Rehab x2 TENS Electrotherapy Unit User Manual Rev C June 2020

OPERATING INSTRUCTIONS

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MANUAL DE INSTRUCCIONES

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MODE D’EMPLOI

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ISTRUZIONI PER L’USO

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BRUKSANVISNING

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OPERATING INSTRUCTIONS – ENGLISH BEFORE USING THE STIMULATOR 1. INTRODUCTION...4 2. MEDICAL BACKGROUND...5 3. PRECAUTIONARY MEASURES... 6

PATIENT INFORMATION 4. OVERVIEW...10

CONTROL BUTTONS...10 DISPLAY SYMBOLS...11

5. OPERATION...12

STEP-BY-STEP USE...12 CEFAR EASY TOUCH™ – AUTO STIMULATION MODE...14 SPECIAL INSTRUCTIONS...15 TIMER...16 PROGRAM PAUSE...16

6. REPLACEMENT OF BATTERIES...17

PROFESSIONAL INFORMATION 7. PROGRAMS...18

PRESET PROGRAMS...18 CUSTOM PROGRAMS...22 PROGRAM LOCK...26 DISABLE THE AUTO FUNCTION...26 COMPLIANCE...26

ADDITIONAL INFORMATION 8. ACCESSORIES...27 9. CARE INSTRUCTIONS...28 10. TROUBLESHOOTING...29 11. FREQUENTLY ASKED QUESTIONS (FAQ)... 30 12. TECHNICAL DATA...32

KEY TO THE SYMBOLS... 33

14. ELECTROMAGNETIC COMPATIBILITY (EMC) TABLES...34

APPENDIX CLINICAL GUIDE...38 © 06/2020 DJO - 2948 Rev C

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1. INTRODUCTION 4

INTENDED USE: CEFAR REHAB X2 (2946) is a 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. INTENDED USER: The user of CEFAR REHAB X2 can be a Health Care Professional or a patient. The device should be used indoors and may be used in a healthcare facility setting or in a home environment

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) with 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 physiotherapist or other caregiver for the best results.

TENS TENS (Transcutaneous Electrical Nerve Stimulation) gives good results in acute and chronic pain conditions 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 endorphins, 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 complement to other pharmacological and/or physical treatments. TENS does not always treat the cause of pain. Consult your doctor if pain persists.

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3. PRECAUTIONARY MEASURES 6

3.1. CONTRAINDICATIONS •

Implanted electronic devices. Do not use the device on patients who have a cardiac pacemaker, implanted defibrillator, or other implanted electronic device, because this may cause electric shock, burns, electrical interference, or death.

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TENS for Undiagnosed Pain. Do not use the device as a TENS device on patients whose pain syndromes are undiagnosed.

3.2. WARNINGS •

Consult with physician. Consult with the patient’s physician before using the device, because the device may cause lethal rhythm disturbances to the heart in susceptible individuals.

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Skin condition. Apply stimulation only to normal, intact, clean, healthy skin.

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Long term effects. The long-term effects of chronic electrical stimulation are unknown.

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Stimulation location. Stimulation over Neck or Mouth. Do not apply stimulation over the patient’s neck (especially the carotid sinus) or the patient’s mouth, because this could cause severe muscle spasms resulting in closure of the airway, difficulty in breathing, or adverse effects on heart rhythm or blood pressure.

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Stimulation across Chest. Do not apply stimulation across the patient’s chest, because the introduction of electrical current into the chest may cause rhythm disturbances to the patient’s heart, which could be lethal.

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Across the head. Since the effects of stimulation of the brain are unknown, stimulation should not be applied across the head, and electrodes should not be placed on opposite sides of the head.

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Stimulation over compromised skin. Do not apply stimulation over open wounds or rashes, or over swollen, red, infected, or inflamed areas or skin eruptions (e.g., phlebitis, thrombophlebitis, varicose veins).

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Stimulation near cancerous lesions. Do not apply stimulation over, or in proximity to, cancerous lesions.

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Stimulation over eyes. Do not apply stimulation directly on the eyes.

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Environment. Electronic monitoring equipment. Do not apply stimulation in the presence of electronic monitoring equipment (e.g., cardiac monitors, ECG alarms), which may not operate properly when the electrical stimulation device is in use.

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Bath or Shower. Do not apply stimulation when the patient is in the bath or shower. Do not apply stimulation in humid atmosphere exceeding 75% of relative humidity.

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Sleeping. Do not apply stimulation while the patient is sleeping.

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Driving or operating machinery. Do not apply stimulation while the patient is driving, operating machinery, or during any activity in which electrical stimulation or involuntary muscle contraction can put the patient at risk of injury.

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Electrosurgical equipment or defibrillators. Disconnect the stimulation electrodes before using electrosurgical equipment or defibrillators. Otherwise skin burns may be caused below the electrodes and the device might be destroyed.

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Magnetic Resonance Imaging. Do not wear electrode or the device during Magnetic Resonance Imaging (MRI) scans as this may result in metal overheating and causing skin burns in the area of the electrode.

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Flammable or explosive environment. Do not use the device in areas where there is a risk of fire or explosion, such as oxygen-rich environments, in the vicinity of flammable anaesthetics, etc.

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Power supply. Never connect stimulation cables to an external power supply as there is a risk of electric shock.

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Near other equipment. Do not use the device beside or stacked on top of any other equipment. If you must use it side by side or on top of another system, you should check that the device works properly in the chosen configuration.

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Miscellaneous. Electrodes for Single Patient. Do not share electrodes with other persons. All users should have individual set of electrodes to prevent undesirable skin reactions or disease transmission.

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Accessories. Use this device only with the leads, electrodes, and accessories recommended by the manufacturer. Use of other accessories may adversely affect the performance of the device or may result in stronger electromagnetic emissions or reduce the electromagnetic immunity of the device.

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No Modification. No modification of the equipment is allowed.

3.3. PRECAUTIONS •

Supervision. Use this device only under the continued supervision of a licensed practitioner. Electrode placement and stimulation settings should be based on the guidance of the prescribing practitioner.

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Manufacturer. The manufacturer does not take any responsibility for any electrode placements other than recommended.

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Pregnancy. The safety of electrical stimulation during pregnancy has not been established.

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Skin irritation. Some patients may experience skin irritation or hypersensitivity due to the electrical stimulation or electrical conductive medium (gel). The irritation may be reduced by using an alternate conductive medium or alternate electrode placement. Some patients may experience redness under the electrodes after a session. This redness usually disappears within a few hours. Advise the patient to consult the clinician if the skin redness does not disappear after a few hours. Do not start another stimulation session in the same area if the redness is still visible. Don’t scratch the redness area.

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Heart Disease. Patients with suspected or diagnosed heart disease should follow precautions recommended by their physicians.

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Epilepsy. Patients with suspected or diagnosed epilepsy should follow precautions recommended by their physicians.

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Internal Bleeding. Use caution when the patient has a tendency to bleed internally, such as following an injury or fracture.

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After Surgery. Use caution following recent surgical procedures when stimulation may disrupt the patient’s healing process.

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Over uterus. Do not place electrodes directly over the uterus or connect pairs of electrodes across the abdomen if you are pregnant. The reason is that, theoretically, the current could affect the foetus’s heart (although there are no reports of it being harmful).

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Lack of sensation. Use caution if stimulation is applied over areas of skin that lack normal sensation. Don’t apply stimulation on patient unable to express themselves.

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Stimulation. The stimulator should only be used with skin electrodes intended for nerve and muscle stimulation. Muscle soreness may occur after stimulation but usually disappears within a week.

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Hot casing or batteries. Under extreme use conditions, some parts of the casing might reach up to 109 °F (43 °C). Use caution when manipulating the batteries right after device use or when holding the device. There is no particular health risk associated with this temperature besides your comfort.

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Children. Keep this device out of the reach of children.

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Electrode Size. Do not use electrodes with an active area less than 16 cm2, as there will be a risk of suffering a burn injury. Caution should always be exercised with current densities more than 2mA/ cm2.

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Strangulation. Do not wrap leadwires around your neck, and keep them out of the reach of children. Strangulation may result from entanglement in the leadwires.

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Tripping. Care should be used to avoid tripping on lead wires.

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Damaged Device or Accessories. Never use the device or any of its accessories if it is damaged (case, cables, etc.) or if the battery compartment is open as there is a risk of electric shock. Carefully inspect the lead wires and connectors prior to each use.

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Inspect Electrodes. Inspect electrodes before each use. Replace electrodes when they begin to deteriorate or lose adhesion. Poor contact between the electrodes and the patient’s skin increases the risk of skin irritation or burns. Electrodes will last longer if used and stored according to instructions on electrode packaging. Attach the electrodes in such a way that their entire surface is in contact with the skin.

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Foreign bodies. Do not allow any foreign bodies (soil, water, metal, etc.) to penetrate the device and the battery compartment.

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Batteries. Do not carry batteries in a pocket, purse, or any other place where the terminals could become shortcircuited (e.g. by way of paper clip). Intense heat could be generated and injury may result. Never open the battery cover during stimulation in order to avoid electrical shock. Remove the batteries from the device if you do not intend to use it for a prolonged period of time (more than 3 months). Extended storage of the batteries in the device might lead to batteries and device damage.

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Cable. The cable is best preserved if left attached to the stimulator between sessions. Do not jerk the cable or connection.

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Heat and Cold products. The use of heat or cold producing devices (e.g. electric heating blankets, heating pads or ice packs) may impair performance of the electrode or alter the patient’s circulation/sensitivity and increase the risk of injury to the patient.

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Pulled muscles. Do not apply electrodes over pulled muscles. Using the stimulator on a previously extended muscle might further pull such muscle. The higher the stimulation intensity, the higher the risk to further overextends such muscle.

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Additional Precautions for TENS – TENS is not effective for pain of central origin, including headache. – TENS is not a substitute for pain medications and other pain management therapies. – TENS devices have no curative value. – TENS is a symptomatic treatment and, as such, suppresses the sensation of pain that would otherwise serve as a protective mechanism. • Effectiveness of TENS is highly dependent upon patient selection by a practitioner qualified in the management of pain patients. 3.4. DANGERS •

Electrodes. Any Electrode with a minimum active area of 16 cm² may be used with this device. Use of an electrode with an area less than 16 cm² can cause burns when the unit is used at higher intensities. Consult your clinician prior to using any electrode less than 16 cm².

3.5. ADVERSE REACTIONS •

Patients may experience skin irritation and burns beneath the stimulation electrodes applied to the skin.

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Patients may experience headache and other painful sensations during or following the application of electrical stimulation near the eyes and to the head and face.

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Patients should stop using the device and should consult with their physicians if they experience adverse reactions from the device.

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Precaution: Do not disconnect any stimulation cables during a session while the stimulator is switched on. Switch the stimulator off first. Always turn off the stimulator before moving or removing any electrodes during a session.

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Precaution: Do not use electrodes with an active area less than 16 cm2, as there will be a risk of suffering a burn injury. Caution should always be exercised with current densities more than 2mA/cm2.

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Precaution: Do not apply stimulation in the vicinity of metal. Remove jewelry, body piercings, buckles or any other removable metallic product or device in the area of stimulation. Never use the electrodes contra-laterally, i.e. do not use two pins connected to the same channel on opposite segments of the body.

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Precaution: Never carry out an initial stimulation session on a person who is standing. The first five minutes of stimulation must always be performed on a person who is sitting or lying down. In rare instances, people of a nervous disposition may experience a vasovagal reaction. This reaction is connected with fear of the muscle stimulation as well as surprise at seeing one of their muscles contract without having intentionally contracted it themselves. A vasovagal reaction causes heart to slow down and blood pressure to drop, which can make you feel weak and faint. If this does occur, stop the stimulation and lie down with the legs raised until the feeling of weakness disappears (5 to 10 minutes). Precaution: Sudden temperature changes can cause condensation to build up inside the stimulator. To prevent this, allow it to reach room temperature before use.

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4. OVERVIEW 10

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 mode*.

3. DECREASE (left and right channel)

1 2

2

3

3

4

4

5

6

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· 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 mode*.

6. TIMER

4. AUTO (left and right channel)

· Initiates the timer setting.

· 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+)*.

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7. PROGRAMMING/CONFIRMATION (S=SET) · Turns the stimulator into programming mode for custom programs P28–P30 when pressed for 2 seconds. · Confirms settings in programming mode.

8. HAND SWITCH CONNECTION · By using the hand switch, the contractions in programs with intermittent stimulation can be manually controlled.

9. CABLE HOLDER *Professional use

DISPLAY SYMBOLS 1

2

3

4

5

1

11

6 7 8

8

9

10

11

10

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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/rest 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 12

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 the cable.

B. Attach the electrodes to your body.

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 S the skin. P AUTO

AUTO

C. Connect the cable to the CEFAR REHAB X2.

5. SELECT A PROGRAM (P1–P30)

AUTO AUTO AUTO AUTO

SorS P– P– to step forward or Press the PROGRAM button backward until the program of your choice is shown on the display. P+ P+

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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. AUTO

AUTO

NMES Press the INCREASE button for each channel until you get visible muscle contractions. Press and hold the button to increase the amplitude continuously. P

S

Note! Both channels must be used for programs P5 and P17–P18. AUTO

P

AUTO

S

Note! Always increase the amplitude cautiously! See section SPECIAL INSTRUCTIONS for the following cases: • Mixed frequency stimulation • Intermittent stimulation + hand switch • Intermittent stimulation with Active Rest An automatically activated key lock prevents unintentional changes during treatment. The key lock is activated if no button is pressed for 20 seconds. Press any of the DECREASE buttons to deactivate the key lock. The treatment time is preset, but can be changed by using the timer function, see section TIMER.

AUTO

P

AUTO

S

7. STOP THE STIMULATION

You can stop the stimulation before the program time has elapsed by pressing the DECREASE button 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. AUTO

AUTO

AUTO

AUTO

The last used program is saved when the stimulator is turned off and then pre-selected the next time S P S P the stimulator is turned on. The stimulator turns off after 5 minutes of inactivity to spare batteries.

CEFAR EASY TOUCH™ – AUTO STIMULATION MODE 14

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 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, S P and the amplitude increases gradually. AUTO

AUTO

7. FINISH THE AUTO TEST

TENS programs: Press the AUTO button able. P

AUTO

AUTO

again when the stimulation level feels comfort-

AUTO

again at the first visible muscle response.

S

NMES programs: Press the AUTO button

AUTO

P

S

If you press AUTO too late, or want to 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. If 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 pressing the INCREASE or DECREASE buttons until the stimulation feels pleasant. If doing so, the automatic amplitude setting is lost. AUTO

P

S

AUTO

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 2 with rest time between the muscle contractions (work 3 1 3 1 time), see figure. The contraction gradually increases 4 during ramp-up time and reaches maximum contrac1. Ramp-up time 3. Ramp-down time tion during work time. During ramp-down time, the 2. Work time 4. Rest time stimulation 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 bottom 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 contraction. 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 flashing, increase the amplitude gradually until you get muscle contractions without pain. Amplitude setting for Active Rest: When the bottom part of the work/rest symbol increase the amplitude gradually until you get muscle vibrations. See chapter FREQUENTLY ASKED QUESTIONS for further information on Active Rest.

is flashing,

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TIMER 16

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 . The time is decreased by 1 minute each time you press the button. The time is flashing on the display, S P while setting the timer. S P

AUTO

P

S

AUTO

AUTO

AUTO

4. Press the TIMER button

PROGRAM PAUSE AUTO

P

AUTO

to confirm the timer setting.

AUTO

S

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 AUTO AUTO AUTO AUTO

2. Press any of the PROGRAM buttons P+ P+ or

S S

P– P–

to deactivate it. to pause the program.

AUTO AUTO AUTO AUTO

Start stimulation again by pressing any of the PROGRAM buttons P+ P+ SorS AUTO

P

S

AUTO

P– P–

.

If stimulation is paused for more than five minutes, the stimulator turns off automatically to spare batteries.

AUTO

6. REPLACEMENT OF BATTERIES 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. Turn off the stimulator. 2. Locate the battery compartment on the back of the stimulator. 3. Remove the battery cover by pressing the mark at the top firmly and sliding the cover downwards. 4. Remove the batteries. 5. Insert the new batteries correctly according to the polarity markings (+ and –) inside the battery compartment, see picture. 6. Replace the battery cover. 7. 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.

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7. PROGRAMS 18

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 conditions with TENS, see the clinical guide last in this manual. For further information on programs P4–P5, see chapter FREQUENTLY ASKED QUESTIONS.

P1 – CONVENTIONAL TENS

High-frequency stimulation that causes a ting­ling sensation. This is often the first choice for both acute and long-term pain. Frequency 80 Hz Pulse duration 180 µs 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 µs 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 µs Pulse duration 2 180 µs 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 µs 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 stimulated area. Always use 2 channels and 4 electrodes. Frequency 80 Hz Pulse duration 1 70 µs Pulse duration 2 180 µs Modulation time 2 sec. Total program time – – min.

P6 – GUIDE TO INTRAMUSCULAR INJECTIONS A program used to increase the precision of intramuscular botox (botulinum toxin) injections. These injections are used for spasticity, dystonia, facial hemi­spasm and bruxism. Frequency 1 Hz Pulse duration 50 µs 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

Frequency 1 Frequency 2 Pulse duration Modulation time Total program time

P8 – WARM UP, LONG

Frequency 1 Frequency 2 Pulse duration Modulation time Total program time

2 Hz 8 Hz 300 µs 10 sec. – – min.

2 Hz 8 Hz 300 µs 10 sec. – – min.

P9 – INTERMITTENT STIMULATION Smaller muscle groups Frequency Pulse duration Work time Rest time Ramp-up time Ramp-down time Total program time

50 Hz 200 µs 4 sec. 4 sec. 2 sec. 2 sec. – – min.

P10 – INTERMITTENT STIMULATION Larger muscle groups Frequency Pulse duration Work time Rest time Ramp-up time Ramp-down time Total program time

50 Hz 400 µs 4 sec. 4 sec. 2 sec. 2 sec. – – min.

P11 – INTERMITTENT STIMULATION Smaller muscle groups Frequency Pulse duration Work time Rest time Ramp-up time Ramp-down time Total program time

65 Hz 200 µs 6 sec. 8 sec. 2 sec. 2 sec. – – min.

P12 – INTERMITTENT STIMULATION

Larger muscle groups Frequency Pulse duration Work time Rest time Ramp-up time Ramp-down time Total program time

65 Hz 400 µs 6 sec. 8 sec. 2 sec. 2 sec. – – min.

P13 – INTERMITTENT STIMULATION Smaller muscle groups Frequency Pulse duration Work time Rest time Ramp-up time Ramp-down time Total program time

50 Hz 200 µs 10 sec. 10 sec. 1 sec. 2 sec. – – min.

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P14 – INTERMITTENT STIMULATION Larger muscle groups

P18 – ALTERNATING STIMULATION Larger muscle groups

Frequency Pulse duration Work time Rest time Ramp-up time Ramp-down time Total program time

Frequency Pulse duration Work time Rest time Ramp-up time Ramp-down time Total program time

50 Hz 400 µs 10 sec. 10 sec. 1 sec. 2 sec. – – min.

P15 – INTERMITTENT STIMULATION Neurology, smaller muscle groups Frequency Pulse duration Work time Rest time Ramp-up time Ramp-down time Total program time

40 Hz 200 µs 5 sec. 15 sec. 4 sec. 2 sec. – – min.

P16 – INTERMITTENT STIMULATION Neurology, larger muscle groups Frequency Pulse duration Work time Rest time Ramp-up time Ramp-down time Total program time

40 Hz 400 µs 5 sec. 15 sec. 4 sec. 2 sec. – – min.

P17 – ALTERNATING STIMULATION Smaller muscle groups Frequency Pulse duration Work time Rest time Ramp-up time Ramp-down time Total program time

50 Hz 200 µs 4 sec. 6 sec. 1 sec. 1 sec. – – min.

50 Hz 400 µs 4 sec. 6 sec. 1 sec. 1 sec. – – min.

P19 – STIMULATION WITH ACTIVE REST Smaller muscle groups Frequency – work Frequency – rest Pulse duration Work time Rest time Ramp-up time – work Ramp-down time – work Ramp-up time – rest Ramp-down time – rest Total program time

50 Hz 8 Hz 200 µs 10 sec. 10 sec. 2 sec. 2 sec. 1 sec. 1 sec. – – min.

P20 – STIMULATION WITH ACTIVE REST Larger muscle groups Frequency – work Frequency – rest Pulse duration Work time Rest time Ramp-up time – work Ramp-down time – work Ramp-up time – rest Ramp-down time – rest Total program time

50 Hz 8 Hz 400 µs 10 sec. 10 sec. 2 sec. 2 sec. 1 sec. 1 sec. – – min.