Operating instructiOns – english
Contents
1. P19 STIMULATION WITH ACTIVE REST Smaller muscle groups Frequency work 50 Hz Frequency rest 8 Hz Pulse duration 200 us Work time 10 sec Rest time 10 sec Ramp up time work 2 sec Ramp down time work 2 sec Ramp up time rest 1 sec Ramp down time rest 1 sec Total program time min P20 STIMULATION WITH ACTIVE REST Larger muscle groups Frequency work 50 Hz Frequency rest 8 Hz Pulse duration 400 us Work time 10 sec Rest time 10 sec Ramp up time work 2 Sec Ramp down time work 2 Sec Ramp up time rest 1 sec Ramp down time rest 1 sec Total program time min P21 STRENGTHENING Upper extremities Frequency 1 Frequency 2 Pulse duration Work time Rest time Ramp up time Ramp down time Total program time P22 STRENGTHENING Lower extremities Frequency 1 Frequency 2 Pulse duration Work time Rest time Ramp up time Ramp down time Total program time P23 STRENGTHENING Back and trunk Frequency 1 Frequency 2 Pulse duration Work time Rest time Ramp up time Ramp down time Total program time 25 Hz 45 Hz 200 us 5 sec 8 sec 2 Sec 1 sec min 45 Hz 65 Hz 400 us 5 sec 8 sec 2 1 sec min 30 Hz 50 Hz 300 us 5 sec 8 sec 2 sec 1 sec P24 RECOVERY Smaller muscle groups Frequency Pulse duration Total program time P25 RECOVERY Larger muscle groups Frequency Pulse duration Total program t2. Frequency 2 Preset 15 Hz Range 2 120 Hz Modulation time Preset 55 Range 5 15 s Time Preset min Range 1 99 min Level 1 Level 2 Level 3 Conventional Pulse duration Preset 180 us Range 50 400 ys Frequency work Preset 80 Hz Range 1 120 Hz Frequency rest Preset 0 Hz Range 0 10 Hz Work time Preset 3 s Range 1 30 s Rest time Preset 10 s Range 5 60 s Ramp up time work Preset 2 s Range 0 10 s Ramp down time work Preset 2 s Range 0 10 s INTERMITTENT I SIMULTANEOUS 51 Frequency modulation FM Pulse duration Preset 180 15 Range 50 400 ps Frequency work 1 Preset 5 Hz Range 2 120 Hz Frequency work 2 Preset 15 Hz Range 2 120 Hz Frequency rest Preset 0 Hz Range 0 10 Hz Work time Preset 55 Range 5 30 s Rest time Preset 10 s Range 5 60 s Ramp up time work Preset 2 s Range 0 10 s ALTERNATING ALT Pulse duration Preset 180 us Range 50 400 us Frequency work Preset 80 Hz Range 1 120 Hz Work time Preset 3 s Range 1 30 s Ramp up time work Preset 2 s Range 0 10 s Ramp down time work Preset 2 s Range 0 10 s Rest time Preset 10 s Range 5 60 s Time Preset min Range 1 99 min Time Ramp down time work Preset min Preset 25 Range 0 10 s Frequency between 1 5 Hz gt Burst stimulation Other frequency gt Conventiona
3. 99 5 mA Symmetrical biphasic pulse 100 compensated Number of preset 27 Number of custom 3 Stimulation Conventional Burst Modulated frequency pulse duration Mixed frequency Alternated modulated pulse duration CEFAR Flow TENS Intermittent Max pulse 400 us Max frequency 120 Hz INCL ahs Sau eon dk ae oe 1 to 99 min Off Environment for storage use and Temperature 10 C 40 C Air humidity 30 75 Air pressure 700 hPa 1060 hPa Power 2 x 1 5 V AA non rechargeable or 2 x 1 2 V AA rechargeable batteries Current consumption for one channel 80 Hz 30 MA 150 mA EMS max channel 31 mA BC toda dt wbx hehe oe eee Bae dos 120 x 50 x 30 mm Weight ca 180 g KEY TO THE SYMBOLS A Read the operating instructions before to use Patient part type Body Floating Dispose of the worn out stimulator in accordance with local and national regulations One or more of the following markings may appear on your device 0413 Complies with the European Medical Device Directive 93
4. a fracture Goal 1 Increased strength in the anterior tibial muscle and in the peroneus longus and brevis 2 Reduced spasticity 3 Improved walking 4 Increased mobility of the ankle Placement of electrodes 1 Place one pair of electrodes over the anterior tibial muscle Placement of electrodes 2 Place one pair of electrodes on the peroneus longus and brevis Suggested programs CEFAR REHAB X2 9 11 13 LOWER LEG ACHILLES RELATED PROBLEMS Examples of indications Achilles related problems Goal Concentric or eccentric increase in strength in the gastrocnemius muscle Placement of electrodes Place one pair of electrodes over the gastroc nemius Suggested programs CEFAR REHAB X2 10 12 14 LOWER LEG ALTERNATING STIMULATION Examples of indications Reduced mobility of the plantar flexion and dorsal flexion of the ankle Goal 1 Increased plantar and dorsal mobility in the foot 2 Reduced spasticity Placement of electrodes Place one pair of electrodes over the anterior tibial muscle and one pair over the gastrocnemius Suggested programs CEFAR REHAB X2 18 ANKLE INSTABILITY Examples of indications 1 Ankle instability after distorsion etc 2 Pes planus flatfoot Goal Increased stability of the ankle and increased strength in the posterior tibial muscle Placement of electrodes Place one pair of electrodes over the lower part of the posterior tibial muscle
5. change this value by pressing the INCREASE or DECREASE button V The valid range for the parameter is shown in the pro gramming chart Press the PROGRAMMING CONFIRMATION button to confirm your setting You are now moved to the next stage if any in the programming procedure Repeat step 7 and 8 until the parameter value in the last stage is set 10 The programming procedure is finished and you will automatically exit the programming mode The new program is now selected and ready for use The program is also stored in the stimulator for future use A custom program can be changed by redoing the programming Programming chart Level 1 Programming CEFAR REHAB X2 P28 P29 P30 See the programming chart on next page for intermittent stimulation Level 3 Conventional Frequency Preset 80 Hz Range 1 120 Hz Pulse duration Preset 180 us Range 50 400 ys Time Preset min Range 1 99 min Frequency Preset 2 Hz Range 1 5 Hz Time Preset min Range 1 99 min Pulse width duration modulation PWM Frequency Preset 80 Hz Range 2 120 Hz Pulse duration 1 Preset 70 ps Range 50 400 ys Pulse duration 2 Preset 180 us Range 50 400 ys Modulation time Preset 3 s Range 1 10 s Time Preset min Range 1 99 min Frequency modulation FM Pulse duration Preset 180 us Range 50 400 us Frequency 1 Preset 5 Hz Range 2 120 Hz
6. create a hazardous situation 4 OVERVIEW CONTROL BUTTONS 1 ON OFF Turns the stimulator on and off Turns the stimulator off even when the key lock is activated Can be used for terminating the stimulation at all times 2 INCREASE left and right channel Increases the amplitude intensity of stimulation Press and hold the button to increase the amplitude continuously Note Always increase the amplitude cautiously Terminates AUTO stimulation mode Increases the number of minutes when setting the timer right button Used when turning the program lock on and off left button Scrolls through choices in programming 3 DECREASE left and right channel Decreases the amplitude intensity of stimulation Press and hold the button to decrease the amplitude continuously Deactivates the key lock Terminates AUTO stimulation mode Decreases the number of minutes when setting the timer right button Used when turning the program lock on and off left button Scrolls through choices in programming 4 AUTO left and right channel Starts the AUTO test mode Confirms the selected amplitude level in AUTO test mode 5 PROGRAM Selects a program P1 P30 Use P to step forward through the programs and P to step backward Pauses an ongoing program Used when activating deactivating the program lock P 6 TIMER Initiates the timer setting PROGRAMMING CONF
7. on programs P4 P5 see chapter FREQUENTLY ASKED QUESTIONS 1 CONVENTIONAL TENS High frequency stimulation that causes a ting ling sensation This is often the first choice for both acute and long term pain Frequency 80 Hz Pulse duration 180 us Total program time min P2 BURST TENS Low frequency stimulation that produces visible muscle contractions The pain relief sets in slower but lasts longer than conventional TENS Frequency 2 Hz Pulse duration 180 us Total program time min P3 MODULATED PULSE DURATION TENS A type of high frequency stimulation where the pulse duration varies continuously This can cause an undulating sensation which may be more pleasant than constant pulse duration Frequency 80 Hz Pulse duration 1 70 us Pulse duration 2 180 us Modulation time 2 sec Total program time min P4 MIXED FREQUENCY TENS A combination of high and low frequency stimulation which can lead to a more effective pain relief treatment Frequency 1 80 Hz Frequency 2 burst 2 Hz Pulse duration 180 us Modulation time 3 3 sec Total program time min P5 FLOW TENS An alternating stimulation causing a massaging and pumping effect that can be used for pain relief and increased circulation in the stimu lated area Always use 2 channels and 4 elec trodes Frequency 80 Hz Pulse duration 1 70 us Pulse duration 2 180 us Modulation time 2 sec Total program time min GUID
8. pairs of electrodes across the abdomen if you are preg nant The reason is that theoretically the current could affect the foetus s heart although there are no reports of it being harmful If skin irritation should occur treatment should be temporarily discontinued If problems continue contact your health care provider Hypersensitivity to tape and gel can occur in isolated cases The problem usually disappears when the tape or gel is changed to another type Do not use electrodes with a surface lt 16 cm as there will be a risk of suffering a burn injury Caution should always be exercised with current densities gt 2 mA cm Observe caution when using electrotherapy at the same time as the patient is connected to monitoring equipment with body worn electrodes The stimulation might interfere with the signals to the monitoring equipment Never open the battery cover during stimulation in order to avoid electrical shock Turn off the stimulation before removing the electrodes from the skin If an electrode comes off turn off the stimula tion before picking it up Getting electrical stimulation through the fingers is unpleasant but not harmful Observe caution when stimulating in the immediate vicinity of cellular phones that are switched on since this may affect the output power of the stimulator Observe caution if you use the stimulator while driving Unintentional stimulation changes might extract focus from the driving and
9. start again for any reason press the AUTO button again to start over 8 REPEAT THE AUTO TEST FOR THE OTHER CHANNEL Repeat steps 6 7 for the other channel 9 THE STIMULATION STARTS The program starts after a few seconds and the amplitude is automatically adjusted to an optimal level of stimulation lf the hand switch is connected you can start using it now Even if you are in AUTO stimulation mode you can increase or decrease the amplitude at any time by press ing the INCREASE or DECREASE buttons VU until the stimulation feels pleasant If doing so the automatic amplitude setting is lost SPECIAL INSTRUCTIONS Mixed frequency stimulation P4 Mixed frequency stimulation is a combination of high 80 Hz and low 2 Hz frequency stimulation with separate amplitude settings 1 First set the amplitude for 80 Hz stimulation when the upper part of the high low frequency symbol is flashing 2 When the bottom part of the symbol flashes for the first time the amplitude for 2 Hz stimulation will Start at the same level as is set for 80 Hz Adjust the amplitude until you get visible muscle contractions The period between the frequency changes is preset to 3 seconds See chapter FREQUENTLY ASKED QUESTIONS for further information on mixed frequency stimulation Intermittent stimulation hand switch P9 P23 Programs 9 23 are intermittent stimulation programs 2 9 with rest time between the muscle contractions work time see
10. the trapezius rhomboid muscles and one over the infraspinatus teres minor Suggested programs CEFAR REHAB X2 9 11 13 UPPER ARM REDUCED FUNCTION IN BRACHIAL BICEPS Examples of indications 1 Reduced function in the brachial biceps for example after a fracture or spinal injury 2 Reduced supination of the elbow Goal 1 Increased strength and endurance in the brachial biceps 2 Increased supination of the elbow Placement of electrodes Place one pair of electrodes over the brachial biceps Suggested programs CEFAR REHAB X2 9 11 13 19 UPPER ARM REDUCED FUNCTION IN BRACHIAL TRICEPS Examples of indications 1 Reduced function in the brachial triceps for example after a stroke 2 Elbow fracture Goal 1 Increased strength in the brachial triceps and increased control of the elbow 2 Increased strength in the brachial triceps Placement of electrodes Place one pair of electrodes over the brachial triceps Suggested programs CEFAR REHAB X2 9 11 13 19 UPPER ARM ALTERNATING STIMULATION Examples of indications Extension flexion defect in the elbow Goal 1 Increased mobility of the extension flexion of the elbow 2 Reduced spasticity Placement of electrodes Place one pair of electrodes over the brachial triceps and one pair over the brachial biceps Suggested programs CEFAR REHAB X2 17 18 LOWER ARM REDUCED STRENGTH HYPOTROPHY IN THE HAND EXTENSORS
11. 42 EEC Notified body Intertek ETL Semko 0413 Complies with CSA 22 2 69050 1 Certification mark issued by 509 INFORMATION RELATED TO ELECTROMAGNETIC COMPATIBILITY EMC CEFAR REHAB X2 is designed to be used in typical domestic or clinical environments and is approved according to the EMC safety standard of EN 60601 1 2 CEFAR REHAB X2 emits very low levels in the radio frequency RF interval Therefore it is not likely to cause any interference in nearby electronic equipment radios computers telephones CEFAR REHAB X2 is designed to withstand foreseeable disturbances originating from electrostatic discharg es mains supply magnetic fields and radio frequency transmitters Such as mobile telephones CLINICAL GUIDE INTRODUCTION This clinical guide gives tips and practical advice on how to use the CEFAR REHAB X2 to treat common orthopedic and neurological indications The guide is organized by indication area For each indication the guide gives the goal of treatment and suggestions for where to place the electrodes NMES is an active training method and the pictures show how NMES can be integrated with training For each indication appropriate programs are suggested but custom programs can also be created for patient specific treatment A program with a short pulse duration 200 us is ideal for treating smaller muscle groups while a longer pulse duration 350 400 us is better for larger muscle g
12. E TO INTRAMUSCULAR INJECTIONS A program used to increase the precision of intramuscular botox botulinum toxin injec tions These injections are used for spasticity dystonia facial hemispasm and bruxism Frequency 1 Hz Pulse duration 50 us Total program time min PRESET PROGRAMS NMES CEFAR REHAB X2 has 21 preset NMES programs covering warm up rehabilitation strengthening recovery and massage In the clinical guide last in this manual is a list of indications with suggested treatment programs and electrode placements for each indication P9 P16 and P19 P23 can be used together with the hand switch which makes it easy to manually control muscle contractions P7 WARM UP SHORT P11 INTERMITTENT STIMULATION Frequency 1 2 Hz Smaller muscle groups Frequency 2 8 Hz Frequency 65 Hz Pulse duration 300 us Pulse duration 200 us Modulation time 10 sec Work time 6 sec Total program time min Rest time 8 sec Ramp up time 2 sec P8 WARM UP LONG Ramp down time 2 sec Frequency 1 H Total program time min Frequency 2 8 Hz Pulse duration 300 us P12 INTERMITTENT STIMULATION Modulation time 10 sec Larger muscle groups Total program time min Frequency 65 Hz Pul ti 4 INTERMITTENT STIMULATION sons oe Smaller muscle groups p Rest time 8 sec Frequency Ramp up time 2 sec Pulse duration 200 us Ramp cown time 2 Work time Total program time min Rest time 4 sec Ramp up t
13. Examples of indications 1 Reduced wrist extension and or flexion spas ticity for example after a stroke 2 Reduced wrist extension after fracture Goal 1 Facilitation and reduced spasticity 2 Increased mobility of the wrist and increased strength in the hand extensor muscles Placement of electrodes Place one pair of electrodes over the hand extensor muscles Suggested programs CEFAR REHAB X2 9 11 13 15 LOWER ARM ALTERNATING STIMULATION Examples of indications Reduced extension and flexion of the wrist Goal 1 Increased extension and flexion of the wrist 2 Reduced spasticity Placement of electrodes Place one pair of electrodes over the hand extensor muscles and one over the hand flexor muscles Suggested programs CEFAR REHAB X2 17 HAND THUMB EXTENSION Examples of indications 1 Reduced extension of the thumb 2 Flexor spasticity in the thumb Goal 1 Increased extension of the thumb 2 Reduced spasticity in the thumb Placement of electrodes Place a small oval electrode over the extensor pollicis brevis and a small round one proximal to the oval one Suggested programs CEFAR REHAB X2 9 11 13 15 HAND REDUCED OPPOSITION GRIP ABILITY Examples of indications Reduced opposition grip ability Goal Increased opposition and improved grip Placement of electrodes Place a small electrode over the thenar muscles and another small one over the hypothenar muscles Sugg
14. IES A battery symbol is shown on the display when the batteries are almost empty As long as the stimulator is working normally you can continue the treatment When stimulation feels weaker than usual or the stimulator turns off it is time to replace the batteries If the stimulator is not used for some time approximately 3 months the batteries should be removed from the stimulator The stimulator operates on either two non rechargeable 1 5 V AA batteries or two rechargeable 1 2 V AA batteries recharged in a separate charger REPLACING THE BATTERIES 1 Locate the battery compartment on the back of the stimulator on Aa WwW N Turn off the stimulator Remove the battery cover by pressing the mark at the top firmly and sliding the cover downwards Remove the batteries Insert the new batteries correctly according to the polarity markings and inside the battery com partment see picture Replace the battery cover Dispose of the exhausted batteries in accordance with local and national regulations NOTE Non rechargeable batteries may not be charged due to the risk of explosion 1 PROGRAMS PRESET PROGRAMS TENS CEFAR REHAB X2 has six preset TENS programs for pain relief The program overview below shows the stimulation mode and parameter settings for each program For information on treating various pain condi tions with TENS see the clinical guide last in this manual For further information
15. IRMATION S SET Turns the stimulator into programming mode for cus tom programs P28 P30 when pressed for 2 seconds Confirms settings in programming mode HAND SWITCH CONNECTION By using the hand switch the contractions in pro grams with intermittent stimulation can be manually controlled 9 CABLE HOLDER Professional use DISPLAY SYMBOLS 1 BROKEN CIRCUIT left and right channel Broken circuit The reason for a broken circuit may be too high resistance or cable breakage See chapter TROUBLESHOOTING 2 PAUSE Paused program 3 KEY LOCK Activated key lock The key lock is automatically activated if no key is pressed for 20 seconds Deactivate the key lock by pressing the left or right DECREASE button 4 PROGRAM LOCK Activated program lock 5 BATTERY STATUS Empty batteries This symbol is only shown when the batteries are almost empty 6 PROGRAM NUMBER Selected program number 7 REMAINING TIME Remaining program time in minutes and seconds Time is flashing during timer setting 8 AUTO STIMULATION MODE CEFAR EASY TOUCH left and right channel Activated automatic amplitude setting AUTO is flashing during test mode and steady during stimulation 9 AMPLITUDE BARGRAPH left and right channel Selected amplitude as a bargraph 10 AMPLITUDE LEVEL left and right channel Current of selected amplitude in mA not shown in AUTO stimulation mode 11 WORK REST intermittent stimulation Work re
16. OPERATING INSTRUCTIONS ENGLISH BEFORE USING THE STIMULATOR 4 2 MEDICAL BACKGROUND 0 PRECAUTIONARY MEASURES siscssccassctsesrastesscnasscessteansensecantesan 6 PATIENT INFORMATION As OVERVIEW 7 CON ROE DUTON tsetse neal 7 E TE 8 OPERATION rece ES 9 9 CEFAR EASY TOUCH AUTO STIMULATION 11 SPECIAL INSTRUCTION Sicistinae 12 cere teeter 13 PROGRAM PAUSE aaeain aE 13 O REPLACEMENT OF BATTERIES 14 PROFESSIONAL INFORMATION J PROGRAMS 15 PRESET PROUGRAMO 15 CUSTOM PROGRAMS 19 PROGRAM LOCH na A 23 DISABLE THE AUTO FUNCTION 23 23 ADDITIONAL INFORMATION i ACG eyo OIE 24 9 CARE Nd 24 10 TROUBLE 25 11 FREQUENTLY ASKED QUESTIONS 26 TECHNICAL DAP 28 THE SYMBOLS 29 APPENDIX CUNCA ODE 30 1 INTRODUCTION CEFAR Medical has been a medical supplier of electrotherapy products for more than 30 years The company was established in Sweden in 1975 and is today one of Europe s leading companies in electro therapy The Cefar stimu
17. Suggested programs CEFAR REHAB X2 9 11 13 FOOT HALLUX VALGUS Examples of indications Hallux valgus Goal Increased abduction of the big toe Placement of electrodes Place one pair of electrodes over the abductor hallucis Suggested programs CEFAR REHAB X2 9 11 13
18. art of the work rest symbol is flashing increase the amplitude gradually until you get muscle vibrations See chapter FREQUENTLY ASKED QUESTIONS for further information on Active Rest TIMER The treatment time is preset but the timer function allows you to set the treatment time yourself You have the option to change the timing from to 99 minutes If you choose to stay on the stimulation will go on until you stop the stimulation manually To set the timer 1 Select a program and start the stimulation see section STEP BY STEP USE 2 Press the TIMER button to initiate the timer function 3 Increase the time by pressing the right INCREASE button The time is increased by 1 minute each time you press the button Decrease the time by pressing the right DECREASE button V The time is decreased by 1 minute each time you press the button The time is flashing on the display while setting the timer 4 Press the TIMER button to confirm the timer setting PROGRAM PAUSE You can pause the programs up to five minutes To pause a program 1 If key lock is on press any of the DECREASE buttons V to deactivate it 2 Press any of the PROGRAM buttons or to pause the program Start stimulation again by pressing any of the PROGRAM buttons P j or P J If stimulation is paused for more than five minutes the stimulator turns off automatically to spare batteries 6 REPLACEMENT OF BATTER
19. elenburg reduced function in hip abductors 2 Post stroke treatment Goal 1 Increased strength in hip abductors 2 Improved gait Placement of electrodes Place one pair of electrodes over the hip abductors and tensor fasciae latae Suggested programs CEFAR REHAB X2 12 14 16 KNEE INSTABILITY Examples of indications 1 Postoperative after ACL knee operation 2 Extension defect 3 Post stroke treatment Goal 1 Increased control of the quadriceps 2 Increased mobility and decreased pain in the knee Placement of electrodes Place one pair of electrodes over the quadriceps Suggested programs CEFAR REHAB X2 12 14 16 KNEE MUSCULAR IMBALANCE Examples of indications Muscular imbalance in the medial vastus in relation to the lateral vastus Goal Increased strength in the medial vastus Placement of electrodes Place one pair of electrodes over the medial vastus Suggested programs CEFAR REHAB X2 10 12 14 KNEE ALTERNATING STIMULATION Examples of indications Reduced flexion and extension of the knee Goal 1 Increased mobility of the knee 2 Reduced spasticity Placement of electrodes Place one pair of electrodes over the quadriceps and one pair over the hamstrings Suggested programs CEFAR REHAB X2 18 LOWER LEG REDUCED DORSAL FLEXION AND PRONATION Examples of indications 1 Reduced dorsal flexion after e g a stroke 2 Reduced dorsal flexion after
20. ent to other pharmacological and or physical treatments TENS does not always treat the cause of pain Consult your doctor if pain persists 3 PRECAUTIONARY MEASURES Inspect the equipment prior to use Use the stimulator only as stated in the operating instructions Only Cefar accessories should be used with the stimulator WARNING People with implanted electronic equipment such as pacemakers and intracardiac defibrillators must not be treated with CEFAR REHAB X2 Pregnant women should not be treated with CEFAR REHAB X2 during the first trimester 12 weeks Due to the location of the carotid arteries and the carotid bodies do not stimulate the front or sides of the neck since a drop in blood pressure can occur Stimulation should not take place while the user is connected to high frequency surgical equipment It may cause burn injuries on the skin under the electrodes as well as problems with the stimulator Do not use the stimulator in the vicinity of shortwave or microwave therapy equipment since this may affect the output power of the stimulator Keep the stimulator out of reach of children CAUTION Stimulate with precaution while treating angina pectoris and the thoracic region on patients with cardiac arrhythmia The electrodes are only to be placed on healthy skin Avoid skin irritation by ensuring that good contact is achieved between electrodes and skin Do not place electrodes directly over the uterus or connect
21. eset work time With the hand switch connected the rest time will last until you press the hand switch button Without hand switch the rest time is preset and depending on the program you use Note The preset work time can be shortened but not extended It is therefore preferable to use a program with a longer work time when using the hand switch Note When using CEFAR EASY TOUCH the AUTO stimulation mode must have started before you press the hand switch button Note The hand switch does not work during alternating stimulation 17 18 WHAT DOES ACTIVE REST MEAN It means that low frequency stimulation is active during rest time causing muscle vibrations to maintain circulation The Active Rest stimulation helps eliminate lactic acid and waste products thereby reducing muscle soreness afterwards and keeping the muscle prepared for the next contraction Note The amplitude level must be set for both contractions and Active Rest HOW LONG WILL THE ELECTRODES LAST The self adhesive electrodes last for approximately 20 to 40 occasions The durability depends on how good the care and maintenance instructions are followed WHICH DISTANCE SHOULD HAVE BETWEEN THE ELECTRODES It is recommended to have a distance of 3 to 30 cm between the electrodes HOW DO FIND THE OPTIMAL POSITION OF THE ELECTRODES FOR NMES Use carbon rubber electrodes and gel Slide the electrodes slowly over the muscle while stimulating at 2 Hz The optimal po
22. ested programs CEFAR REHAB X2 9 11 13 15 TRUNK THORACIC SPINE HYPOMOBILITY Examples of indications 1 Thoracic hypomobility 2 Increased thoracic kyphosis Goal 1 Mobility training of the thoracic spine 2 Improved posture Placement of electrodes Place two pairs of electrodes along the spinal erector muscles paravertebrally and over the rhomboid muscles at the height of the hypomobile area Suggested programs CEFAR REHAB X2 10 12 14 p TRUNK LOWER BACK AWARENESS TRAINING OF BACK EXTENSORS Examples of indications Pain insufficiency in lower back Goal 1 Increased awareness of the trunk muscles 2 Increased postural control 3 Increased stability Placement of electrodes Place two pairs of electrodes paravertebrally in the lumbar region along the spinal erector muscles on both sides Suggested programs 2 10 12 14 p TRUNK AWARENESS TRAINING OF ABDOMINAL MUSCLES Examples of indications Reduced function in the abdominal muscles Goal 1 Increased strength in the abdominal muscles 2 Increased awareness of the trunk muscles 3 Increased postural control 4 Increased stability Placement of electrodes Place two pairs of electrodes over the abdomi nal muscles bilaterally Suggested programs CEFAR REHAB X2 10 12 14 HIP POSITIVE TRENDELENBURG Examples of indications 1 Positive Trend
23. figure The contraction gradually increases 4 during ramp up time and reaches maximum contraction 1 time 3 Ramp down time during work time During ramp down time the stimulation gt Worktime A Rest time gradually decreases until the rest time starts The rest time can be without or with stimulation Active Rest In intermittent stimulation programs the work rest symbol is shown on the display The upper part of the symbol is flashing during work time and the bot tom part during rest time Programs P9 P16 and P19 P23 can be used together with the hand switch to manually control the duration of the work time and rest time Press the hand switch button during rest time for ramp up time and contrac tion The duration of the work time is preset but can be shortened by pressing the hand switch button The rest time lasts until the hand switch button is pressed again See chapter FREQUENTLY ASKED QUESTIONS for further information on using the hand switch Intermittent stimulation with Active Rest P19 P20 In programs with Active Rest the stimulation is active also during the rest time which means that you have to perform two amplitude settings for each channel Amplitude setting for contractions work time When the upper part of the work rest symbol is flash ing increase the amplitude gradually until you get muscle contractions without pain Amplitude setting for Active Rest When the bottom p
24. gel drying out does not apply to adhesive gel They must then be taken off washed and dried before being applied again This is especially important for persons with sensitive skin In connection with stimulation make sure that the electrodes are firmly in place When using carbon rubber electrodes use plenty of electrode gel and avoid drying out by applying tape around all the edges of the electrodes Rinse the carbon rubber electrodes and the skin with water after use Do not use detergent for the electrodes Self adhesive multi use electrodes are re moistened if necessary with a few drops of water and kept air tight in a plastic bag on protective paper when they are not in use Never expose the stimulator to water Wipe it off with a damp cloth if necessary Do not jerk cables or connections The cables are best preserved if left attached to the stimulator between sessions 10 TROUBLESHOOTING THE STIMULATION DOES FEEL THE SAME AS USUAL Check that all settings are correct see section STEP BY STEP USE and make sure that the electrodes are correctly placed Slightly change the position of the electrodes THE STIMULATION FEELS UNPLEASANT The skin is irritated For advice on skin care see chapter PRECAUTIONARY MEASURE The electrodes begin to lose their stickiness and do not stick properly to the skin Moisten the adhesive surface with a few drops of water before placing on the skin The electrodes are wo
25. ic neuralgia Goal Pain alleviation Placement of electrodes Place one pair of electrodes bilaterally over and under the painful area Suggested programs CEFAR REHAB X2 1 3 BACK NEUROGENIC PAIN Examples of indications Sciatica Goal Pain alleviation Placement of electrodes Place electrodes over a muscle in the affected area Suggested programs CEFAR REHAB X2 1 2 4 p 0 LJ BACK NOCICEPTIVE MUSCLE PAIN Examples of indications 1 Lumbalgia 2 Low back pain Goal Pain alleviation Placement of electrodes In the painful area e g erector spinae gluteal muscles Suggested programs CEFAR REHAB X2 1 3 4 5 p 0 LJ SHOULDER SUBLUXATION AND REDUCED ABDUCTION Examples of indications 1 Subluxated shoulder for example after a stroke 2 Reduced muscular function in the shoulder after a fracture luxation etc Goal 1 Increased stability centralizing the head of the humerus 2 Increased function strength in the shoulder muscles Placement of electrodes Place electrodes around the shoulder over M Deltoid and M Supraspinatus Suggested programs CEFAR REHAB X2 9 11 13 15 SHOULDER REDUCED STRENGTH HYPOTROPHY Examples of indications Reduced strength in external rotation of the shoulder Goal Increased strength and endurance in the infraspinatus rhomboid muscles and teres minor muscles Placement of electrodes Place one electrode over the middle of
26. ime P26 MASSAGE Smaller muscle groups Frequency 1 Frequency 2 Pulse duration Modulation time Total program time P27 MASSAGE Larger muscle groups Frequency 1 Frequency 2 Pulse duration Modulation time Total program time 4 Hz 200 us min 4 Hz 400 us min 5 Hz 15 Hz 200 us 5 sec min 5 Hz 15 Hz 400 us 5 sec min CUSTOM PROGRAMS With the CEFAR REHAB 2 it is possible to create and store three custom programs P28 P30 for patient specific treatment To create a custom program follow the programming procedure below To use a custom program follow the instructions in the section STEP BY STEP USE Programming 1 Press the ON OFF button to turn the stimulator on 2 Press the PROGRAM button P or P to step forward or backward until Program 28 29 or 30 is shown on the display Select one of these programs 3 Press the PROGRAMMING CONFIRMATION button for 2 seconds to enter the programming mode See the programming chart for the following steps 4 Level 1 shown in the upper right corner of the display The first step in the programming procedure is to choose between e Continuous stimulation e Intermittent I stimulation Press the INCREASE or DECREASE button V to toggle between and I Confirm your choice by pressing the PROGRAMMING CONFIRMATION button You are moved to the next stage in the programming procedure 5 Level 2 For Con
27. ime 2 sec P13 INTERMITTENT STIMULATION Ramp down time 2 sec Smaller muscle groups Total program time mN Frequency 50 Hz P10 INTERMITTENT STIMULATION Larger muscle groups 5 group Rest time 10 sec Frequency 50 Hz Ramp up time 1 sec Pulse duration 400 us Ramp cown time eee Work time 4 Total program time min Rest time 4 sec Ramp up time 2 sec Ramp down time 2 sec Total program time min P14 INTERMITTENT STIMULATION Larger muscle groups Frequency 50 Hz Pulse duration 400 us Work time 10 sec Rest time 10 sec Ramp up time 1 sec Ramp down time 2 sec Total program time min P15 INTERMITTENT STIMULATION Neurology smaller muscle groups Frequency 40 Hz Pulse duration 200 us Work time 5 sec Rest time 15 sec Ramp up time 4 sec Ramp down time 2 sec Total program time min P16 INTERMITTENT STIMULATION Neurology larger muscle groups Frequency 40 Hz Pulse duration 400 us Work time 5 sec Rest time 15 sec Ramp up time A sec Ramp down time 2 Sec Total program time min P17 ALTERNATING STIMULATION Smaller muscle groups Frequency 50 Hz Pulse duration 200 us Work time 4 sec Rest time 6 sec Ramp up time 1 sec Ramp down time 1 sec Total program time min P18 ALTERNATING STIMULATION Larger muscle groups Frequency 50 Hz Pulse duration 400 us Work time 4 sec Rest time 6 sec Ramp up time 1 sec Ramp down time 1 sec Total program time min
28. imultaneously for 2 seconds 3 The left side of the display shows the usage time in hours and the right side in minutes To reset the usage time press the right DECREASE button VU for 2 seconds 4 Wait for 5 seconds or press the TIMER button 5 The left side of the display shows the total usage time in hours and the right side in weeks The total usage time cannot be reset 6 Wait for 5 seconds or press the TIMER button to exit compliance mode 8 ACCESSORIES REHAB X2 comes with neck strap and a belt clip allowing you to wear the stimulator around your neck or on your belt and have your hands free during treatment The electrodes will eventually wear out and have to be replaced It is recommended to replace the elec trodes after approximately 20 40 times of usage The hand switch included can be used in some NMES programs for full manual control of the time of contractions The cables are best preserved if left attached to the stimulator between sessions For purchase information contact your Cefar dealer or visit www cefar se 9 CARE INSTRUCTIONS Taking care of and cleaning the Cefar equipment is simple with the following instructions Keep stimulator and accessories in the original case when they are not in use It may however be practical to allow the electrodes to remain on the body between treatments Carbon rubber electrodes can generally remain for 2 3 hours without the electrode
29. ith electrodes attached to the skin for transmitting electrical impulses into the body The impulses stimulate the nerves to send signals to a specifically targeted muscle which reacts by contracting just as it does with normal muscular activity Electrical muscle stimulation is suitable for all the muscles in the body It can be used to strengthen muscles weakened by surgery a fracture etc and improve mobility It is also an excellent tool for stroke rehabilitation helping patients in handgrip and gait training Electrical muscle stimulation for rehabilitation purposes should be tried out individually by a physiothera pist or other caregiver for the best results TENS TENS Transcutaneous Electrical Nerve Stimulation gives good results in acute and chronic pain condi tions of many kinds It is clinically proven and used daily by physiotherapists other caregivers and top athletes around the world High frequency TENS activates the pain inhibiting mechanisms of the nervous system Electrical impulses from electrodes placed on the skin over or near the painful area stimulate the nerves to block the pain signals to the brain and the pain is not perceived Low frequency TENS stimulates the release of endor phins the body s natural painkillers TENS is a safe treatment method and has in contrast to drugs and other pain relief methods no side effects It may be sufficient as the only treatment form but it is also a valuable complem
30. l stimulation Rest time must be greater than Work time Ramp up time work Ramp down time work Time 0 5 s is shown as 05 on the display Preset min Range 1 99 min Range 1 99 min PROGRAM LOCK The stimulator can be locked to prevent changing of programs To activate deactivate the program lock 1 Select the program you want to lock unlock see section STEP BY STEP USE 2 Press the PROGRAM button and the left DECREASE button WY simultaneously for 2 seconds 3 Press the left INCREASE or DECREASE button V A ON is shown on the left side of the display when activating the program lock and OFF when deactivating it The button toggles between ON and OFF 4 Press the PROGRAM button to finish the program lock setting DISABLE THE AUTO FUNCTION The stimulator can be locked to disable the AUTO function To enable disable the auto function 1 Press the PROGRAM button and the left INCREASE button Z simultaneously for 2 seconds 2 Press the left INCREASE or DECREASE button 7 ON is shown on the left side of the display when the auto function is enabled and OFF when the function is disabled The button toggles between ON and OFF 3 Press the PROGRAM button to finish the setting COMPLIANCE Compliance gives you the possibility to monitor the use of the stimulator 1 Turn the stimulator ON 2 Press the TIMER button and the right DECREASE button s
31. last used program is saved when the stimulator is turned off and then pre selected the next time the stimulator is turned on The stimulator turns off after 5 minutes of inactivity to spare batteries CEFAR EASY TOUCH AUTO STIMULATION MODE To provide a pain relieving effect the level of stimulation should be perceived as a little bit stronger than the pain intensity Since the body initially adapts to the set level of stimulation it is often required to adjust Eg the amplitude a couple of times to reach the optimal level of stimulation By using CEFAR EASY TOUCH the amplitude is automatically adjusted and the optimal level is reached after a few minutes of stimulation For NMES the primary aim is to cause a strong but not painful muscular contraction With CEFAR EASY TOUCH it is easy to reach the correct stimulation level By using the patient s individual sensory motor threshold CEFAR REHAB X2 applies a coefficient to reach the optimal intensity of stimulation To use CEFAR EASY TOUCH Follow steps 1 5 in the section STEP BY STEP USE 6 START THE AUTO TEST Press the AUTO button for the left or right channel AUTO starts flashing on the display and the amplitude increases gradually 1 FINISH THE AUTO TEST TENS programs Press the AUTO button again when the stimulation level feels comfortable NMES programs Press the AUTO button again at the first visible muscle response If you press AUTO too late or want to
32. lators are widely used by public and private health care professionals around the world Electrical nerve and muscle stimulation is effective has no side effects and is economical Through clini cal research areas of application for TENS Transcutaneous Electrical Nerve Stimulation and NMES NeuroMuscular Electrical Stimulation are rapidly expanding Cefar is working actively to further develop the method towards a natural treatment alternative for both health care professionals and consumers More information about TENS NMES and our products can be found on our web site www cefar se CEFAR REHAB 2 15 dual channel nerve stimulator intended for both muscle rehabilitation NMES and pain relief TENS The stimulator features 27 preset programs and 3 custom programs The channels are simultaneous which means that a selected program applies for both channels By using CEFAR EASY TOUCH the stimulation is automatically set to the correct intensity for each person 2 MEDICAL BACKGROUND NMES NMES NeuroMuscular Electrical Stimulation is used successfully both in medical rehabilitation and as a complement to athletic training on all levels The goal of electrical muscle stimulation is to achieve contractions or vibrations in the muscles Normal muscular activity is controlled by the central and peripheral nervous systems which transmit electrical signals to the muscles NMES works similarly but uses an external source the stimulator w
33. ntil the program of your choice is shown on the display Note When selecting a program the amplitude must be set to 00 0 mA for both channels For further information on the programs see chapter PROGRAMS 6 START THE STIMULATION TENS Press the INCREASE button for each channel until you reach a comfortable level of stimulation Press and hold the button to increase the amplitude continuously NMES Press the INCREASE button for each channel until you get visible muscle contractions Press and hold the button to increase the amplitude continuously Note Both channels must be used for programs 5 and 17 18 Note Always increase the amplitude cautiously See section SPECIAL INSTRUCTIONS for the following cases e Mixed frequency stimulation e Intermittent stimulation hand switch e Intermittent stimulation with Active Rest An automatically activated key lock prevents unintentional changes during treatment The key lock is acti vated if no button is pressed for 20 seconds Press any of the DECREASE buttons V to deactivate the key lock The treatment time is preset but can be changed by using the timer function see section TIMER 7 STOP THE STIMULATION You can stop the stimulation before the program time has elapsed by pressing the DECREASE button V until the amplitudes are 00 0 mA or by pressing the ON OFF button When the program is finished remaining time 00 00 is flashing on the display The
34. quipment for example a pacemaker or an intracardiac defibrillator must not be treated with electrical stimulation Pregnant women should not use electrical stimulation during the first 12 weeks of the pregnancy Read the safety precautions in this manual PRECAUTIONARY MEASURES WHEN SHOULD USE MIXED FREQUENCY STIMULATION With mixed frequency stimulation both muscle nerves 2 Hz and sensory nerves 80 Hz are stimulated The stimulator switches between these two frequencies every three seconds providing the benefits of both high frequency stimulation fast pain relief and low frequency stimulation longer lasting but slower pain relief This stimulation type can lead to more effective treatment of long term pain conditions WHAT KIND OF PROGRAM IS P5 FLOW TENS Cefar Flow TENS is a new comfortable way of stimulation requiring four electrodes Use it on large areas to obtain pain relief together with a massage muscle relaxation The alternating stimulation gives a pumping effect that increases the circulation in the area WHAT IS THE ADVANTAGE OF USING THE HAND SWITCH It helps you to get an effective and individual stimulation by allowing you to manually control the time of contractions in intermittent stimulation programs By pressing the hand switch button during contraction the stimulation gradually decreases until the rest time starts If you do not stop the stimulation manu ally during contraction it will continue the whole pr
35. rn out and need to be replaced There is insufficient electrode gel on the carbon rubber electrodes Slightly change the position of the electrodes THE STIMULATION FEELS WEAK OR NOT AT ALL Check if the batteries need to be replaced see chapter REPLACEMENT OF BATTERIES Electrodes are too old and need replacement THE BROKEN CIRCUIT SYMBOL IS SHOWN ON THE DISPLAY SYMBOL Q The broken circuit symbol indicates that the resistance is too high or that a cable is broken too high resistance can be caused by a bad connection between the electrodes and your skin or that the electrodes need to be replaced cable breakage be checked by pressing the cable s pins against one another while increasing the amplitude for the corresponding channel to 11 mA If the amplitude now drops to 0 0 mA and X starts flashing the cable needs to be replaced Note Never increase the amplitude above 20 mA when you check for cable breaks since this can damage the stimulator THE STIMULATOR IS NOT WORKING lf the error symbol appears on the display when you start the stimulator it means that the stimulator is broken and needs to be replaced Note Do not use the stimulator contact your Cefar dealer Cefar will only be responsible for service and repairs performed by Cefar or a distributor appointed by Cefar 11 FREQUENTLY ASKED QUESTIONS FAQ CAN ANYONE USE ELECTRICAL STIMULATION People with implanted electrical e
36. roups The length of the work time and the rest time varies from program to program For weaker muscles we recommend programs with longer rest times to give the muscle time to rest between contractions Just as with other training methods NMES treatment should be adjusted to the patient s ability Depending on the muscular status and where the patient is in the rehabilitation process treatment can last from 5 to 60 minutes and be repeated from three times a week to twice a day Remember that the patient may develop sore muscles after NMES treatment Suitable electrode sizes are suggested for each indication We use the electrodes sizes shown below The electrodes we recommend are shadowed 123 4 5 2 32 mm 250 mm 40 60 50 100 80 130 50 50 50 90 DO o Aa N gt NECK THORACIC SPINE NOCICEPTIVE MUSCLE PAIN Examples of indications 1 Tension type headache 2 Myalgia in the trapezius Goal 1 Reduced headache 2 Pain alleviation Placement of electrodes Place the electrodes over M Trapezius Suggested programs CEFAR REHAB X2 1 3 4 5 KNEE NOCICEPTIVE JOINT PAIN Examples of indications Gonarthrosis Goal Alleviation of knee pain Placement of electrodes Place one pair of electrodes medially and laterally over and under the joint space of the knee Suggested programs CEFAR REHAB X2 1 2 3 TRUNK NEUROGENIC PAIN Examples of indications Postherpet
37. sition for the electrodes is where the strongest motor response occur FOR HOW LONG CAN STIMULATE TENS 80 Hz Can be used without an upper limit but at least 30 min at each occasion TENS 2 Hz Can cause sore muscles but normally 20 45 min three times a day is recommended NMES Depending on the muscle s status and where the patient is in the rehabilitation process treatment can last from 5 to 60 minutes and be repeated from three times a week to twice a day Remember that the patient may develop sore muscles after NMES treatment 12 TECHNICAL DATA CEFAR REHAB X2 is a dual channel stimulator intended for both muscle rehabilitation NMES and pain relief TENS The stimulator features 27 preset programs and 3 custom programs Treatment with electrical stimulation requires the stimulation current to penetrate the resistance of the skin and the electrode about 1000 ohms CEFAR REHAB X2 can penetrate this resistance and maintain a current of up to 99 5 mA With a change in load from 100 to 1000 ohms the stimulation current changes less than 10 from the set value The stimulator operates on either two non rechargeable 1 5 V AA batteries or two rechargeable 1 2 V AA batteries recharged in a separate charger CEFAR REHAB X2 Number of 5 2 non independent Constant current Up to a resistance of 1000 ohm Stimulation 0
38. st indication for programs with intermittent stimulation The upper part of the symbol is flashing during work time and the bottom part during rest time 11 HIGH LOW FREQUENCY mixed frequency stimulation High low frequency indication for mixed frequency programs The upper part of the symbol is flashing during high frequency and the bottom part during low frequency 5 OPERATION STEP BY STEP USE CEFAR REHAB X2 can be used for both TENS and NMES treatment Use only those treatment programs that your health care provider has determined are the most effective for your needs The stimulator has two simultaneous channels which means that both channels stimulate with the same program A hand switch is provided to make it easy to manually control muscle contractions in NMES programs 1 INSERT THE BATTERIES Insert the batteries see chapter REPLACEMENT OF BATTERIES 2 ATTACH THE ELECTRODES A Connect the electrodes to B Attach the electrodes to C Connect the cable to the the cable your body CEFAR REHAB X2 3 CONNECT THE HAND SWITCH Note This is only applicable for programs P9 P16 and P19 P23 4 SWITCH THE STIMULATOR ON Press the ON OFF button This button can be used for terminating the stimulation at all times even when the key lock is activated Always switch the stimulation off before removing electrodes from the skin 5 SELECT A PROGRAM P1 P30 Press the PROGRAM button or to step forward or back ward u
39. tinuous stimulation there are no choices at Level 2 You are moved directly to Level 3 If you chose Intermittent stimulation on Level 1 you now have two choices e Simultaneous 51 stimulation e Alternating Alt stimulation Press the INCREASE or DECREASE button 7 to toggle between SI and Alt Confirm your choice by pressing the PROGRAMMING CONFIRMATION button You are moved to the next stage in the programming procedure 6 Level 3 The available stimulation types on this level depend on your previous choices Press the INCREASE or DECREASE button V to see the different stimulation types alternate the display The programming chart shows the parameter setting possibilities for each stimulation type Continuous stimulation types e Conventional e Burst e Pulse width duration modulation PWM e Frequency modulation FM Intermittent Simultaneous stimulation types e Conventional e Frequency modulation 3 For Intermittent Alternating stimulation your only choice is Conventional stimulation which is not shown on the display You are moved directly to the next stage in the programming procedure see step 7 Press the PROGRAMMING CONFIRMATION button to confirm your choice of stimulation type and you are moved to the next stage in the programming procedure In the following steps you will set the parameters for the selected stimulation type A preset parameter value is shown on the screen but you can
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