to the SwissSTIM® PHYSIO user manual.
Contents
1. Do not apply electrodes over open wounds or over swollen infected or inflamed areas or skin eruptions e g phlebitis thrombophlebitis varicose veins etc e DONOT APPLY STIMULATION o Over frontal area of the neck near carotid sinus nerves o Over the neck or mouth Severe spasms of the laryngeal and pharyngeal muscles may occur with contractions strong enough to close the airway and or cause difficulty in breathing Stimulation over the neck could also have a adverse effects on the heart rhythm or blood pressure Transcerebrally or transthoracically Over or in proximity to cancerous lesions On patients who have a hernia abdominal or inguinal o To the frontal laryngeal and temporal regions of the neck e Advise patients to never use the SwisSs77 Physio while driving operating machinery or during activities in which involuntary muscle contractions may endanger the user or others e The effects of stimulation of the brain are unknown Therefore do not apply stimulation across the head and do not place electrodes on opposite sides of the head Do not allow use of the SwisSs77 Physio in the bath or shower Patients with suspected heart problems or epilepsy must obtain appropriate medical advice Never allow use of the Swisss7 m Physio while sleeping NEVER immerse the SwisSs77 Physio unit in any liquid 4 Valmed SA Switzerland O OO D Health Precautions e The safety of neuromuscular stimulation during pregnancy ha2. at the level of maximum discomfort or in positions indicated by the prescribing physician The following treatment procedure is recommended Program s Program 1 only for the first 5 treatments at maximum tolerable intensity in order to relieve muscle spasm followed by Program 2 for subsequent treatments Treatment frequency every 24 hours for 7 to 10 days Stimulation intensity initially low progressively increasing to reach the maximum patient tolerance level Normally soasms which are usually painful are inhibited right away following the treatment and the relief lasts for some time It is normal to experience return of pain after some time following each treatment It may even be reported as an aggravation of pain by some patients This is only relative and temporary and the spasm free periods following treatment will become longer and longer until the discomfort disappears Stimulation in such cases has not only spasm relieving action but also it may reeducate paravertebral muscles to provide better support for the spine thus preventing the recurrence of back problems D NCREASI NG LOCAL BLOOD CI RCULATION Local blood flow increases with stimulation and reaches a peak within the first 15 20 minutes from the onset of stimulation Therefore short stimulation treatments are recommended Program Program 1 is recommended although blood flow increase happens as a beneficial side effect when using any stimulation program T
3. Guide Program Reference Guide 10 15 20 21 23 26 Valmed SA Switzerland Ill Indications Contra I ndications Warnings Precautions and Guidelines A Indications The SwisSs77 Physio is intended for use by licensed health practitioners patients under the care of licensed health professionals and is limited to prescription sales The Swisss7m Physio treatment programs are designed and intended for stimulation of all parts of the body EXCEPT transthoracically the head and the front part of the neck The specific indications for use include Prevention or retardation of muscle disuse atrophy Relaxation of muscle spasms Increasing local blood circulation Muscle re education and strengthening Immediate post surgical stimulation of calf muscles to prevent venous thrombosis Maintaining or improving range of motion of extremities B Medical Contraindications Do NOT use the Swisss7 m Physio on patients who have e An implanted cardiac pacemaker defibrillator or other implanted electronic or metallic devices e Any type of cancer in active metastatic phase C Warnings for Medical Professionals Do not use in the presence of functioning high frequency electrosurgery devices Do not use in the immediate vicinity lt 0 5 meter 2 feet of active microwave ovens Long term effects of chronic electrical stimulation are not known Keep out of the reach of children Apply electrodes ONLY to normal intact clean skin
4. Swisssyx Physio is ON use these keys to scroll through the programs Once a stimulation program has started use these keys to increase the stimulation ntensity one key for each channel 4 Multiple Function Scroll Keys When the SwisSs7 Physio is ON use these keys to scroll through the programs Once a stimulation program has started use these keys to decrease the stimulation ntensity one key for each channel After stimulation program is completed use either key to turn the Swisss7m Physio OFF B Display LCD Screen I ndications Swisss77m Physio START SCREEN PHY SIO EHSL ISH L x x EE OGE ams EA A Example Program Screen se SELECT Pi Program i DIK Stim Qi mih Phase nz MENU NAVIGATION KEY SCROLL I NDICATORS PE PROGRAM NUMBER INDICATOR Prostram 1 PROGRAM NAME INDICATOR z min Stim PROGRAM DURATION INDICATOR minutes Phase z PROGRAM PHASE NUMBER INDICATOR 10 O Valmed SA Switzerland s dimn OSmih Od mir iit WARM UP PHASE AND DURATION INDICATOR Indicate that warm up phase is selected dark background and lasts eleven minutes 05 mitt SPECIFIC WORK PHASE NDI CATOR AND DURATION Indicate the specific work phase and five minutes duration Ze Od DI SIMA COOL DOWN PHASE INDICATOR AND DURATION Indicate the winding down phase and four minutes duration EEN BATTERY CHARGE INDICATOR Example SEa Eira ee STIMULATION INTENSITY INDICATORS ON EAC
5. place at least two electrodes on each muscle in such way that the direction of stimulation a straight imaginary line between the electrodes is aligned with the longitudinal axis of the muscle Program s Program 1 is best suited however Program 4 can be used if preferred by the patient Treatment frequency No more than every 2 hours for as long as needed Stimulation intensity During the first 2 treatments at light intensity well below maximum Thereafter increase the intensity for subsequent treatments in accordance with patient tolerance B PREVENTION OR RETARDATION OF MUSCLE ATROPHY When immobilized for medical reasons all muscles are subject to atrophy wasting To remedy this stimulation of muscles is recommended when normal physical exercise is impossible Program s Program 2 only for at least first 5 treatments follow with Program 2 in combination with Program 3 for more intense workout Treatment frequency Every 24 hours but not less than every 48 hours for as long as immobilization lasts 15 Valmed SA Switzerland Stimulation intensity Initially low progressively increasing to reach the maximum patient tolerance level C PARTIAL ATROPHY AND OR SPASM OF PARASPI NAL MUSCLES The SwisSstim Physio is especially effective for relieving spasm and accompanying discomfort in the spinal region The stimulating electrodes should be placed symmetrically on both sides of the spine see electrode placement photos
6. H CHANNEL ndicate stimulation ntensity level independently set on the two channels Example gt GD PS ee TEINISH END OF PROGRAM I NDI CATOR FINISH The session is over 4 beeps can be heard Switch the unit OFF by pressing one of the two keys with a downward pointing arrow W 11 Valmed SA Switzerland SMART CARD ABSENT INDICATOR The smart card on which the programs are recorded is not in place or is not properly inserted Switch unit OFF open the back battery slot and insert the smart card or check that card is correctly positioned SMART CARD INVALID INDICATOR GENE The smart card inserted in the back slot is not valid Switch unit OFF open the back battery slot and insert a valid smart card PHUSE PAUSE Pause mode during treatment STOP Enables user to stop the program before pre set time RESUME Enables user to quit PAUSE mode and resume treatment from where it was stopped CHANGE PHASE OPTION Enables the user to return to the phase menu and repeat or lengthen one particular phase or skip to the following phase C Inserting New Batteries Slide back cover until battery compartment is open Insert new battery use ONLY a 9 volt alkaline or lithium high quality battery and ensure proper polarity D Inserting or Replacing Smart Card The Smart Card contains the specific program information for your SwisSs7 Physio your stimulator comes with this card ins
7. VALMED HO swisswave User Manual SwISSsmm Physio V 7 0 2005 Phone 41 27 203 65 81 Version 1 1 website www valmed ch Fax 41 27 203 65 87 email info valmed ch I Introduction The Swisssrm i Physio is manufactured distributed by VALMED SA Sion Switzerland The SwisSs77y Physio is manufactured in accordance with the requirements of European Safety Standards EN 60601 1 EN 60601 2 10 and meets all requirements of the American Safety Standards for Transcutaneous Stimulators as set forth in ANSI AAMI NS4 1985 It is approved by the United States Food and Drug Administration FDA K022175 The SwisSs77 Physio is a Class Medical Device and conforms to the requirements of European Directive CEE 93 42 and holds certificate number CE 0476 B BF device IAW IEC 601 1 External Placement on Body A Read this User Manual especially SECTIONS 3 and 4 before using the Swisssrm Physio Manufacturer is not liable for any damage caused by the improper use of the SwisSs7 Physio neuromuscular stimulator 2 Valmed SA Switzerland VI VII VIII XI Table of Contents Introduction Table of Contents Indications Contraindications Warnings Precautions and Guidelines Terminology Safety Treatment and Electrode Data Swisssrm Physio Unit Components Operating Instructions Program Descriptions Useful Information Swisssrm Physio Technical and Safety Data Electrode Placements and Program
8. by the brain through very efficient electrical stimulation signals that travel through motor nerves A signal will activate a discrete number of muscle cells known as a motor unit a motor unit is a single motor nerve and the muscle cells connected to it Groups of motor nerves and muscle cells are known as motor points The full contraction of a muscle typically involves multiple motor units acting simultaneously the force of contraction is proportional to the number of motor units activated The gradual activation of motor units enables smooth and controlled development of force this process is known as spatial summation Neuromuscular stimulation using the SwisSs7 Physio achieves similar muscle movement without use of brain signals These movements are termed involuntary When a single electrical impulse of adequate intensity is applied externally involuntarily to a group of neuromuscular junctions motor points in a muscle the result is a single short contraction twitch in that muscle When these single twitches are repetitive and the repetition rate exceeds 10 twitches per second the contractile force of each succeeding twitch adds to the preceding twitch an additional degree of contraction resulting in a higher overall force and hence muscle contraction This effect is termed temporal summation The minimal repetition rate at which twitch contractions fuse together is termed the tetaniza
9. ently e es 14 O Valmed SA Switzerland VII PROGRAM DESCRIPTIONS The Swisssr m Physio has four basic muscle stimulation programs each program is offered in three treatment times for a total of 12 discrete program options The four basic programs address specific stimulation application for skeletal muscles See Guide on page 26 Always stimulate muscles isometrically make sure that the limb whose muscle s is being stimulated is firmly secured to prevent the movement of the limb resulting from muscle contraction Medical professionals should select the appropriate treatment time 20 30 or 40 minutes If longer treatment times are desired for example if home treatments are prescribed for a patient the prescribed programs may be repeated by the user or multiple programs used Using complete program stimulation cycle 3 phases is recommended SwisSs77 Physio treatment modalities are A RELAXATION OF MUSCLE SPASM If a muscle spasm is present in any part of the body the spasm can be relieved by immediate application of stimulation to the affected muscle s A spasm which is usually painful is inhibited after stimulation and the relief will last for some time It is normal to experience a return of pain It may even be reported as an aggravation of pain by some patients This is only relative and temporary and the spasm free periods following treatment will become longer and longer until the pain disappears To relax the spasms
10. fter contraction Ramp after contraction contraction Stimulus frequency maximum with tetanic oh SA e contractions Max Impulse duration Ex Total Cycle Program time selectable gt 20 30 40 20 30 40 20 30 40 20 30 40 19 Valmed SA Switzerland VIII Useful Information A Inserting or Replacing Batteries The battery charge indicator will indicate when the battery weakens and requires replacement If the battery is not replaced the Swisss7m Physio will cease operating within one 1 hour Remove slide the cover of the unit Remove old battery and insert a fresh 9 volt lithium alkaline or rechargeable NiMh battery Ensure proper battery polarity the Swisssrmm Physio will not operate if polarity is reversed B Warnings Concerning Battery Handling Always read and follow the specific instructions provided by battery manufacturers Note the following Ensure that battery polarity is correct Do not expose batteries to temperatures exceeding manufacturer s specifications Do not store and or ship this unit with batteries inserted Do not attempt to recharge alkaline or lithium batteries Do not dispose of any battery in fire Note that batteries may present burn or fire hazard if short circuited Improper battery handling may result in explosion leakage or flames C Handling Cleaning the Swisssmnm Physio Unit Use soft brush or soft cloth to clean unit case do not use liquid cleansers Use same proced
11. imparted impulse energy in turn is a function of e The current intensity selected by the practitioner for the patient e Skin and electrode electrical resistance less resistance results in more delivered energy and e Electrode placement the closer electrodes are to motor points the higher the energy The intensity of the stimulation should be at a level where the involuntary muscle contractions are visible and felt by the person to be treated The controls on the Swisssnm Physio are easily adjusted to achieve this It is likewise true that the stronger the muscle contractions are the higher the effectiveness of the therapy This has to be tempered however with a person s comfort level For comfortable and effective stimulation the delivered energy should be optimized This can be achieved by a combination of the following steps e Ensure that the person s skin is clean e Apply heat for example a thermal wrap to the skin to increase local blood circulation e Moisten skin before placing the electrodes on the skin e Reduce electrode resistance by using the largest electrodes possible for a given anatomical area e Optimize electrode placement using the placements recommended in this manual and e If possible have the person to be treated assist by also voluntarily contracting the stimulated muscles Dry skin is highly resistant to the conduction of electric current Wet or perspiring skin has Significantly lower resis
12. location use the following simplified application method Program s If muscle spasm is present start with Program 1 and follow with Program 3 Otherwise use only Program 3 Treatment frequency Once per day daily or on alternate days Number of treatments Normally 20 treatments but can be increased when necessary to reach the treatment goals or recovery of normal or desired function Stimulation intensity Initially low progressively increased after two or three treatments reaching maximum setting when possible at the eighth treatment session For most effective maintenance of range of motion of extremities the following factors are important e At all times try to use the optimal stimulation intensity i e the strongest contractions within the limits of patient comfort and tolerance with no pain e Stimulation intensity has no absolute value and may vary from day to day and also during a treatment Thus when the skin and muscles are warmed using thermal wraps for example Or a series of massages or a steam bath have been performed before the stimulation treatment a slightly lower intensity will suffice to give the desired effect e t is possible to treat several areas at once on one patient which permits considerable time Savings 18 Valmed SA Switzerland The timing sequences and frequencies for the Swisss7m Physio programs are shown in this table Program Program Programs Programs Ramp a
13. o emphasize that no neuromuscular stimulator including the Swisssrm Physio should be used by a patients with an implanted cardiac pacemaker and that the safety standards for pregnant women has not been established The Swisssyw Physio is designed so that even improper or accidental application of the stimulator will not produce cardiac rhythm disturbances this does not apply to persons who have implanted cardiac pacemakers This safety factor is due to the minimal electrical charge of the stimulating impulses which under all conditions do not exceed 24 microcoulombs zero net current This charge is below the standard of 25 microcoulombs established in the Association for Advancement of Medical Instrumentation AAMI for cardiac rhythm disturbance safety AAMI ANSI NS 4 1985 Many if not most individuals harbor apprehension anxiety or even fear regarding electricity It is therefore very important that patients understand how completely safe treatments with the SwiSSs77 Physio are Educating the patient before treatment is therefore a recommended first step The effective value of the stimulation voltage a patient will experience during treatment with the Swisssy u Physio is very low below 5 volts root mean square at the maximum setting of the intensity knobs C Practical Treatment Suggestions During neuromuscular stimulation the number of motor units in a muscle that are activated depends upon the stimulus impulse energy This
14. ombs is significantly below the cardiac rhythm disturbance Safety margin of 25 micro coulombs per pulse the standard as established by the Association for Advancement of Medical Instrumentation AAMI in AAMI ANSI standard NS4 1985 and acknowl edged by the U S Food and Drug Administration FDA Specific safety features in the SwisSs77 Physio include 1 Impossible for users to modify the embedded programs users can only modify the inten sity of stimulation 2 All programs begin with minimal electrical ntensity the user must increase the ntensity to the desired training level Maximum possible electrical impulse is 20 micro coulombs 4 Cable design prevent the possibility of accidental connection to a power source such as an AC power outlet 5 Automatic control of stimulation current density precludes excessive current density at the electrode skin interface and ensures skin safety 22 Valmed SA Switzerland X Electrode Placement Channel 2 electrodes may be attached to other leg in order to treat both legs Use oval 3 by 5 electrodes for large areas e g leg muscles and round 3 electrodes for smaller areas such as forearm muscles Do not use smaller electrodes than recommended above Leads for Channel 1 are depicted in RED and leads for Channel 2 in BLUE Where only one set of electrodes is shown Channel 1 is depicted but CALVES Channel 2 may be used instead Channels may be reversed if desired from tha
15. p Split electrode layout is when one pair of electrodes is split on each side of the body e g one electrode on the right quadriceps and one electrode on the left quadriceps This layout may result in unevenness of contractions which may be difficult to correct Bi polar electrode layout is ideal for large muscles An electrode is placed at each end of the muscle such that good well controlled contractions are obtained For all layouts the electrode placement should correspond to the location of the motor points of the treated muscle s For placement guidance see Section X THE BOTTOM LI NE The Swisss7m Physio is a truly valuable adjunct for the medical professional in assuring effec tive treatments for Prevention or retardation of muscle disuse atrophy Relaxation of muscle spasms Increasing local blood circulation Muscle re education and strengthening Immediate post surgical stimulation of calf muscles to prevent venous thrombosis Maintaining or improving range of motion of extremities 8 Valmed SA Switzerland V Swisssy x Unit Components 9 Valmed SA Switzerland VI Operating Instructions A Key Symbols and Functions S Select Key Use this KEY to select a program select a program phase and to START a selected program Once a program has started use this KEY to make further selections in the program d Multiple Function Scroll Keys s Use either key to turn the Swisssy x Physio ON When the
16. pplied as a standard accessory with the Swissszw Physio mold easily to body contours and are reusable The specific instructions for electrode use are indicated on the factory sealed storage pouch The recommended sizes are oval 3 by 5 electrodes for large areas e g leg muscles and round 3 electrodes for smaller areas such as forearm muscles e Use only skin pads electrodes supplied by manufacturer Other electrodes may not stimulate correctly and may render the treatment ineffective e Apply electrodes only to clean intact normal skin e Do not apply electrodes over open wounds inflamed swollen or infected skin area or over any skin eruptions such as varicose veins phlebitis etc e Do not share electrodes with other patients Multiple patient use may result in adverse skin reactions e Replace self adhesive electrodes when they do not adhere stick firmly to the skin G Potential Adverse Reactions Skin irritation and burns beneath the electrodes has been reported from use of some neuromuscular stimulators 5 Valmed SA Switzerland IV Terminology Safety Treatment and Electrode Data A Terminology Human physical movements are determined by muscle actions on the skeletal system A muscle is shortened contracts when it is voluntarily activated by the brain This shortened muscle exerts force on the attached bone s causing movement with skeletal joints acting as pivots All muscle contractions are controlled
17. reatment frequency every 24 hours or as needed Stimulation intensity initially low progressively increasing to reach the maximum patient tolerance level E MUSCLE RE EDUCATION Muscle stimulation may be applied to patients before during or after physiotherapy re education Stimulation may also be applied during and or after immobilization following orthopedic surgery involving the long bones and joints After deciding which parts of the body are to be treated and upon selection of the appropriate number of electrodes and their location use the following simplified application method 16 Valmed SA Switzerland Program s If muscle spasm is present start with Program 1 followed by Program 2 Otherwise use only Program 2 Treatment frequency Daily or on alternate days Number of treatments Normally 20 treatments but can be increased to 40 when necessary to reach the treatment goals or recovery of normal or desired functions Stimulation intensity Initially low progressively increased after two or three treatments reaching maximum setting when possible by the eighth treatment session For most effective reeducation of muscles and joints the following factors are important e Try at all times to use the optimal stimulation intensity i e the strongest contractions should be achieved within the limits of patient comfort and tolerance with no pain e Stimulation intensity has no absolute value and may vary from da
18. ress one of the scroll keys again and the unit will beep and switch OFF L Connections Please refer as needed to the control schematic of the Swisss7m Physio page 9 1 Ensure that the unit is OFF 2 Connect the skin pads electrodes to each output cable 3 Position the skin pads electrodes on the motor points of the muscles to be treated refer to page 23 in this manual for proper positions 4 Connect the output cables to the output socket of the Swisss7m Physio unit The two 2 cables can be connected to either output socket on the SwisSs7z Physio the SwisSSs77 Physio unit will function properly M Automatic Switch OFF The Swisssmm Physio will automatically switch OFF three 3 minutes after completion of a program To turn the unit OFF immediately press one of the W scroll keys N Troubleshooting If the SwisSs77 Physio unit is not working please check the following Is the battery correctly inserted Are the cable connectors properly inserted into the Swisss7m Physio unit Are the skin pads electrodes connected to the cables Are the skin pads electrodes adhering to the skin If not wet the pad surfaces sparingly with water With incorrect non symmetrical stimulation feeling please check the following oei beiz Electrodes may be dry or greasy Electrodes not positioned correctly Weak battery Non symmetrical positioning of the electrodes See Section X Intensity on the two channels are set differ
19. s 10 Power Supply One 9 Volt lithium alkaline or NiMh rechargeable battery Battery charge lasts approximately 20 hours according to stimulation intensity The output and program timing parameters are stable 2 throughout the life of the battery Standard Accessories Four skin pads nonpolar self adhesive reusable electrodes One alkaline 9 Volt battery 2 cables Carrying case and User Manual Size Unit size is approximately 12 5 8 1 2 6 cm Weight is 200 grams or approximately 7 oz Cleaning Maintenance Use soft brush or soft cloth to clean unit case do not use liquid cleansers Use same procedure with electrical leads The SwisSs7 Physio is designed to be maintenance free 21 Valmed SA Switzerland B Safety The Swisss7 m Physio meets the requirements of ANSI AAMI NS4 1985 American Standard and the IEC 601 2 10 European Safety Standard Specific Safety Features and Measures to Prevent Misuse The Swisssrm Physio is inherently designed so that improper or accidental application of this unit cannot produce cardiac rhythm disturbances This does not include individuals with implanted cardiac pacemakers This inherent safety is due to the minimal electric charge of all stimulating impulses in the Swisssrm Physio In all programs of stimulation the typical impulse is below 10 micro cou lombs and the maximum possible impulse is 20 micro coulombs zero net current Moreover this maximum charge of 20 micro coul
20. s not been established e Use caution when if o Patient has skin areas that lack normal sensation o Following surgical procedures if muscle contractions might impede the healing process o Over a menstruating or pregnant uterus o There is a tendency to bleed internally following acute trauma or fracture e Place electrodes in accordance with illustrations in this User Manual e Ensure that patient extremities are isometrically fixed braced during treatment sessions to prevent movement that results from stimulation e This unit should not be used while driving operating machinery or during any activity in which involuntary muscle contractions may place the user at undue risk of injury e Some users may experience skin irritation or hypersensitivity due to the electrical stimulation or the conductive medium e Application of moderate heat thermal wrap to muscles as well as moistening skin prior to treatment improves treatment efficacy use of cold packs on treated muscles after treatment is likewise recommended e This unit should only be used with the leads electrodes and accessories provided by the manufacturer E DO NOT use the Swisssrm Physio on patients who e Have an implanted cardiac pacemaker defibrillator or other implanted electronic or metallic devices Are pregnant Have cardiac problems or cardiac disease Have epilepsy Have abdominal or inguinal hernia F Electrode Guidelines The PalsFlex electrodes that are su
21. t indicated in the following photos QUADRICEPS On both legs THIGHS Channel 2 electrodes may be at On one leg tached to other thighs in order to treat both thighs TIBIA FEMORAL BICEPS 23 Valmed SA Switzerland FEMORAL BICEPS AND CALVES TRICEPS ABDOMINALS FOREARM UPPER TRAPEZIUS BICEPS DELTOID 24 Valmed SA Switzerland LOWER TRAPEZIUS NECK BACK 25 Valmed SA Switzerland XI Program Reference Guide jJu ned Aq pouojoJd J X slu ul e J G ASHE Sd UHA UOIJCUIGUIOD UI sr X S u w 2e 31 G ISA JO cd SN X d UUA enuljuod Ju s ud useds YIM JUO SUL IAZ SUL dO NO ILOW X dO J NVY ON ISWSYON I dO ONIN IV LN IVN NOLLVINWLLS TVO IDYNSLSOd 3LV ICANN I Ad S ISOEINOYHL SNONSA dO NO LLNSAA dd JHL SOS NOLLVINWILS TIOSNIA ATWO cd UIN nulluOo u u u s d si wseds Jl jUO sr NO ILV2nG43 3t d LEIA NO UL IL ID GOO 18 1V2O1 ONISVIAONI Sd LEIA TVN IdSVaVd X JO INSVdS YO ANV AHdO tLLV TV LLYVd AHdOULV 319S IA dO NOILLVGYVLad YO NOLLNSAAdd X WSVdS JTIOSNIN dO NOLLVXV Ida vd wieibold d weibold Zd Z weibold Ld weiboid D918 1 OO O uO E EO9Ipu Valmed SA Switzerland 26
22. talled If the card needs to be installed do so ONLY when your Swisss7 m Physio is OFF Open battery compartment and insert the Smart Card into its slot making sure that the card is properly positioned LABEL on the card facing up E Turning the Swisss7 m Physio ON Press one of the scroll keys marked d to turn the Swisssrm Physio ON This activates the LCD screen and sound but not the ntensity function This function is only activated 12 Valmed SA Switzerland after a program selection has been made If the Swisssyx Physio logo does not appear or if the display indicates low battery strength the Swisss7 m Physio will not function properly If the message SWITCH OFF NOW AND INSERT CARD appears turn the SwisSs77 Physio OFF by pressing one of the N scroll keys Insert Smart Card If the message INVALID CARD CHANGE CARD appears an invalid card has been inserted F Selecting a Stimulation Program and Duration Make sure the SwisSs7 Physio is ON The LCD display will indicate the number of programs Scan the programs by using the scroll keys and select desired program and duration Once a program is selected by using the S Select KEY the LCD display will show specific information about the program name total program duration and program phases phase length The program will start with the first program phase unless a specific phase is selected and will complete ALL phases of the program unless the user selec
23. tance It is true that individuals tend to vary in their normal levels of skin 7 Valmed SA Switzerland moisture It is also best to precede treatments with the application of some form of heat to the areas to be treated There are a number of means for doing this form thermal wraps to steam baths or hot whirlpool treatments Oily skin also prevents optimal conductivity and should be treated with soap and water prior to start of a treatment session As a minimum the skin should be moistened with a sponge or cloth prior to treatment D Application and Handling of Electrodes When voluntary muscle movements occur the complex contraction patterns involving several muscles bones and joints are represented in the cerebral cortex of the brain rather than the movement of each individual muscle Thus the brain typically calls a combination of muscles into action this should be the objective when using neuromuscular stimulation NMS as well There are several different methods for placing electrodes on the body The following guidelines are based on using NMS to exercise groups of muscles involuntarily in the same fashion that these muscles contract voluntarily Electrode in pairs layout is the recommended electrode placement Each pair of electrodes is placed on the same side of the body e g one electrode on the right leg vastus lateralis and the other on the same leg on the vastus medialis both being a part of the quadriceps muscle grou
24. tion frequency typically in the range of 25 to 50 impulses per second depending upon the specific muscle Tetanization frequencies are used to create electrically stimulated contractions known as tetanic muscle contractions During natural voluntary muscle contractions the force is partly the result of summation of single repetitive twitches temporal summation but also a function of the total number of motor units that have been activated by brain signals Therefore a voluntary muscle contraction force is a result of both temporal and spatial summations During neuromuscular electrical stimulation the muscle contraction force is highest at the tetanic stimulation frequency due to temporal summation Contraction force also depends upon the total number of motor units activated which in turn are dependent on placement of electrodes and their distance to the motor points on a muscle B Safety The Swisssym Physio is designed to provide a totally safe treatment without sacrificing effectiveness In this respect the SwisSs7z Physio is non pareil Further to ensure safety durability and efficiency only premium electrical components are used All stimulation impulses generated during Swisssnm Physio treatment sessions carry such minimal amounts of electrical energy that they are unlikely to produce any adverse effects when 6 Valmed SA Switzerland the stimulator is used in accordance with this manual It is important however t
25. ts only a specific program phase G Selecting a Phase of a Stimulation Program Selecting only a program phase is possible Once a program has been selected icons for the program phases will appear on the LCD display Use the scroll keys to high light the desired phase and press the S Select KEY to select the phase H Automatic Program OFF Function If no scroll key is pressed within 60 seconds the Swisss7m Physio will automatically switch OFF to conserve battery life Selecting Program I ntensity Once a program has been selected the ntensity controls on the Swisss7 m Physio are activated There are 2 scroll keys a d and a for each right and left channel of the SwiSSs77 Physio Use the scroll key for each channel to increase Intensity and the V scroll key to decrease the Intensity level The ntensity scale is a 100 step scale with 100 corresponding to the maximum ntensity level J Using Pause Function gt Any Swisssr m Physio program can be paused by pressing the S Select KEY once When this is done the following choices can be made STOP Stops program RESUME Program resumes from point it was stopped CHANGE PHASE Returns user to program phase menu and allows user to repeat a phase skip to next phase or repeat the entire program 13 Valmed SA Switzerland K Switching the Swisss7 m Physio OFF During Treatment Press both scroll keys until the ntensity level falls to 0 p
26. ure with electrical leads The Swisss7m Physio is designed to be maintenance free D Storage Conditions The Swisss7 m Physio may be stored for prolonged periods with no degradation REMOVE the battery when the unit is not used on a regular basis E Battery Disposal Always dispose of batteries in accordance with battery manufacturer instructions F Warranty Free replacement for two 2 years except for accessories and shipping charges Free replacement will be made if defect is in manufacture of unit free replacement does not apply when damages are related to improper use or abuse of unit 20 Valmed SA Switzerland IX Swisssnm Physio Technical and Safety Data A Technical Characteristics Stimulation Channels Two independent isolated channels Separate ntensity control levels for each channel Adjustments 5 keys control all stimulation functions and ntensity levels Display The graphical LCD 100 X 30 pixels 46x16 mm signals all stimulation functions stimulation in tensity per channel length of program battery charge status etc Output Current waveform during training Asymmetrical biphasic with fast rise and zero net current Voltage waveform open circuit Low voltage rectangular compensated monophasic impulse Peak open circuit voltage during each impulse 45 Vp 10 Maximum Output at 500 Load RMS voltage lt 5 V volts 10 Peak open circuit voltage during treatment 90mA milliampere
27. y to day and also during a treatment Thus when the skin and muscles are warmed using thermal wraps for example or a series of massages or a steam bath have been performed before a stimulation treatment a slightly lower intensity will suffice to give the desired effect e t is possible to treat several areas at once on one patient allowing considerable saving of time e It is possible to mount the stimulator electrodes on the skin under a cast and thus prevent muscle atrophy even on a limb which is fully immobilized as for instance in patients in a pelvipaedic cast F CALF MUSCLE STIMULATION FOR THE PREVENTION OF VENOUS THROMBOSIS BY IMMEDIATE POSTSURGICAL STIMULATION Muscle stimulation is effective in reducing the evidence of and preventing the symptoms of venous thrombosis After electrode placement on motor points of calf muscles the following treatment method is recommended Program Program 2 Treatment frequency As prescribed by physician or up to 3 x per day for as long as the patient is immobilized Stimulation intensity Initially low progressively increasing up to the maximum patient tolerance level 17 Valmed SA Switzerland G MAI NTAI NING OR INCREASING RANGE OF MOTION OF EXTREMITIES Electrical muscle stimulation may be applied to patients as an adjunct to physiotherapy procedures After deciding which extremities are to be treated and upon selection of the appropriate number of electrodes and their
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