- Frank`s Hospital Workshop
Contents
1. 400 Hz frequency above 400 Hz 7T mA 123 mA 66 mA 138 mA KEN DER 122 mA 140 mA 1 3 to 1 10000 140 mA 140 mA the lower value is always valid Exponential pulses pulses with exponential rise interrupted exponential pulses 1 ms to 29 ms 140 mA for additional limits see the table 30 ms to 49 ms 110 mA for additional limits see the table 50 ms to 69 ms 90 mA for additional limits see the table 70 ms to 99 ms 80 mA for additional limits see the table 100 ms to 299 ms 70 mA for additional limits see the table 300 ms to 800 ms 65 mA for additional limits see the table TECHNICAL PARAMETERS OF ELECTROTHERAPY Page 38 of 39 frequency 0 1 400 Hz frequency above 400 Hz 100 1 67 mA 138 mA 106 mA 140 mA 122 mA 140 mA 1 2 to 1 10 000 140 mA 140 mA the lower value is always valid Stimulation pulses 0 1 ms to 29 ms 140 mA for additional limits see the table 30 ms to 49 ms 110 mA for additional limits see the table 50 ms to 69 ms 90 mA for additional limits see the table 70 ms to 99 ms 80 mA for additional limits see the table 100 ms to 299 ms 70 mA for additional limits see the table 300 ms to 1000 ms 65 mA for additional limits see the table Trabert current Ultra Reiz 92 mA Leduc current 140 mA Faradic current 140 mA Neofaradic current 140 mA Galvanic current 65 mA H wave 0 1 35 Hz 140 mA ELI Microcurrents 1000 uA Spastic sti2. La i i IM b F a Y ZR e r Fi p E i E Ha TE EB lee SA i as D A SR l 3 S ELT A se EC 3 ore X gl Lo t pix Erin L a Ines i KR EE l F Cl USER S GUIDE 1001E20 12 2007 CONTENTS 1 GENERAL EFFECT OF ELECTROSTIMULATION cece ccecccsceeeeeeeeeeeeeeaeeeaeeeeeeeeeeaessaaessoaaseeaessonessoneesoaes 5 2 CLASSIFICATION OF ELECTROTHERAPEUTIC CURRENTS cccccccseccssseeeeeeeeeeeeeeeeeeeeeeeeeeneeeeneeseeeeseanes 6 2 1 Gaane IN UM saa eect ota a 6 2 2 P lse Direct EE 6 2 3 Atona Aen EE 6 2 3 1 TEN EE T 2 3 2 Classic Four polellnterterence A T 2 3 3 IN e Oe E en E NCC Te EE E om 1 2 3 4 elef lafen En Ee T 2 3 5 Beleeg e eee 8 3 EFFECISOFELECIROIHERAPY EE 9 3 1 Anslgesic Ge nn a ome ene nt foe en ee ee d iet Mm EU MMC M ADEL D reer arene 9 3 2 Myorelaxation and Spasmolytic Eitect nennen nennen nnne nnne nnne nnns 10 3 3 TOPR ER e RE RE T T T 10 3 4 Antiedematous m Mio 9 RIDE 11 3 5 Placebo Effect ERN EIE Ex 11 3 6 Bizet ARTT Cc 11 3 7 Contraindications for Electrotherapy cccccccssseccccescecceeececceueeecseueeeceusecceuecesseueeesseeeeseueeessegseesessessessaaes 12 3 8 SEENEN 12 4 SETUP AND CONTROLS OF ELCTROTHERAPY ccccccccssseeeeeeeeeeseeeaseeeeeeeeeeneeeeaesseaesseaseesaneesanessaneesons
3. 1 second MF 1 second pause SHAAN DD f AAA mY 8 a INA llth ah A parameters of CP ISO type alternation of DF and MF with amplitude 80 of DF 1 second DF 1 second MF the parameters are defined for basic pulse frequency 50 Hz TECHNICAL PARAMETERS OF ELECTROTHERAPY Page 33 of 39 6 1 19 GALVANIC CURRENT IONTOPHORETIC type continuous interrupted by 8 000 Hz with duty factor 95 6 1 20 MICROCURRENTS type rectangular triangular exponential monophasic symmetric alternating and combined pulse 0 2 to 1 000 ms rectangular combined 1 to 1 000 ms other pause 0 1 to 10 000 ms monophasic symmetric combined then by the pulse length 0 1 to 5 000 ms alternating then by the pulse length frequency 0 1 to 1 000 Hz rectangular 0 1 to 700 Hz combined 0 1 to 900 Hz other monophasic 0 1 to 450 Hz other symmetric and alternating modulation see Modulation of Currents below note CC mode only IL D LH n 6 1 20 SPASTIC STIMULATIONS ACCORDING TO HUFSCHMIDT pulses 0 1 to 25 ms delay between channels 10 to 3 000 ms frequency 0 15 to 50 Hz depending on the set pulse length and delay TECHNICAL PARAMETERS OF ELECTROTHERAPY Page 34 of 39 6 1 22 HIGH VOLTAGE THERAPY HVT LL A ER IK Heck oe type single peak double peak triple peak pulses symmetric alternating pulse 20 us pulses single symmetric alternating 30 us double peak pulses 40 us triple peak
4. 100 5 000 to 10 000 500 TECHNICAL PARAMETERS OF ELECTROTHERAPY Page 36 of 39 6 5 MAXIMUM INTENSITY VALUES TENS 10 us to 160 us 140 mA 161 us to 400 us 140 mA for additional limits see the table 61 mA 97 mA 70 mA 113 mA 2 pole interference 140 mA 4 pole interference 100 mA Isoplanar interference 100 mA Dipole interference 100 mA Russian stimulation 140 mA Diadynamics DF 70 mA MF 100 mA CP 80 mA LP 80 mA RS 100 mA CP ISO 80 mA Rectangular pulses combined pulses interrupted rectangular pulses 0 2 ms to 29 ms 140 mA for additional limits see the table 30 ms to 49 ms 110 mA for additional limits see the table 50 ms to 69 ms 90 mA for additional limits see the table 70 ms to 99 ms 80 mA for additional limits see the table 100 ms to 299 ms 70 mA for additional limits see the table 300 ms to 1000 ms 65 mA for additional limits see the table TECHNICAL PARAMETERS OF ELECTROTHERAPY Page 37 of 39 100 1 50 mA 80 mA the lower value is always valid Triangular pulses interrupted triangular pulses 1 ms to 29 ms 140 mA for additional limits see the table 30 ms to 49 ms 110 mA for additional limits see the table 50 ms to 69 ms 90 mA for additional limits see the table 70 ms to 99 ms 80 mA for additional limits see the table 100 ms to 299 ms 70 mA for additional limits see the table 300 ms to 1000 ms 65 mA for additional limits see the table frequency 0 1
5. 13 4 1 COornmmomPararie CNS geen 13 4 1 1 Suidas ere oe eee ee 13 4 1 2 ri eh ereeeeans 14 4 1 3 Therapy Pii m e 14 4 1 4 Sanel ele eiii MERERI T TT T m 14 4 2 TEN c 14 4 2 1 i ES 14 4 2 2 Pulse Frequency Pause sssssssssssssessseseeen nennen nnne nne nani sasa isa sanas asa siia saei sane rsen asas e ssa snas sanas 14 4 2 3 See Me ln TE 15 4 3 2 pole 4 pole Isoplanar and Dipole Interterence 15 4 3 1 Carrier FRC OU CINCY E 15 4 3 2 Electro e ln 15 4 4 PRS Sir UN e EE 16 4 4 1 esi Freau NE MENTRE 16 4 4 2 x r3aielpe As M 16 4 4 3 Pulse Length Electro Parameters esee nennen nnne nnne nnne nnn nnns 16 4 5 le Dee Une SUNG CS RR m 16 4 5 1 e Mail MCN 16 4 5 2 hiis x TREE 16 4 5 3 zi eite Al NS e TTE 16 4 6 Diadynamie 0 e 9 co eee T 17 4 6 1 bio E er ter ere cer ers ere 17 4 6 2 icr MP 17
6. 4 6 3 Electo e eee eee ce cou E Eutelsat E lu ee ME MEE 17 Page 2 of 39 4 7 4 7 1 4 7 2 4 7 3 4 8 4 8 1 4 8 2 4 8 3 4 9 4 10 4 10 1 4 11 4 11 1 4 11 2 4 11 3 4 12 4 12 1 4 13 4 13 1 4 13 2 4 13 3 4 13 4 4 13 5 4 13 6 4 14 4 14 1 4 14 2 4 15 4 15 1 4 15 2 4 15 3 4 15 4 4 16 4 16 1 4 16 2 4 17 4 17 1 4 17 2 5 5 1 6 6 1 6 1 1 6 1 2 6 1 3 6 1 4 6 1 5 6 1 6 6 1 7 Pulses Rectangular Triangular Exponential and with Exponential Rise Combined Interrupted 18 Re 18 Pulse IPFOQUGIICY PAUSE EU Nm T m 18 See Re 18 Stimulation EE 19 DNS ead cota 19 miM mM TEE 19 Electro Parameters RE E ONT 19 Trabert Current Leduc Current Faradic Current Neofaradic Current H waves 19 Galvanic CGurrent cess eeeseeeeseeeesseeesseeeeseeeeeeseeseseeeessneetaneeess 19 po o 19 Microcurrents ee 20 pio 20 Pulse Frequency Pause nennen nnne nnne nnns nni rese sse sisi rise sina iss r se sina nnne anser 20 Electro Parameters c MEM 20 Spastic Stimulation 2 0 0 cece ccc eeccceeeee ae eeeeeeeesee cess eeeseeeeseeeeseeeesaeeeeseeceseeeessueesaeeeeseeeesesneceseesessueetsneesseeeeaes 20 Pulse Delay FrSQUENGY e 20 ES SIV OG AOI REMPORTE 21 Constant FRC UCI IG
7. 5 to 70 s 6 1 5 INTERFERENCE DIPOLE VECTOR SN eeh WS T Pd type automatic manal rotation carrier frequency 3 600 to 10 000 Hz AMF 0 to 200 Hz Spectrum 0 to 200 Hz frequency sweep see Frequency Sweep below dipole rotation from 3 rev per second to 1 rev per 30 seconds auto rotation 6 1 6 RUSSIAN STIMULATION HHH carrier frequency 2 500 to 10 000 Hz pulse frequency 40 to 150 Hz pulse pause ratio 1 1 to 1 8 exception otherwise the pulse period ratio is used modulation trapezoid surges for parameters see Modulation of currents below 6 1 7 MID FREQUENCY SURGES AMPLITUDE MODULATED HHHHHH carrier frequency 2 500 to 10 000 Hz pulse 0 1 to 50 ms depending on the set carrier frequency pulse frequency 9 8 to 1 000 Hz depending on the set carrier frequency modulation see Modulation of Currents below TECHNICAL PARAMETERS OF ELECTROTHERAPY Page 29 of 39 6 1 8 RECTANGULAR PULSES HDD fe Web type monophasic symmetric alternating pulse 0 2 to 1 000 ms pause 0 1 to 10 000 ms monophasic symmetric then by the pulse length 0 1 to 5 000 ms alternating then by the pulse length frequency 0 1 to 1 000 Hz modulation see Modulation of Currents below 6 1 9 TRIANGULAR PULSES ch INN type monophasic symmetric alternating pulse 1 to 1 000 ms pause 0 1 to 10 000 ms monophasic symmetric then by the pulse length 0 1 to 5 000 ms alternating then by the p
8. 8 Hz and intensity at the highest tolerable level up to the threshold of pain thus thin fibres of the C type are stimulated creation of endorphins To achieve a combination of both above stated mechanisms of easing pain use burst modulation The carrier frequency should be about 100 Hz burst frequency up to 10 Hz even frequencies lower than 1 Hz are not exceptional Currents with burst modulation bring a cumulated analgesic effect According to the depth of the required effect the procedures can be ordered as follows from the most superficial to the deepest ones e analgesic effect of anelectrotonus galvanic current e diadynamic currents LP and CP ISO e Trabert current e TENS e 2 pole interference amplitude modulated mid frequency currents e 4 pole interference isoplanar interference and vector fields MYORELAXATION AND SPASMOLYTIC EFFECT Especially after posturographic examination had proved that overall administration of so called myorelaxancies has a negative long term influence on the body posture the possibility of exact aiming at the hypertonic muscle has been regarded as an especially valuable advantage of myorelaxation procedures In the overall application of myorelaxancies there are first affected the phasic muscles which have been already weakened due to the layer syndrome Later or when a stronger dose is applied there are also affected the tonic muscles and only at the end at the strongest dosage are hyp
9. advantage is that it can be applied by point electrode and thus can be effectively used in combination with therapeutic ultrasound ISOPLANAR INTERFERENCE A special form of four pole interference where the additional modulation of both channels enables the treated area to be distributed to the whole space of the current circuits interlacement This implies that placing of individual electrodes is much easier they do not need to form a perfect cross anymore The effect of these currents is very diffuse in depth and delicate CLASSIFICATION OF ELECTROTHERAPEUTIC CURRENTS Page 7 of 39 2 3 5 DIPOLE VECTOR FIELD Additional phase and amplitude modulation of the basic signals of four pole interference enables only one direction of the electric field s action to be achieved a so called dipole is created in the tissue In the direction of this dipole the modulation of the field reaches up to 100 in the other directions it is almost zero You can either rotate this dipole abscissa manually and thus precisely aim the required effect of the therapy at the treated tissue or let it rotate automatically CLASSIFICATION OF ELECTROTHERAPEUTIC CURRENTS Page 8 of 39 3 1 EFFECTS OF ELECTROTHERAPY ANALGESIC EFFECT Pain is a multi factor phenomenon and practice positively shows that various types of pain respond more or less well to various physiotherapeutic i e also electrotherapeutic procedures There are several mechanisms of t
10. of the stimulation pulse Possible settings beep the length of the beep corresponds to the length of the generated pulse click a short click indicates the beginning of the generated pulse no sound TRABERT CURRENT LEDUC CURRENT FARADIC CURRENT NEOFARADIC CURRENT H WAVES Special types of pulse currents for their parameters see the chapter Technical Parameters GALVANIC CURRENT TYPE Continuous or interrupted The length of interruption is 5 us repeating frequency is 8000 Hz SETUP AND CONTROLS OF ELECTROTHERAPY Page 19 of 39 4 11 4 11 1 4 11 2 4 11 3 4 12 4 12 1 MICROCURRENTS are designed for application by tip or point electrode TYPE The waveforms of the particular current types are best illustrated in the following table rectangular monophasic l rectangular symmetric E i l LL rectangular alternating t i triangular monophasic triangular symmetric TAA d i M b ij P E na na l exponential monophasic exponential symmetric EY triangular alternating Fi E exponential alternating combined L PULSE FREQUENCY PAUSE This dialog is the same as the dialog Pulse Frequency Pause for standard pulses chapter 4 7 2 ELECTRO PARAMETERS For details see the chapter Pulse Modulation SPASTIC STIMULATION PULSE DELAY FREQUENCY It is possible to set the length of T1 pulses which are generated by channel E1 the length of T2 pulses w
11. pulses frequency 0 1 to 500 Hz modulation see Modulation of Currents below note CV mode only 6 2 MODULATION OF CURRENTS Types constant frequency random frequency burst sine surges trapezoid surges symmetric surges Random frequency standard 30 Burst not designed for HVT number of bursts in a pulse 3 to 10 frequency of bursts 0 1 to 100 Hz depending on length and freq of pulses Sine surges surge length 0 15 to 35 s for HVT from 3 to 35 s pause length 0 02 to 70 s for HVT from 3 to 70 s Trapezoid surges rise fall 1to35s for HVT from 3 to 35 s time of stimulation pause between surges 1to 35s for HVT from 3 to 35 s Symmetric surges sweep time 1to35s for HVT from 3 to 35 s contour 1 to 99 96 TECHNICAL PARAMETERS OF ELECTROTHERAPY Page 35 of 39 6 3 FREQUENCY SWEEP INTERFERENCE types continuous jump symmetric Random selection of frequency during yes no sweep Continuous sweep frequency rise and fall 1 to 35s frequency hold 0 to 35s Jump sweep frequency hold 1to 35s Symmetric sweep sweep time 1to 35s contour 1 to 99 96 6 4 STEPS IN SETTING PARAMETERS Steps in setting parameters of currents 0 10 to 0 30 0 01 0 30 to 1 00 0 05 1 00 to 3 00 0 10 3 00 to 10 0 0 5 10 0 to 30 0 1 0 30 0 to 100 5 100 to 300 10 300 to 1 000 50 1 000 to 3 000 100 3 000 to 10 000 500 applies for all settings except carrier frequency 2 500 to 5 000
12. the extent of change of the basic frequency of therapeutic surges AMF The resulting I mA Carrier frequency high frequency Frequency of therapeutic surges low frequency frequency of therapeutic surges then ranges from AMF to AMF Spectrum and changes according to the set way of frequency sweep 4 14 2 FREQUENCY SWEEP defines the ways of sweep of the resulting frequency of therapeutic surges between AMF and AMF Spectrum e continuous rise of frequency upper hold fall and lower hold e continuous random e in jumps upper and lower hold e injumps random e symmetric time of change sweep time contour e symmetric random The differences between particular ways of sweep are displayed in the following pictures SETUP AND CONTROLS OF ELECTROTHERAPY Page 22 of 39 4 15 4 15 1 4 15 2 The difference between standard and random way of sweep is again best illustrated in the following two pictures In the classic way of sweep the change of frequency always involves two values AMF and AMF Spectrum In the random way of sweep the equipment selects the resulting generated frequencies randomly from the values between AMF and AMF Spectrum This way of sweep reduces the risk of the tissue getting used to the generated frequencies and thus in some cases it increases the success of therapy standard sweep random sweep ELECTRODIAGNOSTICS MOTOR POINT DETECTION Before any electrodiag
13. DF basic diadynamic pulses of frequency 100 Hz or 120 Hz two way rectified mains frequency according to the mains frequency 50 60 Hz MF basic diadynamic pulses of frequency 50 Hz or 60 Hz one way NANAANRAAANS rectified mains frequency according to the mains frequency 50 60 Hz CP diadynamic pulses created by combination of types DF and MF the VYYYYYYYYS PV P f pulses alternate every 1 second for basic frequency 50 Hz and every 1 2 second for basic frequency 60 Hz CP ISO the same combination of pulses DF and MF but the mutual VYYYYYYYY 6 a 6 64 intensity of currents is equalized by the base line owing to the difference in perception of DF and MF intensity of the MF current is 11 9o lower than that of the DF current NWWYWn P P f LP diadynamic current with smooth transitions between DF and MF surges The whole change of the MF surge to DF and back to MF lasts 10 or 12 f g i i seconds and the length of the MF surge is 6 or 7 2 seconds according to basic frequency 50 Hz 60 Hz RS diadynamic current combined of the MF current time 1 or 1 2 second and a pause length 1 or 1 2 second according to basic frequency 50 60 Hz BASE To the pulse component of the diadynamic current there is added the galvanic component base It can be defined proportionally the base component represents the set percentage of the total intensity ELECTRO PARAMETERS Basic Frequency Basic frequency which the diad
14. ERAPY Page 10 of 39 3 4 3 5 3 6 ANTIEDEMATOUS EFFECT is practically connected with hyperaemia vessel eutonisation and higher capillary permeability Therefore the therapies referred to as trophic are also antiedematous see the previous paragraph PLACEBO EFFECT Opponents of physical therapy tend to refer to its effects as placebo If PT is applied accidentally without knowledge of its mechanism accurate aiming and dosage as often happens its effects can be called this Exact verification of the effects of PT faces many problems e Owing to the fact that lege artis application of PT requires especially the patient s individuality and momentary functional status to be taken into account including the limbic system status mood muscular tonus season of the year weather motivation attitude to problems etc it is almost impossible to create a group for further statistical processing Creation of a control group is practically out of question e The effect of PT lies almost only in affecting the afferent system The afferent system processes all data including visual auditory tactile and other analysers Since a slight stimulus is very often sufficient to deviate the organism from the existing functional balance even pathological and using its enormous self repairing abilities the organism helps itself there cannot be carried out e g a blind experiment without at least minimum excitation of the afferent system an
15. M Fc w E 21 Pandom FC US eo C MRTPT n 21 BS Ee CEN 21 Me US Ee 21 Trapezoid SUN Sigs beans E 21 Ale re er ss TETTE TERR 21 Interference Parameters cccccecccceececeececeeeeeaeececeeeeceecesseeeeseeeesenecsaeeeseeeeseeessacessueesseeeeseuseeeseeesaeessaes 22 AMF and Spectrum E 22 gebe SW 9 METEO T 22 eife Lee 23 Motor Point Uetechon nennen nnne nnne nnne nnne anas rie nauis asa isa nsa sa esa ananas anas 23 Rheobase E Te E TE 23 Accommodation Coefficient 24 gei E 24 Combined Therapies E 25 Polarity of Ultrasound Head 25 Setting of Parameters of Combined Therapy 25 Specific Electrothierdpy Settings EE 26 Check of Contactof EIBCITOOOS Ee 26 Measuring Ol EICCWOUCS NR 26 RECOMMENDATIONS FOR ELECTROTHERAPY eeeeeeseeen nennen hene h nnn REENEN EE assu sanus asas a ss san nna nnn 27 SOP PVA tele mme 27 TECHNICAL PARAMETERS OF ELECTROTHERAPY cccccsceceseeeeeeeeeeeeeeseeeeeeeeeeseeeaseesenessaneesenesonaes 28 Parameters of Particular Therapies Current ccccccccccseccceecceeeececeececeeceeseeeeseeeeseecessueeeseeeesaeeessneeesaness 28 TEN teneeeenieesneis 28 4 pole I
16. NICAL PARAMETERS OF ELECTROTHERAPY Page 31 of 39 6 1 14 TR BERT ULTRA REIZ 2 5 6 1 15 LEDUC type pulse pause frequency modulation type pulse pause frequency modulation 6 1 16 FARADIC NEOFARADIC 6 1 17 H WAVE type pulse pause frequency modulation type pulse pause frequency modulation LD monophasic 2ms o ms 143 Hz see Modulation of Currents below ood monophasic 1 ms 9ms 100 Hz see Modulation of Currents below on AA monophasic rectangular faradic monophasic triangular neofaradic 2ms 20 ms 45 5 Hz see Modulation of Currents below uu symmetric 2 x 5 6 ms 0 22 to 10 000 ms 0 1 to 87 7 Hz see Modulation of Currents below TECHNICAL PARAMETERS OF ELECTROTHERAPY Page 32 of 39 6 1 17 DIADYNAMICS type DF MF CP LP RS CP ISO base 0 0 5 1 2 5 1096 basic frequency 50 or 60 Hz the currents were derived from these frequencies pulse interruption 8 000 Hz duty factor 95 96 VV VV VV VV VV VV tif i ff ls parameters of DF type continuous sine pulses frequency 100 Hz NAAAAAAAN fh fi amp i fi Oh fo parameters of MF type continuous sine pulses frequency 50 Hz PIN AAA A parameters of CP type alternation of DF and MF 1 second DF 1 second MF parameters of LP type alternation of modulated DF 10 seconds and MF 6 seconds AWWW R APA A AA parameters of RS type alternation of MF and pause
17. SIFICATION OF ELECTROTHERAPEUTIC CURRENTS Page 6 of 39 2 3 1 2 3 2 2 3 3 2 3 4 In general e short duration of the pulse improves the subjective perception e the zero average value DC component prevents chemical damage of the tissue e frequency and amplitude are responsible for the required therapeutic effect TENS TENS transcutaneous electrical nerve stimulation Nowadays a very prevalent group of currents which substitutes the standard applications of diadynamic currents Russian stimulation etc TENS pulses are low power and have zero DC component Therefore besides suppression of chemical damage of the tissue the risk of electrical damage of the tissue is also minimized As can be seen from their name these currents are intended for the stimulation of nerve stems or nerve fibres Their major utilization is in the alleviation of pain inhibition of itching etc The mechanism of their effect is most often explained by the so called gate theory of pain Besides treating pain these currents can also be effectively utilized in electrogymnastics stimulation of non denervated muscles CLASSIC FOUR POLE INTERFERENCE Four electrodes are located crosswise Two frequency signals with different frequencies fa and fg are brought to the tissue Their interference in the tissue induces a low frequency surge in the centre of the cross its frequency IS AMF fa fp This surge of the frequency AMF has a therapeutic
18. ble with red banana plugs socket marked is cathode use the cable with white or black banana plugs e negative polarity the polarity of sockets is reversed cathode anode e positive reversal the first half of therapy has positive polarity of the signal in the middle of therapy the polarity automatically changes to negative e negative reversal the first half of therapy has negative polarity of the signal in the middle of therapy the polarity automatically changes to positive e pos rev with interrupt the first half of therapy has positive polarity of the signal in the middle of therapy the polarity automatically changes to negative during the change the equipment interrupts therapy and waits for re setting of the correct intensity e Deg rev with interrupt the first half of therapy has negative polarity of the signal in the middle of therapy the polarity automatically changes to positive during the change the equipment interrupts therapy and waits for re setting of the correct intensity THERAPY TIME Can be set within a range from 00 01 to 99 59 min sec PHYSIOLOGICAL EFFECTS Characterize particular diagnoses and programs and can be adjusted For the meaning of particular symbols see the chapter Symbols of Effects A E T R TENS TYPE symmetric the positive pulse is immediately followed by the negative one alternating the positive pulses regularly alternate with the negative ones UI
19. cal properties correspond to AC 4 7 2 PULSE FREQUENCY PAUSE In this dialog box it is possible to set the basic parameters of generated pulses pulse length pause between pulses and pulse frequency All these three parameters are mutually related by the following mathematical relations and therefore during change of one parameter the other ones can change too monophasic pulses frequency 1 000 pulse pause Hz ms ms symmetric pulses frequency 1 000 2 pulse pause Hz ms ms alternating pulses frequency 1 000 2 pulse 2 pause Hz ms ms asymmetric pulses frequency 1 000 pulse 7 pause Hz ms ms Note The relations are based on the electrical waveform of the pulses and the manner of their generation 4 77 3 ELECTRO PARAMETERS For details see the chapter Pulse Modulation SETUP AND CONTROLS OF ELECTROTHERAPY Page 18 of 39 4 8 4 8 1 4 8 2 4 8 3 4 9 4 10 4 10 1 STIMULATION PULSES TYPE The two basic types suitable for stimulation are rectangular and triangular PULSE PAUSE The setup dialog is similar to that in the previous chapter Pulse Frequency Pause but it is possible to set only the pulse length and pause length For correct stimulation by individual pulses it is recommended to maintain the following relation tpause 0 003 tpucse s ms ELECTRO PARAMETERS Sound Signal The sound signal indicates the moment of generation
20. cy pulses DF duty factor parameter is the ratio of the pulse length to the length of the pause between pulses PULSE LENGTH ELECTRO PARAMETERS In this dialog which is similar to that for setting trapezoid surges see the chapter Trapezoid Surges it is possible to set the rise time of the amplitude of low frequency currents duration of stimulation fall time and duration of relaxation MID FREQUENCY SURGES These stimulation pulses are in principle similar to Russian stimulation but have a wider range of possible individual settings CARRIER FREQUENCY See the previous chapter Carrier Frequency PULSE FREQUENCY PAUSE In this dialog box it is possible to set the basic parameters of generated pulses length of pulse of the mid frequency surge pause between pulses and pulse frequency All these three parameters are mutually related by the following mathematical relation and therefore during change of one parameter the other ones can change too frequency 1 000 pulse pause Hz ms ms The limits of setting individual parameters are determined by the carrier frequency ELECTRO PARAMETERS The parameters to be set are the same as for most basic stimulation pulses For details see the chapter Pulse Modulation SETUP AND CONTROLS OF ELECTROTHERAPY Page 16 of 39 4 6 DIADYNAMIC CURRENTS 4 6 1 4 6 2 4 6 3 TYPE The basic types of diadynamic currents are as follows PCOCCPCCTYY CC Y Y Y
21. d or higher components of CNS e Functional defects of the locomotive organs which are the main positive effects of PT tend to self repair if they are not prevented from that e g by inappropriate pharmacotherapy If correctly indicated PT both initiates and accelerates this self repair which indeed can be hardly proved exactly DEFERRING EFFECT A troublesome patient is often invited for a check up only after undergoing usually ten procedures and hopefully will be better then This way of thinking is immoral unethical and discreditable to a specialist but nevertheless most of the existing prescriptions of PT unfortunately belong to this category In some surgeries patients are even told that the effect of the chosen PT will become apparent only after several months which means that the physician fully relies on the body s self repair abilities Indication of PT should then not be based only on the diagnosis especially if the diagnosis is confusing e g periarthritis humeroscapularis etc The attending physician should know the answers to the following questions e What is the cause of the complaints i e usually pain e s the defect functional or organic e Where was the defect initiated where is are the key area s e Which of the above mentioned effects of PT is the most important for the patient at the moment e ls there not a risk of aggravation or organification of the functional defect after the chosen PT Wi
22. ded for all currents except TENS apply side 2 of the electrode in the sponge cover to the patient s body 1 cover Before first use rinse the electrode sponge covers thoroughly in tepid water They are impregnated by the manufacturer with a special substance which prevents them from going mouldy After washing and drying the electrode covers stiffen It is not a defect after moistening they will become soft again RECOMENDATIONS FOR ELECTROTHERAPY Page 27 of 39 6 TECHNICAL PARAMETERS OF ELECTROTHERAPY 6 1 PARAMETERS OF PARTICULAR THERAPIES CURRENTS 6 1 1 TENS ch o BHO HA type symmetric alternating asymmetric pulse 10 to 400 us pause 0 15 to 2 500 ms depending on the pulse length pulse type and the set frequency frequency 0 2 to 1 000 Hz alternating 0 4 to 1 000 Hz symmetric asymmetric modulation see Modulation of Currents below 6 1 2 4 POLE INTERFERENCE E carrier frequency 3 600 to 10 000 Hz AMF 0 to 200 Hz Spectrum 0 to 200 Hz frequency sweep see Frequency Sweep below 6 1 3 2 POLE INTERFERENCE MALLA carrier frequency 3 600 to 10 000 Hz AMF 0 to 200 Hz Spectrum 0 to 200 Hz frequency sweep see Frequency Sweep below TECHNICAL PARAMETERS OF ELECTROTHERAPY Page 28 of 39 6 1 4 ISOPLANAR INTERFERENCE oS carrier frequency 3 600 to 10 000 Hz AMF 0 to 200 Hz Spectrum 0 to 200 Hz frequency sweep see Frequency Sweep below field rotation 0
23. ecting the motor point Rheobase is the lowest intensity of rectangular pulse current to initiate muscle contraction Chronaxie is the length of pulse which initiates muscle contraction and the intensity of which is 2x higher than rheobase SETUP AND CONTROLS OF ELECTROTHERAPY Page 23 of 39 The values of rheobase and chronaxie can be determined from the completely measured l t curve see the chapter I t Curve or can be measured by the following simplified method First measure the rheobase length of the measured pulse is 1000 ms and then the chronaxie The equipment automatically sets the correct intensity of the measuring pulse you set its length by the time stop knob turn it to set the pulse length press it to start or stop the stimulation After finding both values save the measured results It is recommended to write in the note whether the stimulation point electrode was cathode or anode 4 15 3 ACCOMMODATION COEFFICIENT is measured at the motor point of the muscle by a triangular and a rectangular pulse with the electrode polarity which was determined as more sensitive when detecting the motor point Accommodation coefficient is the ratio between the intensity of the triangular pulse and the intensity of the rectangular pulse Pulse width is 1000 ms and pause between pulses is 3 seconds First measure the rectangular pulse after measuring and saving it by the time stop knob 17 the equipment automaticall
24. effect both basic currents of the frequency fa and fg are used only for transport of the AMF surges to the tissue The fa frequency is constant changes in the fg frequency by the value of the so called Spectrum serve to change the resulting frequency AMF to the frequency AMF Spectrum Interference has similar effects as low frequency currents although it is carried by a current of higher frequency and does not stress the tissue under the electrode so much The carrier frequency of channels ranges from 3 5 to 10 kHz The higher this frequency the better it is tolerated by the patient The advantage of four pole interference is the in depth aiming of the treated area and lower stress on the superficial skin Therefore higher intensity values can be set than for the two pole application TWO POLE INTERFERENCE According to the new recommended terminology these groups should be called bipolar applied amplitude modulated mid frequency currents however owing to the length of this name we are keeping to the original one The resulting low frequency current of the frequency AMF or AMF Spectrum is created by the equipment Therefore two electrodes are sufficient for its application The absolute intensity values that can be reached are lower than in classic interference this current is more poorly tolerated by the patient than classic interference and at the same time the stress on the skin surface is higher than in classic interference Its
25. ertonic muscles also positively affected This effect lasts for several weeks and affects the structure of the spine very negatively even after acute complaints have subsided Procedures with myorelaxation effect include therapeutic ultrasound 2 pole interference with contour frequency 100 200 Hz 4 pole interference currents and high voltage therapy in the same frequency modulation band For small superficial muscles especially in the hands paraffin can also be used A favourable side effect of myorelaxation is also the analgesic effect TROPHIC EFFECT is caused by hyperaemia which occurs in almost all types of PT except cryotherapy Since the mechanism of hyperaemia in various types of PT is different it is necessary to take these mechanisms into account so as to be able to select the particular PT Generally galvanization can be recommended especially longitudinal capillary hyperaemia vessel eutonisation low frequency currents of frequency 30 60 Hz and intensity at or above the threshold motor activity level muscle micropump or ultrasound laser polarized specified achromatic light vacuum overpressure therapy etc The trophic effect may be partly caused by the fact that most forms of PT esp laser biolamp and magnetotherapy bring energy into the organism to be used by cells or other structures for their activity The trophic hyperaemic effect is also usually connected with the analgesic effect EFFECTS OF ELECTROTH
26. h the patient which can be unpleasant The CC mode is therefore useful for most static applications with fixed electrodes including e g suction cups However if you want to use point electrodes combined therapy with ultrasound head moving electrodes e g roller etc it is suitable to switch over to the constant voltage mode because moving the electrode in the current mode causes a temporary reduction in the contact area between the electrode and the patient s skin and consequently a significant rise in the current density which could be painful for the patient Similarly for therapies where muscle contractions are expected and or electrodes could slightly move on the skin it is suitable to select the constant voltage mode of stimulation CV constant voltage mode in this mode the voltage on the electrodes is constant Owing to physiological effects the current in the tissue may slightly rise during therapy and therefore it is usually necessary to adjust the set intensity according to the patient s feelings approximately every one or two minutes Still this mode is suitable especially in cases where the CC mode would bring problems pain and reduction in output intensity i e in applications with moving electrodes and applications which are accompanied by muscle contraction SETUP AND CONTROLS OF ELECTROTHERAPY Page 13 of 39 4 2 4 2 1 4 2 2 POLARITY e positive polarity socket marked is anode use the ca
27. he analgesic effect of electrotherapy besides the well known gate theory of pain there is also a proven increase in the production of endogenous opiates The analgesic effect is also supported by the trophic effects of the flowing current Timely myorelaxation removes muscular hypertone and thus also pain of myofascial origin Since the analgesic effect of electrotherapy is fundamental and most utilized it shall be described in a little more detail Pain is usually simply defined as an unpleasant sensory and emotional experience connected with actual or potential damage of tissue We usually distinguish between acute and chronic pain Acute pain is short lasting maximum several days or weeks It is caused by mechanical damage of the tissue or by a disease comes immediately after a painful stimulus and subsides when it ends the intensity of pain depends on the intensity of the stimulation On the other hand chronic pain is long lasting more than 3 months or it recurs its intensity does not depend on the intensity of stimulation emotions particularly play a leading role The now generally accepted theory of perception of pain is based on the assumption of the existence of a specific sensory system which transfers information from pain receptors nociceptors to the central nervous system by special preformed nerve paths However the process is in fact much more complicated and those interested can learn about it in the available specialized lite
28. hich are generated by channel E2 the delay between pulses T1 and T2 and the repeating frequency of pulses It is also possible to independently set the polarity of pulses T1 and T2 see the buttons polarity 1 and polarity 2 SETUP AND CONTROLS OF ELECTROTHERAPY Page 20 of 39 4 13 PULSE MODULATION 4 13 1 CONSTANT FREQUENCY The set current has no supplementary modulation and is not further influenced See the picture rectangular pulses 4 13 2 RANDOM FREQUENCY During generation the frequency of the generated current randomly changes within a range of approx 30 See the picture with random compression of rectangular pulses 4 13 3 BURST Low energy group of several pulses following immediately one after the other It is possible to set the number of pulses in burst and frequency of bursts Hz For information there is calculated the pause between bursts ms and burst length ms It is also possible to choose from several pre defined values 4 13 4 SINE SURGES High energy group of pulses which can cause e g a muscle contraction It is possible to set the sine su
29. lectrotherapy generator with the symbol of the GA ultrasound head on its tab see the picture Usually it is the electrotherapy generator E1 Only the lists of this generator contain combined therapies including combined diagnoses combined programs and manual selection of therapy carrier frequency After selecting the combined therapy no matter whether from the list of diagnoses diag the list of programs prog or using manual control man the electro generator screen displays the standard electro parameters setup screen with the added parameters ultrasound button After pressing the parameters ultrasound button you can set all parameters of the ultrasound therapy as required For a detailed description of ultrasound parameters see the Ultrasound Therapy User s Guide Connected Devices BTL 4000 Topline Pulse and BTL 4000 Topline Sono For a schematic drawing of the interconnection of these devices see the User s Manual The devices are controlled separately therapies are run on each device individually On the BTL 4000 Topline Sono device start therapy on the generator U1 and uncheck the option with electro SETUP AND CONTROLS OF ELECTROTHERAPY Page 25 of 39 4 17 SPECIFIC ELECTROTHERAPY SETTINGS 4 17 1 4 17 2 CHECK OF CONTACT OF ELECTRODES Here it is possible to disable or enable the check of contact of the electrodes with the patient s body during therapy From the factory this functio
30. mulation 140 mA HVT 390 V TECHNICAL PARAMETERS OF ELECTROTHERAPY Page 39 of 39
31. n asymmetric positive rectangular pulses are followed by exponential pulses of negative polarity Nowadays the most widespread type of TENS probably because of its favourable effects which are similar to those of DC pulses and electrochemical properties corresponding to AC PULSE FREQUENCY PAUSE In this dialog box it is possible to set basic parameters of the generated TENS TENS pulse length pause between TENSes or TENS frequency All these three parameters are mutually related by the following mathematical relations and therefore during change in one parameter the other ones can change too SETUP AND CONTROLS OF ELECTROTHERAPY Page 14 of 39 4 2 3 4 3 4 3 1 4 3 2 symmetric TENS frequency 1 000 000 2 pulse 1000 pause Hz us ms alternating TENS frequency 1 000 000 2 pulse 2000 pause Hz us ms asymmetric TENS frequency 1 000 000 7 pulse 1000 pause Hz us ms Note The relations are based on the electric waveform of TENS and the manner of their generation ELECTRO PARAMETERS For details see the chapter Pulse Modulation 2 POLE 4 POLE ISOPLANAR AND DIPOLE INTERFERENCE CARRIER FREQUENCY Frequency of the carrier which transports to the tissue for two pole interference or creates in the tissue for four pole interference a low frequency therapeutic surge I mA Carrier frequency high frequency Frequency of therapeutic
32. n is ON We recommend disabling it only if you want to use electrotherapy especially for motor stimulations MEASURING OF ELECTRODES The electrodes which are applied to the patient s body during therapy are subject to ageing which manifests itself by gradual growth of their resistance up to a level where further use is impossible the device keeps displaying the message bad contact of electrodes with the patient The usability time of the electrodes depends especially on the used types of currents This function serves to check the quality of the electrodes The check starts after pressing the start stop button The current status of electrodes is displayed in the bottom part After switching on press the electrodes against each other then the device displays the text result SETUP AND CONTROLS OF ELECTROTHERAPY Page 26 of 39 5 1 RECOMMENDATIONS FOR ELECTROTHERAPY USE OF PLATE ELECTRODES The equipment can work with plate BTL electrodes For plate electrodes use sponge covers moistened with water or therapeutic solution in case of iontophoresis Before first use of the covers it is necessary to rinse them in tepid water Moistening the covers or sponges prevents the patient from being burnt When generating low energy currents TENS apply side 1 of the electrode in the sponge cover to the patient s body One layer of the sponge cover will be between the electrode and the patient s skin For high energy currents recommen
33. nne nnne nennen nnn nnns 34 Microcurrents E E nnne EEE sine sse sasa disais se sana essai asas r se snas nnns 34 Spastic Stimulations according to Hufschmidt cc eeccccseeeeeceeeeeeceeeeeeaeeeeeseeeeeeeeeeeeeseeeeesseeeeesaeeeeeeas 34 High voltage Therapy HVT 35 Modulation Of Current S EEEEEEEEEEEEEEEEEEEEEEEEMM 35 Frequency Sweep Interference cccccccssscecceseecceececceueeccceuseeceececseuececsueeesseeesseueeessageesseusesessgsessages 36 Steps in Setting Parameters cccccscccccssececseseecccescecceuececsesececsuseecceuseessegeeecsgeeessuseessauseeesseseeessasesssageees 36 Maximum Intensity Valli EE 37 Page 4 of 39 GENERAL EFFECT OF ELECTROSTIMULATION Electrotherapy is one of the most widespread types of physical therapy PT When correctly indicated and applied it is very effective However it cannot be taken out of the context of comprehensive therapy not can it be regarded as a Cure all Most of the physical procedures have similar effects and depending on the parameters some of them may be dominant The main effects are e analgesic e myorelaxation trophic and antiedematous By selection of a procedure and its parameters you can select one of the above stated effects or their combination Continuing education is a very important aspect of healthcare delivery Many excellent resources are available today to expand the user s knowledge of many aspects of electrical stimulation thera
34. nostic measuring first find the motor point of the muscle i e the point at which the muscle stimulation is the most significant contraction is initiated by the lowest set value of intensity You should also determine by which electrode cathode or anode the measuring will be done Anode connect the positive electrode red banana plug to the plate electrode as a reference electrode This electrode shall be placed proximally or distally to the treated muscle It is also possible to use a suction cup electrode continuous vacuum mode Cathode the negative electrode black banana plug is connected to the stimulation point electrode To find the motor point it is recommended to use pulses of length approx 5 ms for healthy muscle and approx 100 ms for denervated muscle The pause between pulses should be 2 3 seconds After finding the motor point reverse the polarity of the output current positive polarity negative or shift the electrodes red banana plug to the point electrode and the black one to the reference electrode and measure the muscle sensitivity for the reversed polarity of the signal the stimulation electrode in this case is anode For further stimulation use that connection of electrodes polarity for which the muscle is more sensitive RHEOBASE CHRONAXIE is measured in the motor point of the muscle by rectangular pulses with the electrode polarity which was determined as more sensitive when det
35. nterterence ec cece cecccceececeececeeceeeeeece cece eeeeeeeeseeceseecesseeeseeeesueeeseucessneesseeeesaeeeseseeeseeeseeetsaess 28 2 pole lnterterence cece ccc ccecccceeccceeeecceeeeceeeecaeeeseeeeeseeeeseaeeseaeessaeeesecessacessaeeesaeceseusesseesseaaeesseeeeseeeseas 28 Isoplanar Interference cccccceeccccececceececeeeeeeeeeseececeeceseeeeeaeeceseeeseucessecessaeeeseeesaneetsaeceseueeeeseeesaneessnees 29 Interference Dipole Vector 29 Russian Stimulation 2 2 00 cece eececeeceeceececee cece eeeseeeeeeeeeceeeesseeeeseeeeseeessueeesaeeeseucesaueesseeeeseeeeesseeeseeeesanees 29 Mid frequency Surges mpltude Modulated 29 Page 3 of 39 6 1 8 6 1 9 6 1 10 6 1 11 6 1 12 6 1 13 6 1 14 6 1 15 6 1 16 6 1 17 6 1 17 6 1 19 6 1 20 6 1 20 6 1 22 6 2 6 3 6 4 6 5 PRC ICU EE 30 oA ACL NSS RN TU m T uU u 30 Exponential Pulses Pulses with Exponential ise 30 ENEE 31 Stimulation Pulses for Stimulations according to Electrodiagnostics se nnneennenennenennreennrnnerrreenne 31 Ierd len Ee ME 31 Reetz Ultra ReizZ EE ER Rn e ER Faradic Neofaradc 2 eeececcececeececceceeeeceeaeceeaeceeaeceeaeceeaeceeaeaeeeeneaeeueaeeeaeseeaeseeaeseeaeseeaeaeeseeaeseeaeseeaeeees 32 anu 32 DiadynamMi S rc Rissi 33 Galvanic Current lontophoretic ssssessssssssssesseseeee eene nennen n nnne n
36. portant in acute pain i e first decrypt the information being signalled by the pain properly determine the diagnosis or at least a preliminary hypothesis and only then intervene against the pain Pain modified by PT or analgesics can lose its specificity insomuch that later it cannot be decrypted e Together with the application of analgesic PT it is necessary to considerably reduce the administration of analgesics This rule is very important owing to the possibility of relatively precise focusing of the analgesic effect of PT in contrast to the unfocused effect of medicaments and possible undesired interaction between PT and the medicaments e When choosing the type of PT consider the expected effect gate theory endorphins EFFECTS OF ELECTROTHERAPY Page 9 of 39 3 2 3 3 e For chronic or recurrent complaints do not obstinately apply various types of PT but examine the locomotive system or get it examined by a specialist very often the source of these complaints is far from the place of projection of pain catenation generalization For the stimulation of thick myelinized nerve fibres of A beta and delta types gate theory it is suitable to use low frequency currents of frequency 50 150 Hz optimum 100 Hz and intensity at or above threshold sensitivity This method is effective especially for acute and segmentally localised pains For painful chronic syndromes it is most suitable to use low frequencies of 2
37. py BTL recommends a thorough review of this guide prior to operating the equipment GENERAL EFFECT OF ELECTROSTIMULATION Page 5 of 39 2 1 2 2 2 3 CLASSIFICATION OF ELECTROTHERAPEUTIC CURRENTS GALVANIC CURRENT Galvanic current or continuous is current of constant intensity It is always DC It is used mostly for iontophoresis or its trophic stimulating hyperaemic effect is utilized A great disadvantage of galvanic current is the risk of chemical damage to the tissue under the electrodes The damage may be caused by the hydrochloric acid which originates under the anode or by the soda lye which originates under the cathode A similar danger of tissue damage can also occur with any direct current e g diadynamic Direct currents must not be used on patients with metallic implants At present this current is often substituted by galvanic intermittent current This current has the same effects galvanic component is 95 but thanks to interrupting the originally continuous intensity by the frequency 8 kHz itis better tolerated by patients It is suitable especially for iontophoresis PULSE DIRECT CURRENT Pulse direct current is current of variable intensity but with only one polarity The basic pulse shape may vary It includes e g diadynamics combination of pulse DC dosis and galvanic current basis rectangular e g Trabert current triangular and exponential pulses of one polarity Depending on the
38. rature To understand the effects of electrotherapy it is important to understand especially the modulation factors which can influence the perception and transfer of the painful stimulus e The first crucial modulation factor is described by the so called gate theory of pain which is based on the presumption that the nervous mechanism in posterior medullary horns act as a small gate which lets through only a limited flow of nervous impulses from the peripheral afferent fibres to the central nervous system depending on how much it is opened Stimulation of some particular fibres can modulate the extent of the gate s opening or closing for pain and thus also increase or decrease the transfer of nociceptive information A similar gate system is supposed to exist also on the level of the thalamus e The other important modulation factor is described by the neuromodulation theory which is based on the analgesic effect of some substances belonging to the group of so called neuromodulators especially endorphins and encephalins These substances are produced in the central nervous system and according to the mentioned theory they have crucial importance especially in the subjective perception of pain In any case the analgesic effect of electrotherapy is used most often To make PT of real benefit to the patient it is necessary to observe the following principles e Do not suppress the signalling and protective function of pain which is especially im
39. rge length s stimulation time and pause between surges s relaxation time It is also possible to choose from several pre set values 4 13 5 TRAPEZOID SURGES High energy group of pulses which can cause e g a muscle contraction It is possible to set the trapezoid surge rise time s time of rise of stimulation stimulation time s trapezoid surge fall time s subsiding of stimulation and pause between surges s relaxation time It is also possible to choose from several pre set values 4 13 6 SYMMETRIC SURGES High energy group of pulses which can cause e g a muscle contraction It is actually a symmetric trapezoid surge with a different way of setting It is possible to set the sweep time s i e the stimulation and relaxation time always including rise or fall time and the so called contour i e the ratio between the actual stimulation time and the stimulation rise time It is possible to choose from several pre set values SETUP AND CONTROLS OF ELECTROTHERAPY Page 21 of 39 4 14 INTERFERENCE PARAMETERS 4 14 1 AMF AND SPECTRUM AMF is the basic frequency of therapeutic surges which is created in the tissue by interference e g by a combination of the signal of channel E1 with the signal of channel E2 This applies for four pole interference For two pole interference the surges of the basic frequency AMF are directly transported to the tissue by the carrier Spectrum determines
40. surges low frequency ELECTRO PARAMETERS For details see the chapter Interference Parameters Isoplanar Interference Field Rotation Isoplanar vector field is a special form of four pole interference where amplitude modulation of both channels causes even almost 100 96 modulation in the entire area of the current circuits intersection The nature of these regular amplitude changes of channels corresponds to rotation of the whole field This parameter should best be set to the value which equals the entire sweep time for the continuous and jump sweep it is the sum of all set times for the symmetric sweep set the rotation time equal to the sweep time Dipole Interference Dipole Rotation For the dipole vector field with automatically rotating dipole you can set the speed of rotation of this dipole in the area of the intersection of current circuits In the direction of the dipole the depth of modulation is always maximum in the other directions it is minimum SETUP AND CONTROLS OF ELECTROTHERAPY Page 15 of 39 4 4 4 4 1 4 4 2 4 4 3 4 5 4 5 1 4 5 2 4 5 3 RUSSIAN STIMULATION CARRIER FREQUENCY Frequency of the carrier which transports low frequency therapeutic pulses to the tissue similarly as for two pole interference where the carrier transports low frequency surges there PULSE FREQUENCY DF In this dialog box it is possible to set the frequency of low frequen
41. th the answers the physician should choose the type location intensity frequency and total number of treatments and in relation to them also the date of the check up of the patient EFFECTS OF ELECTROTHERAPY Page 11 of 39 3 7 3 8 CONTRAINDICATIONS FOR ELECTROTHERAPY active TB allergy to the solutions used for moistening the electrode sponge covers application in the area of the heart or eyes pacemaker cardiovascular diseases cochlear implants metal implants and or malignancies in the current path skin defects and inflammations bleeding menstruation tumours defects of sensitivity at the site of the electrode psychopathological syndromes and organic psychosyndromes multiple sclerosis pregnancy inflammations of the veins and lymphatic paths SYMBOLS OF EFFECTS A E T R S Symbols of the effects of therapy used in the equipment have the following meaning A E T R S analgesic antiedematous trophic myorelaxation stimulation EFFECTS OF ELECTROTHERAPY Page 12 of 39 4 SETUP AND CONTROLS OF ELECTROTHERAPY 4 1 COMMON PARAMETERS OUTPUT MODE CC constant current mode in this mode the current flowing through the patient is constant regardless of the impedance of the patient s tissue Owing to physiological effects during electrotherapy the impedance of the tissue decreases which in the normal course of events causes spontaneous rise in the current flowing throug
42. ulse length frequency 0 1 to 900 Hz monophasic 0 1 to 450 Hz symmetric alternating modulation see Modulation of Currents below 6 1 10 EXPONENTIAL PULSES PULSES WITH EXPONENTIAL RISE LA ech PEL LG PN rech type monophasic symmetric alternating pulse 1 to 800 ms pause 0 1 to 10 000 ms monophasic symmetric then by the pulse length 0 1 to 5 000 ms alternating then by the pulse length frequency 0 1 to 900 Hz monophasic 0 1 to 450 Hz symmetric alternating modulation see Modulation of Currents below TECHNICAL PARAMETERS OF ELECTROTHERAPY Page 30 of 39 6 1 11 COMBINED PULSES a type asymmetric pulse 0 2 to 1 000 ms pause 0 5 to 10 000 ms depending on the pulse length frequency 0 1 to 550 Hz modulation see Modulation of Currents below 6 1 12 STIMULATION PULSES FOR STIMULATIONS ACCORDING TO ELECTRODIAGNOSTICS Dn DAA type rectangular triangular monophasic pulse 0 1 to 1 000 ms pause 0 5 to 10s pulse generation sound selection no beep depending on the pulse length 6 1 13 INTERRUPTED PULSES nmm a 4 Hr Hr Hri Hrt type rectangular triangular monophasic symmetric alternating interruption frequency 8 000 Hz duty factor 95 pulse 1 to 30 ms pause 1 to 60 ms monophasic 1 to 30 ms symmetric alternating frequency 11 1 to 500 Hz monophasic 11 1 to 333 Hz symmetric 8 3 to 250 Hz alternating modulation see Modulation of Currents below TECH
43. used frequency and intensity it has stimulating trophic and analgesic effects Generally direct current with variable intensity has the same risks as galvanic current corrosion of the skin surface and therefore requires careful observance of the correct procedure especially the correlation between the applied intensity and the length of application The main effect is stimulation which is important especially below the cathode green negative electrode ALTERNATING CURRENT In comparison with DC alternating current is safer and better subjectively tolerated by the patient The basic pulse shape again may be various rectangular triangular harmonic sinusoidal exponential or combined It can be alternating symmetric or asymmetric The DC component is always zero which prevents chemical damage of the skin under the electrodes Therefore this current also allows long term applications even for patients with metal implants Implanted electronic stimulators such as pacemakers etc are indeed quite contraindicated Nowadays low power pulses TENS Transcutaneous Electrical Nerve Stimulation and interference are gaining ground among alternating currents Use of alternating currents in contact electrotherapy implies much lower stress on the tissue under the electrode For these types of current the capacitive component of skin resistance is involved and also thanks to it these currents are very well tolerated by patients CLAS
44. y switches to measuring by the triangular pulse The set intensity is displayed in the upper box on the screen the lower box displays the current measured value of the accommodation coefficient with verbal diagnosis It is recommended to write in the note whether the stimulation point electrode was cathode or anode 4 15 4 I T CURVE is measured at the motor point of the muscle by a triangular or a rectangular pulse with the electrode polarity which was determined as more sensitive when detecting the motor point l t Curve Options nm This menu includes the following options e edit point to quickly and directly set the pulse length and pause length e delete point to delete the measured point of the curve from the graph e new curve rectangular pulses to add a new l t curve to the graph to be measured by rectangular pulses e new curve triangular pulses to add a new l t curve to the graph to be measured by triangular pulses e delete curve to delete the curve from the graph e import curve to load an l t curve from the equipment s memory to the graph e save curve to save the l t curve e motor point detection e calculation of chronaxie rheobase active only if the graph displays just one curve e calculation of accommodation coefficient active only if the graph displays two curves one measured by triangular pulses and the other by rectangular pulses e calculation of stimulation active only if the graph displa
45. ynamic pulses are derived from It is based on the frequency of the mains for countries with mains frequency 50 Hz Europe Asia set the option 50 Hz 100 Hz for countries with mains frequency 60 Hz you can use the option 60 Hz 120 Hz You can select the option according to your practice but please note that the original basic frequency of diadynamic currents was 50 Hz these currents were discovered accidentally by the dentist Bernard in France see POD BRADSKY J VAREKA Fyzik ln terapie l Praha Grada 1998 Interruption This option switches on the momentary interruption of the generated COON waveform The length of the interruption is 5 us and the repeating frequency of Interruption is 8000 Hz AS for power there is no change in the generated W ld waveform duty factor is 96 96 but the patient s tolerance is higher SETUP AND CONTROLS OF ELECTROTHERAPY Page 17 of 39 4 7 PULSES RECTANGULAR TRIANGULAR EXPONENTIAL AND WITH EXPONENTIAL RISE COMBINED INTERRUPTED 4 7 1 TYPE monophasic pulses of only one polarity ATTENTION These pulses have galvanic effect symmetric the positive pulse is immediately followed by the negative one alternating the positive pulses regularly alternate with the negative ones asymmetric combined positive rectangular pulses are folowed by exponential pulses of iun negative polarity Their effects are similar to those of DC pulses but the electrochemi
46. ys two curves measured by triangular pulses i t Curve Properties On this screen define the name of the l t curve and supplementary information and assign it to the patient SETUP AND CONTROLS OF ELECTROTHERAPY Page 24 of 39 4 16 4 16 1 4 16 2 i t Curve Measuring To move along the time axis and change the length of the generated pulse turn the time stop knob To set the intensity of the generated pulse turn the intensity knob To insert the set value of intensity to the graph press the time stop knob Plastic buttons gt gt and lt lt on the screen serve to select which of the displayed l t curves will be active this curve will then be dealt with in the menu and during measuring etc COMBINED THERAPIES POLARITY OF ULTRASOUND HEAD Polarity of the ultrasound head is set on the display e anode in this case select on the display for generator E1 or on the electrotherapy display the output polarity positive e cathode in this case select on the display for generator E1 or on the electrotherapy display the output polarity negative The other electrode to be connected to the patient is the reference electrode of the respective electrotherapy generator as standard E1 This electrode is connected to the output on the electrotherapy preferably by the black cable SETTING PARAMETERS OF COMBINED THERAPY BTL 4000 Topline Combi Devices Combined therapies can be started from the e
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