME 7 min 7 min 7 min 172 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY CONDITIONING II PROGRAM ANTI STRESS MASSAGE This programme can be used for relaxation and well being after physical activity or WHEN a stressful situation It provides very effective muscle relaxation through comfortable stimulation of the muscles which aids circulation and helps the muscles relax WHY Increases vascularisation of the tissues reduces muscle tension To make it as comfortable as possible for the patient use pulse widths equivalent to the PULSE WIDTH chronaxies of the motor nerves of the muscles being stimulated The mi SCAN function can be used to determine the pulse widths suitable for the patient s muscles Precision in positioning the electrodes is less significant than for programmes aiming ELECTRODES 0 develop muscle quality The electrodes can be placed in an alternative way reducing the number of electrodes needed and stimulating more muscles during a session An essential
269. to enter the device If such material has entered into the units it must be immediately checked by a service technician before it can be reused Electricity supply Never connect the stimulation cables to an external power supply as there is a risk of electrocution REHAB THETA PHYSIO 2 SAFETY INFORMATION Do not apply stimulation near the area of an implant such as cochlear implants pacemakers skeletal anchorage or electric implants This could cause an electrical shock burns electrical interference or death Never use the Rehab Theta Physio or the AC adaptor if it is damaged or open There is a risk of electric shock Disconnect the AC adaptor immediately if there is abnormal heating or smell or if smoke comes from the AC adaptor or the device Warning Equipment malfunction this warnings can cause equipment mailfunctions that result in patient hazards Magnetic and electrical fields are capable of interfering with the proper performance of the unit For this reason make sure that all external devices operated in the vicinity of the unit comply with the relevant EMC requirements X ray equipment MRI devices radio systems and cell phones are possible sources of interference as they may emit higher levels of electromagnetic radiation Keep the unit away from such equipment and verify its performance before use Do not use the Rehab Theta Physio within one meter of short wave or microwave devices as this coul
270. to prevent discoloration of the device Do not expose the therapy unit to strong ultraviolet radiation sunlight and fire Do not sterilize the stimulator Do not immerse in liquids 61 REHAB THETA PHYSIO 10 CARE MAINTENANCE TRANSPORT ENVIROMENTAL STATEMENT 10 2 Maintenance Your Rehab Theta Physio does not require calibration or frequently safety testings Each stimulator is tested prior to distribution Its characteristics do not vary under normal conditions If your stimulator contains parts that seem worn or defective please stop using it and contact the customer service centre that has been stipulated and authorised by the manufacturer regarding an upgrade There are no user serviceable parts inside the device If the device appears to be non functional contact DJO Global or your local dealer Warning Shock hazard Equipment damage Do not attempt to repair the stimulator or any of its accessories Never dismantle the device because of risk of electric shock DJO Global declines all responsibilities for any damages or consequences resulting from unauthorised attempts to open modify or repair the stimulator This may only be done by persons or repair services authorised by the manufacturer 62 REHAB THETA PHYSIO 10 CARE MAINTENANCE TRANSPORT ENVIROMENTAL STATEMENT 10 3 Transport 10 3 1 Transport of the Rehab Theta Physio 1 Prepare the device and its accessories for shipping within the ori
271. tremely localised area where the motor nerve is at its most excitable Although the location of the various motor points is now well known there may nevertheless be variations of up to several centimetres between different individuals The Motor Point Pen combined with the motor point program allows determining with greater accuracy the exact location of the motor points for each individual and thus ensuring the greatest effectiveness of the programmes It is recommended to use this programme and the pen before any initial muscular electrostimulation session Once located the motor points can be easily identified by using a skin marker pencil or in any other way thus avoiding the need to repeat this process before each session Electrode placement One stimulation cable has two outputs A positive pole red A negative pole black The positive electrode is the one connected to the positive pole red It is supposed to be attached at the motor point of the muscle Note The Motor Point Pen is designated only to be used in combination with the program Motor Point 44 REHAB THETA PHYSIO 6 TREATMENT OPTIONS Locating the motor point with the Rehab Theta Physio e g locating the motor point of the vastus medialis of the quadriceps 1 Apply a large electrode at the top of the thigh the muscle belly 2 Connect the negative pole of the cable black to the snap pin of the large electrode located towards the inne
272. trode is placed on the paravertebral neck muscles An essential factor in the therapeutic efficacy is to cause visible muscle twitching which may in certain cases require higher stimulation energies to be used The mi RANGE function can be used to determine the minimum level of energy required to produce an appropriate muscle response INTENSITY OPTION 2 2 Yes TORTICOLLIS FREQUENCY PULSE WIDTH TREATMENT TIME 1Hz 250 US 20 min 154 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY PAIN RELIEF Il PROGRAM ARTHRALGIA Various factors such as obesity age trauma poor posture etc are detrimental to the joints WHEN These detrimental factors may cause the joints to deteriorate and to become inflamed and painful WHY To relieve acute and chronic joint pain The principle is to cause a significant influx of tactile sensitivity in order to restrict the HOW entry of pain impulses upon their return to the posterior horn of the spinal cord For this programme the frequency is modulated 50 150 Hz to avoid habituation This pr ration impul itable for the higher level BULSEVIDTH programme uses very short duratio pulses 50 s suitable for the higher leve of excitability of the sensitive AB fibres ELECTRODES electrodes are usually placed in such a way as to cover or surround the painful area The intensity must be increased gradually u
273. trodes are positioned properly B Change the positioning of the electrodes slightly 60 REHAB THETA PHYSIO 10 CARE MAINTENANCE TRANSPORT ENVIROMENTAL STATEMENT 10 1 Care Warning Shock hazard Remove the power cord of the device from the wall outlet before cleaning Shock hazard equipment damage Liquids must not enter the device and its components If liquids have entered into the components the Rehab Theta Physio must be immediately checked by a service technician before it can be reused Never dismantle the device or the AC adapter as they contain high voltage parts with a risk of electric shock All parts of the Rehab Theta Physio can be disinfected by wiping down with a disinfectant Thus it complies with the special hygiene standards for medical technical equipment All components can be cleaned with common disinfectants and mildhousehold detergents Only use a soft cloth and an alcohol based solvent free cleaning product to wipe the therapy unit down Allow the device to completely dry before use Warning Patient hazard patient contamination Before using the unit on another patient clean and disinfect it according to the instructions in this section Caution IN Equipment damage The plastic material used is not resistant to mineral acids formic acid phenols cresols oxidants and strong organic or inorganic acids with a pH value below 4 Use only clear disinfectants
274. ts Activate the contraction by pressing any key on any channel As this contraction phase is very short rapidly increase the energy of channel 1 until satisfactory dorsiflexion is achieved 16 11 2 Spasticity Reminder Spasticity or spastic hypertonia is a term which describes the condition of paretic or paralysed muscles showing different symptoms to varying degrees including in particular an increase in muscle tonus mainly in the antigravity muscles hyperreflexia and clonus During passive stretching of a spastic muscle there is resistance at the beginning of the movement which then diminishes in the course of extension The more rapid the passive stretching movement the stronger this resistance If passive stretching is very rapid and is maintained clonus may occur i e a contractile oscillation of 5 to 7 Hz which persists for 40 to 60 cycles for as long as the stretching is maintained Spasticity is caused by a lesion in the central nervous system which affects the tractus pyramidalis cerebral spinal tract This interruption in central control releases the activity of the myotatic stretch reflex which becomes hyperactive As this stretch reflex is responsible for muscular tonus hypertonia develops affecting mainly the antigravity muscles extensions of the lower limbs and flexors of the upper limbs since these contain more neuromuscular spindles than their antagonist muscles In time spasticity leads to the shortening o
275. ubacromioncoracoid impingement etc The diabetic population is particularly at risk with 20 of this population presenting capsulitis at some stage Note that the initial development is a reflex sympathetic dystrophy even if this does not exactly conform with a strict definition of the term since it essentially affects the limb extremities this reflex sympathetic dystrophy then regresses as the capsule fibrosis and the joint ankylosis develops Clinically we see the development of a first entirely painful acute phase then the shoulder gradually loses mobility as the pain recedes then the shoulder is just stiff and painless At this point there is a loss of active and passive mobility affecting especially the abduction and external rotation of the shoulder external rotation is reduced to at least 50 compared to the healthy side There is spontaneous evolution towards recovery for a period of time that varies from 3 months to 2 years depending essentially on the quality of the rehabilitation treatment used The objectives of rehabilitation are first to relieve pain in the acute phase and then to restore the biomechanical and neuromuscular qualities of the shoulder 16 8 3 1 Protocol Phase 1 Acute phase TENS The criterion for moving from phase 1 to phase 2 is achieving a shoulder that is not painful at rest Clinical examination often exposes a set of symptoms similar to those of rotator cuff tendinopathy for which the same therapeut
276. uency 1 30 Hz 10 Hz 11 1 4 Direct currents Physio device only lontophoresis Hyperhidrosis Continuous current Maximum intensity 20 mA Minimum intensity increment 0 125 mA Oedema Rectangular non compensated current Pulse width 150 US Maximum intensity 120 mA Minimum intensity increment 1 mA Pulse frequency 100 Hz 11 1 5 Information on electromagnetic compatibility EMC The Rehab Theta Physio is designed to be used in typical environments that have been approved in accordance with the EMC safety standard EN 60601 1 2 This device complies with the CISPR standard indicating that radio frequency RF emissions are not likely to cause interference with electronic equipment installed nearby radios computers telephones etc The Rehab Theta Physio is designed to withstand foreseeable disturbances from electrostatic discharge magnetic fields from the mains power supply or RF transmitters Nevertheless it is not possible to ensure that the stimulator will not be affected by powerful RF radio frequency fields from other sources For more detailed information concerning electromagnetic emissions and immunity refer to the EMC tables 65 REHAB THETA PHYSIO 11 TECHNICAL DATA STANDARDS GUARANTEE PATENTS 11 1 6 Enviromental conditions Storage and Transport Conditions The device must be stored and transported in accordance with the following conditions Temperature 20 C to 45 C Maximum relat
277. ufficiency 1 programme is to be used to treat Stage 11 In Stage Il arterial occlusion is responsible for pain that occurs on exertion and is relieved by resting this is known as intermittent claudication SUE To improve the absorption of oxygen by the muscles increase tolerance on exertion and walking distance To avoid further reducing the supply of oxygen to the muscle fibres the contractions HOW remain infra tetanising 9 Hz and are separated by long periods of active rest 3 Hz in order to avoid muscular fatigue To make it as comfortable as possible for the patient use pulse widths equivalent to the PULSE WIDTH chronaxies of the motor nerves of the muscles being stimulated The mi SCAN function can be used to determine the pulse widths suitable for the patient s muscles ELECTRODES _ Electrodes positioned according to the specific indication NERY Stimulation energies must be increased as high as possible whilst still remaining comfortable for the patient OPTION 2 2 No ARTERIAL INSUFFICIENCY 1 14 MIN CONTRACTION ACTIVE REST FREQUENCY 9 Hz 3 Hz DURATION OF RAMP UP 15 15 DURATION OF PHASE 15 5 15 5 DURATION OF RAMP DOWN 15 15 110 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY VASCULAR PROGRAM ARTERIAL INSUFFICIENCY 2 Arterial insufficiency in the lower limbs is conventionally divided into four clinical stages These four stages I II Ill IV depend o
278. upraspinous muscles can be performed simultaneously with active work such as for example proprioception exercises The patient can be placed in the push up position with the hands resting on a trampoline In this position he she is asked to bounce in time with the phase of electrically induced contraction of the spinal muscles This exercise is always performed after warm up and will first be performed with two handed support then one handed support The mi ACTION function can be used to greatly facilitate the combination of voluntary exercises with the stimulation 16 8 2 5 Stimulation energy The stimulation energy must be gradually increased to the maximum of the patient s sub painful threshold 220 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 8 3 Adhesive capsulitis The SECEC European Society for Surgery of the Shoulder and the Elbow gives the following clinical definition for retractile capsulitis limited active and passive mobility by a minimum of 30 in the 3 planes for more than 3 months This limitation results from the thickening inspissation and fibrosis of the joint capsule with recess disappearance which translates into a loss of active and passive shoulder mobility This affliction is idiopathic in a third of cases but in the other two thirds there is a prior shoulder pathology that can be of a highly variable nature shoulder trauma shoulder surgery hemiplegia s
279. use a cushion or a specially designed table to prevent lordosis 239 REHAB THETA PHYSIO 16 HOW TO USE THE REHAB THETA PHYSIO ON SPECIFIC INDICATIONS 16 10 3 5 Stimulation energy The energy must firstly be adjusted on the third channel TENS The energy is gradually increased until the patient feels a strong tingling sensation in the lumbar region The energy is then adjusted on channels 1 and 2 endorphinic The energy is gradually increased in order to cause muscle twitches visible if possibly or at least palpable If the patient finds it hard to tolerate the energy increase due to the discomfort it can cause it is recommended to temporarily stop increasing the energy on the first two channels The energy is then increased again on the third channel TENS in order to increase the feeling of paresthesia in the lumbar region After a minute or two the energy can be increased again on the first two stimulation channels so that the muscle twitches can be seen It is essential to increase the energy on channels 1 and 2 sufficiently to cause visible or at least palpable muscle twitches In fact these muscle twitches are directly responsible for the significant hyperaemia effect and therefore guarantee the effectiveness of the treatment Note When TENS is used in combination with an endorphinic programme such as the Low back pain programme in this case the mi TENS function is inactive 240 REHAB THETA PHYSIO 16 HOW T
280. use and facilitate identification of the different channels The kit includes four 2 1 mm pin connector cables and 8 pin to snap converters 4 2 Connecting the motor point pen Never use the motor point pen for any purposes other than locating the motor point of the muscle Follow the instructions in this manual Clean and disinfect the tip of the motor point pen that comes in contact with the skin before each use Apply a small amount of gel to the skin when looking for the motor point to enhance patient comfort a Refer to the picture above to see how to connect the pen Connect the tip of the motor point pen preferably to the red connector The other connector must be connected to an electrode already on the muscle to be stimulated 25 REHAB THETA PHYSIO 4 DEVICE SETUP 4 3 Charging the unit The Rehab Theta Physio is a portable muscle stimulator powered by a rechargeable battery unit Recharging To recharge the Rehab Theta Physio first disconnect the electrode cables from the device then plug the charger to a wall socket and finally connect the stimulator to the charger The charge menu illustrated below appears automatically Fig 1a 1b Fig 1a The stimulator has been charged for 7 minutes and 27 seconds a full charge may take 2 2 5 hours with the rapid charger delivered with your device Fig 1b Charging is in progress When charging is completed total charge duration flashes and the battery symbol i
281. ven in this situation because even subliminal stimulation has a beneficial effect on the reduction of spasticity To complete the extension passive stretching is also necessary Combined treatment of stimulation and passive motion is therefore given 16 11 3 6 Manual activation of stimulation When the mi SCAN is activated the stimulation session starts automatically with a measurement of the chronaxy This is a short test lasting around ten seconds which allows the optimum duration of the stimulation pulse to be adjusted ensuring maximum comfort The energy should then be gradually increased to cause the first contraction of the antagonist muscle Each contraction is followed by a five second rest period Once this rest period has finished press any button on any channel to trigger the next contraction By doing so each contraction is triggered and therefore controlled by a manual action This technique provides a clear psychological benefit for the patient who can trigger contractions with his her good hand and it also makes it possible to work synchronously with the associated movements 16 11 3 7 Associated actions Passive mobilisation When contraction of the extensors is insufficient to mobilise the fingers and wrist to their maximum range the movement should be completed by passive extension The electrically induced contraction is allowed to develop until the maximum extension it can produce is achieved The movement is the
282. well as on the size of the skin electrode contact area Electric density D mA cm2 Intensity mA Surface area cm2 180 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS To monitor efficacy and safety properly we need to work with strict checks on electric density The equipment must therefore control the intensity of the current in relation to the size of the electrodes being used Furthermore this equipment must be a perfect generator of constant current In this way the intensity and hence the density will not change during treatment when skin resistance decreases as a result of heating and vasodilation of the skin E Penetration Penetration by the ionized medicinal substance depends on several factors 1 Solubility of the medicinal substance 2 Concentration of the medicinal solution 3 Absence of ions competing with the medicine in the solution 4 pH of the solution 5 The solution being placed on the correct electrode 6 Absence of grease on the skin s surface 7 Quantity of sweat gland ducts in the skin 8 Density of the electric current 9 Duration of treatment The size or molecular weight of the medicine it is often said mistakenly that molecular weight is a factor that affects penetration Although it is true at the cellular level for cell membrane penetration it has nothing to do with penetration of the skin during iontophoresis treatment The medicine penetrates the skin via the sweat gland
283. x to ship it Always use the AC adaptor power supply provided by the manufacturer to recharge the unit Do not store the device for a long time with empty batteries Only use electrodes and motor point pen supplied by the manufacturer Other electrodes and motor point pens may have electrical properties that are unsuitable for or may damage the Rehab Theta Physio Size of electrodes Do not use electrodes with an active area of less than 16 cm due to the risk of associated burning Proceed systematically with caution when the density of the current is over 2 mA cm Do not place the electrodes or pen in water Do not apply solvents of any kind to the electrodes or pen Skin irritation Some people with very sensitive skin may experience redness under the electrodes after a session Generally this redness is totally harmless and usually disappears after 10 to 20 minutes However never start another stimulation session on the same area if the redness is still visible Instructions for electrodes See the usage and storage instructions displayed on the bag of electrodes 17 REHAB THETA PHYSIO 2 SAFETY INFORMATION Note For best results wash and clean the skin of any oil and dry it before attaching the electrodes Never use a set of adhesive electrodes for more than 15 sessions as the quality of the contact between the electrode and the skin which is essential for the patient s comfort and the effectiveness o
284. xpanding these equations as part of this work However it can be noted that using these equations which give the variation of Vand it is possible to study the excitation process with any given shape of current and for any given duration 88 REHAB THETA PHYSIO 14 ELECTROTHERAPY THEORY 14 3 4 Chronaxy excitation constant 10 1 e relationship hs chronaxy 1 210 As the chronaxy is a value that characterises tissue excitability tch when it is worth determining the relationship which links it to the therefore 210 10 1 e other factor that characterises excitation k 210 1 e 10 The chronaxy is the useful time corresponding to a stimulation 2 1 e9 1 current which has an intensity double that of the rheobase i e 2 Io It is therefore very easy to find the relationship between the chronaxy and the excitation constant based on the formula 1 giving the intensity duration relationship 2 2 21 e 1 2 el tchk 1 2 2 1n2 tch k therefore t 1n2 k This means that the chronaxy 0 693 14 3 5 Hydraulic model of excitation It is possible to set up a hydraulic model that corresponds exactly to excitation This model allows a better understanding of excitation and may be used to represent the development of the local potential and the threshold under the effect of currents with variable durations and shapes Water flows from tank A towards tank B by m
285. y to understand that all these extra quantities that P has to transport indicate that we have an unfavourable stimulation current B Currents of short duration and higher intensity The durations intended here are close to the excitation constant value k In this case as the flow is high the pump action is short As almost no liquid has gone through L the float does not rise and accommodation is therefore negligible Nevertheless a certain quantity of water returns through K and has to be compensated for by P The Weiss law applies to these kinds of current please refer to the fundamental law of electrostimulation Q q citorIt qd it UN Qis the total quantity of liquid provided by P with I intensity of the stimulation current t pulse duration q 15 the volume of liquid separating Vo from So the quantity of charges that would have to be provided if there were no leak K In other words if the membrane potential varied instantaneously and not exponentially in accordance with a time constant K it the quantity of liquid that returns from Bto A through tap K J Fig 4 E A 90 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS 15 1 Standard Version Programs and their usage Rehab Theta Physio Within the Standard version treatment categories and their programs available for Rehab Theta Physio device are REHABILITATIO
286. z PULSE WIDTH The pulse width for the programme is 180 US ELECTRODES As a general rule the electrodes are placed on or near the painful area The stimulation should produce a sharp but pleasant tingling sensation and visible INTENSITY muscle twitches Please note This programme has two distinct energy levels First adjust the intensity level for 80 Hz TENS until a tingling sensation is felt then repeat the procedure for 2 Hz endorphinic in order to produce visible muscle twitches OPTION 2 2 Yes MIXED TENS FREQUENCY PULSE WIDTH TREATMENT TIME 80Hz3s 2Hz3S 180 us 30 min 105 REHAB THETA PHYSIO 15 AVAILABLE THERAPY PROGRAMS CATEGORY PAIN RELIEF PROGRAM DECONTRACTURING This type of treatment is indicated to relieve pain following acute muscle contractures WHEN torticollis lumbago etc It will also reduce muscle tension in the contracted muscles to facilitate manual handling techniques WHY To decrease muscle tension Current experiments show that muscles twitches caused by a very low frequency of HOW 1 Hz can effectively remove contractures or decrease resting muscle tension of the stimulated muscle To make it as comfortable as possible for the patient use pulse widths equivalent to the PULSE WIDTH chronaxies of the motor nerves of the muscles being stimulated The mi SCAN function can be used to determine the pulse widths suitable for the patient s muscles Electrodes must be p

Download Pdf Manuals

Related Search

Related Contents

Man UC410-HE - Pompe di calore, ecco le regole per accedere alla  User's Manual CPS1000E-DE  EPH-121 (ES)-T.qxd  Dialogic Diva V-8PRI  KW9M Advanced Type User`s Manual  R-506 Programmable Field Strength Meter  H-610 - Acuvance    

Copyright © All rights reserved. Failed to retrieve file