NeuroTrac TENS AcuStim Operators Manual

NeuroTrac™ TENS & AcuStim Operation Manual

Warnings *

This unit must be used with the guidance of a Physiotherapist or Doctor

*

Type BF equipment

*

Do not insert lead wires into a mains power supply

*

Do not immerse unit into water or any other substance

*

Do not use the NeuroTrac™ TENS & AcuStim unit in the presence of a flammable anaesthetic gas mixture and air or with Oxygen or Nitrous Oxide

*

If using rechargeable 9 volt PP3 Nickel Metal Hydride or Ni-Cad batteries be sure to use a CE approved battery charger

*

Never connect the NeuroTrac™ TENS & AcuStim unit directly to a battery charger or any other mains powered equipment

*

Patient Electrodes are for single patient use only

*

Keep out of reach of children

*

Do not use this stimulator on your facial area unless you are under strict guidance from a qualified Clinician

Revised Issue Date: 28/08/2002 Document Number ECS301-OM002-7 2

NeuroTrac™ TENS & AcuStim Operation Manual

Contents Contents

Page

Warnings What is Pain? What is TENS? Contra Indications & Precautions Description of TENS Unit & Functions Quick Start Instructions AcuStim Probe Programmes Lock Mode Using the NeuroTrac™ TENS & AcuStim Unit Treatment Modes How Long do I Use TENS For? Electrode Placement Electrode Types & Tips Suggested TENS Electrode Placement Care & Maintenance Conditions that Respond to TENS Commonly Asked Questions Specifications Warranty Dermatome Chart Clinical References

2 4 4 5 6 7 8 9 10 11 12 12 13 14 15 19 20 21 22 23 24 26

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NeuroTrac™ TENS & AcuStim Operation Manual

What is Pain? When we feel pain it is the body’s process of informing us that something is wrong. To feel pain is important, without this feeling abnormal conditions may go undetected, creating damage or injury to critical parts of the body. Although pain is essential in warning our body of trauma or malfunction, nature may have gone too far in its design. Continued long-term chronic pain has no useful value apart from its importance in diagnosis. Pain begins when a coded signal travels to the brain where it is decoded, and analysed. The pain message travels from the injured area of the body along small diameter nerves leading to the spinal cord. At this point the message is switched to a different kind of nerve that travels up the spinal cord to the brain area. The brain then analyses the pain message, refers it back and the pain is felt.

What is TENS? Transcutaneous Electrical Nerve Stimulation (TENS) uses a small battery operated unit to provide a non-invasive, drug free method of controlling acute and principally long term intractable pain. It can also be used as an adjunctive treatment in the management of post surgical traumatic pain problems. In TENS mild electrical impulses are transmuted through the skin via surface electrodes to modify the body’s pain perception. TENS does not cure problematic physiological conditions; it only helps to control the pain perception. TENS will not work for every user. However Physiotherapists and Doctors throughout the world prescribe TENS extensively and it is generally seen to work for the majority of users. There are millions of small nerve fibres throughout the body and it only requires a few impulses to produce chronic pain. In addition to small fibres, which allow the sensation of pain to be felt, the body is also made up of larger diameter nerve fibres. These larger nerve fibres transmit less unpleasant sensations such as touch or warmth, assisting us to form an impression of our environment. Stimulating the larger nerve fibres using TENS may have the effect of inhibiting the transmission of pain along the smaller nerve fibres to the spinal cord [known as the ‘Pain Gate Theory.]

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NeuroTrac™ TENS & AcuStim Operation Manual

Contra Indications & Precautions Before using this equipment you must first seek the advice of your Physiotherapist or Doctor. Read this operating manual before using the TENS unit TENS should not be used: * * * * * * *

* * *

* * *

By patients fitted with a demand style cardiac pacemakers unless so advised by their Doctor During pregnancy [unless medically advised] By patients with undiagnosed pain conditions With patients who have diminished mental capacity or physical competence who cannot handle the device properly On anaesthetised or desensitised skin When driving a vehicle or operating potentially dangerous equipment Do not place electrodes: * Over carotid sinus nerves * Over larynx or trachea * Inside mouth * Over the area of the heart unless so advised by your Doctor * On your facial area unless under strict guidance from a qualified Clinician The patient should use the unit only as prescribed Do not immerse the unit in water or any other liquid If you experience skin irritation this may be due to over-stimulation. In this case leave the skin to heal and use TENS only for the periods prescribed. Turning the current up too high can cause skin irritation. In this case allow the skin to heal and use TENS at a lower intensity. Some people experience an allergic reaction to the adhesive coating on the surface of the electrode. If this happens use a different make of electrode or change the electrode. If it continues try reducing the pulse width. If the problem still persists try moving the electrode position each day by just the width of the electrode, making sure the electrode positioning is still over the dermatome Keep unit out of reach of children If in doubt about the use of the NeuroTrac™ TENS & AcuStim unit, call your Doctor, Therapist, Clinician or Verity Medical Ltd. for advice Do not use this stimulator on your facial area unless you are under strict guidance from a qualified Clinician

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NeuroTrac™ TENS & AcuStim Operation Manual

Description of TENS Unit & Functions

Channel A

AcuStim Probe

Channel B

CH.B

CH.A

LCD Display

Lead Wire and Pin Lock Button

Select Programme

NeuroTrac™ TENS & AcuStim

SET ESC

Front

Rear

* PRG button

Selects the desired set programme from P01 - P12, AC1 - AC4 or customised programme PC1 - PC2.

* SET button

Displays the menu and changes the parameters for Pulse Rate, Pulse Width and Time for custom programmes.

* ESC button

Stores customised programme and returns to the home position.

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NeuroTrac™ TENS & AcuStim Operation Manual

Quick Start Instructions 1. 2. 3. 4. 5. 6.

Insert a 9 volt PP3 Alkaline battery. Alternatively insert a rechargeable Nickel Hydride battery [Which has a much longer life than the Ni-Cad rechargeable batteries] into the battery compartment. Insert lead wire/s to channel A and B if both channels are to be used. Switch on the unit by pressing the ON/OFF button Press the PRG [Programme] button to select one of the programmes as detailed in table 1 and table 2 on page 9. To start press channel A + and B + key if you are using both channels. To stop the programme press the ON/OFF button which will turn the unit off.

Setting up your own Constant mode parameters. 1.

2. 3.

Select PC1 - PC2 by pressing the PRG button on the front panel Remove the battery lid where you will see two buttons SET and ESC. Press the SET button and the Hz symbol will flash ON/OFF, then press the + or – button on the front panel to adjust the Pulse Rate from 2 Hz - 200 Hz. Press the SET button again and the µS symbol will flash ON/OFF, then press the + or – button to adjust the Pulse Duration from 50 µS - 300 µS Press the SET button again and the Clock symbol will flash ON/OFF, then press the + or – button to adjust the time. Channel A + or – button to hours and Channel B + or – button to change minutes.

After setting up the customised programme parameters, press the ESC button to store the information. Simply repeating the above procedure can reprogramme customised programmes. Note: You must press the ESC button before locking the unit. Operating the AcuStim Device 1. 2. 3.

Insert the Acuprobe Ivory female lead wire into the Ivory socket [see diagram on page 8] and the larger Black lead wire connector into the Black socket. Press the PRG button to select programme AC1 - AC4 [See table on page 9]. To increase or decrease the intensity press the + or – Channel A buttons. To adjust the Acupoint detection tone sensitivity press Channel B + or – buttons. {Maximum intensity 8 m A}.

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NeuroTrac™ TENS & AcuStim Operation Manual

Channel A (Ivory)

AcuStim Probe

AcuStim (Black)

ChA Lead Wire (Ivory)

The AcuStim Probe is an optional accessory which plugs into the TENS unit, allowing electrical acupuncture like stimulation to be applied to acupuncture points anywhere on the body. It also detects these acupuncture points.

Acu Lead Wire (Black)

For more information about obtaining an AcuStim Probe please contact the company you purchased your TENS unit from. Please refer to the AcuStim Probe operators manual for instructions about using and connecting the AcuStim Probe accessory to the TENS unit.

Stimulation Button

Metal Finger Plate for Return Probe Tip

AcuStim Probe Stimulation Button

Metal Finger Plate for Return Optional Return Electrode and Cable AcuProbe Side View

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NeuroTrac™ TENS & AcuStim Operation Manual

Programmes Table 1

Programme

P1

P2

P3

P4

P5

P6

M ode

Con Con Burst

MF

C on C on C on C on

Fre q Hz

80

80

2

65/100

10

50

60

Puls e Width

200 175

200

200/100

175 175 100

75

Time

4 hr 4 hr

4 hr

4 hr

4 hr 4 hr 4 hr 4 hr

10 0

P7

P8

Table 2

Programme

P9

P10

P11

P12

PC1

M ode

C on

C on

MF

Burst

Custom Custom

Fre q Hz

2

80

100/65

2

Puls e Width

175

175

200 / 100

17 5

Time

4 hr

1.5 hr

45 mins

35 mins

Table 3

Programme

AC1

AC2

AC3

AC4

M ode

C on

C on

C on

C on

Fre q Hz

2

8

10

20

Puls e Width

220

220

220

220

Time

--

--

--

--

9

PC2

NeuroTrac™ TENS & AcuStim Operation Manual

Lock Mode Function Lock Mode Function A "Concealed" Lock button is included in the NeuroTrac™ TENS & AcuStim unit, which allows the clinician to accurately monitor the "Home Compliance" of the patient between appointments. The lock function allows the device to be locked in two ways:- One {L:T} to measure the time in use over one hour, and the average mA current used, leaving the parameters i.e. Constant, Burst, Modulation and the Rate and Pulse Width to be freely altered by the user or alternatively {L:PT} locking the device to measure, time, mA current used and locking the parameters in place, which then cannot be changed or altered by the patient during use. Locking the Unit Remove the battery cover and, using the end of the lead wire, gently press on the concealed lock button as shown in the diagram on page 6 until you hear a double bleep. {L:T} Lock time and Current will appear on the LCD screen. If you want to lock the parameters as well press the +/- button until {L:PT} appears. Press the ESC button to lock parameters in place. 0mA

L:T 0mA

0mA

L:PT 0mA

Ch.A

Ch.B

Ch.A

Ch.B

To Unlock the Unit To unlock the unit and display the lock information remove the battery cover. Using the end of the 2mm dia pin press the concealed switch once and you will hear a single bleep. This indicates the unit is now unlocked. The information for time in use and the average mA current used can be read on the front of the LCD display as seen on the diagram below. When you have noted the information press the ESC button to bring the unit back to the Home position. Hours

45 20 mA

20 mA

Ch.A

Ch.B

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NeuroTrac™ TENS & AcuStim Operation Manual

Using the Neurotrac™ TENS & AcuStim Unit RATE [Hz or pulses per second] The RATE to be selected depends primarily on the electrode placement on the patient’s body. If one uses contiguous and dermatome (the electrodes alongside or over the area of pain) electrode placement, a higher rate of 80 Hz –100Hz is desirable. The patient should experience steady continuous stimulation. It has been found that an optimal setting of 80 Hz with a pulse width of 200µS has good effect for most patients and is a good first choice for pain-gating. Patients using Trigger, motor or acupuncture points tend to respond to low rate stimulation 2 Hz-10 Hz and pulse width of 200µS. The desired effect is for the patient to feel individual pulses. PULSE WIDTH [Duration] The wider pulse widths will deliver stronger stimulation for any given intensity [mA] setting. By using a combination of intensity and pulse duration, it is felt that various pulse widths are capable of stimulating different groups of nerve fibres. The wider pulse duration is needed to recruit motor fibres, where as the narrow pulse duration is used more on the sensory fibres. The selection of which pulse duration to use is dependent upon the intended treatment protocol. Stimulating the larger nerve fibres is thought to reduce the speed and the amount at which information is transmitted along the smaller nerve fibres. Also under certain circumstances the brain is thought to produce its own analgesic pain-killing substances, known as endorphins or endogenous opiods.

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NeuroTrac™ TENS & AcuStim Operation Manual

Treatment Modes There are three treatment modes available on the NeuroTrac™ TENS & AcuStim unit: 1. Conventional TENS or normal. This mode enables the user to select any rate between 2Hz – 200Hz, and a pulse width between 50µS-300µS. This is the most frequently used of the three modes. The most common selection is 80Hz with a 200µS pulse width. 2. Burst Mode. This mode is comparable to the low rate TENS technique except that each low rate pulse is substituted for by a short BURST of 9 pulses [200µS] at 150Hz. It is a combination of conventional and low rate TENS. The burst mode is often referred to as acupuncture - like TENS. 3. Modulation TENS this mode was designed to help prevent nerve accommodation that some patient’s experience. It is achieved by continuously cycling the pulse width and rate. Intensity [mA] Patients respond differently to the level of intensity, this is due to differences in individual patient’s skin resistance, enervation and the type and condition of electrode being used. A good formula for setting the intensity is to increase the current so that the patient feels slight muscle contraction, but not strong enough to move a joint, and then slightly reduce the intensity so that it feels comfortable. When using low rate TENS settings, individual twitches will occur. The higher rate TENS settings will increase muscle tension. It is not advised to increase the intensity to experience strong muscle contraction. How Long Do I Use TENS For? This depends on the individual patient’s condition, accuracy of electrode placement, stimulation and the characteristics selected, but typically the onset of pain relief starts after 20-30 minutes. Generally TENS is used for longer periods of normally 1 hour 30 minutes per session. With some patients it can be much longer.

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NeuroTrac™ TENS & AcuStim Operation Manual

Electrode Placement The placement of electrodes is one of the most important parameters in achieving effective pain relief using TENS. This is best left to your Physiotherapist or Doctor to advise as to which location is most appropriate. It may transpire that various positions need to be experimented with before the user finds the most effective positioning. The positioning may be via the contiguous, dermatome, myotome, motor, trigger or acupuncture points. Dermatomes & Myotomes These are areas of the body enervated by a single nerve root via the spinal cord. Each nerve root serves a known area of the skin. The dermatomes are named after the nerve root which serves it. For details of dermatome sites refer to diagrams on pages 24 & 25. Contiguous Placement This form of electrode placement is the most common method used. It involves placing the red lead [proximal] alongside the spine where the dermatome [on which your pain lies] enters and exists. The black lead [distal] is normally placed over or near to the pain site. Your Physiotherapist or Doctor may direct the current to cross through the pain area or using the ‘bracket’ system allow the current to flow on either side of the pain site through the nerve branches that supply the pain location. Acupuncture Points The placement of the red and black electrodes on the skin forms the electrical circuit for TENS. It is the skin itself that creates the highest electrical resistance to stimulation. The Physiotherapist or Doctor may consider using acupuncture loci, which offer much lower resistance properties, as a more effective site for placing the electrodes. Accurately locating an acupuncture site can be difficult, but by using the NeuroTrac™ AcuStim Probe attachment one can accurately locate the chosen site to place the TENS electrodes. {For details refer to AcuStim Probe manual}

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NeuroTrac™ TENS & AcuStim Operation Manual

Electrode Types & Tips Types Available: *

Self-Adhesive Hypoallergenic electrodes have a typical life span (if looked after) of 4/6 weeks. We recommend cleaning the skin before use. After use place the electrodes back onto the plastic film then enclose them back into the ziptag plastic pouch and store in a cool environment. Types available: VS.4040 40 x 40 mm (square), VS.5050 50 x 50 mm (square) (recommended for general use), VS.9050 90 x 50 mm (rectangular) VS.10050 100 x 50 mm (rectangular) (recommended for large muscles), VS.13050 130 x 50 mm (rectangular), VS.30 30 mm Diameter (round), VS.50 50 mm Diameter (round), VS.62 62 mm Diameter (round), VS.75 75mm Diameter (round).

A Few Good Tips [Self- Adhesive Electrodes] *

If you find the electrodes will not stick due to oily skin, cleanse the skin with soap and water, then rinse and dry the area around the electrode site. If this does not work, try cleansing the skin with a swab impregnated with alcohol.

*

Clip away hairy skin using a scissors; don’t use a razor to remove the hairs!

The electrodes conductive material is water- based. If it becomes saturated (e.g. from perspiration), it will lose its adhesive qualities. After use leave the electrodes face up overnight to dry out. At some point the electrodes will become dry. Moisten the adhesive surface with a few drops of water, and apply onto the plastic film overnight. This procedure will give you a few more days of electrode life.

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NeuroTrac™ TENS & AcuStim Operation Manual

Suggested TENS Electrode Placement + = Red - = Black

Finger Arthritis

Knee Arthritis

Neuralgia of Trigeninus

1

Cervical (2 Positions)

15

2

NeuroTrac™ TENS & AcuStim Operation Manual

+ = Red - = Black

Cephalalgia Overorbital

Mandibular Syndrome

Phantom Limb

Herpes Zoster 16

NeuroTrac™ TENS & AcuStim Operation Manual

+ = Red - = Black

Back Pain

Menstrual Pain

1

Lumbar Pain (2 Positions)

Tooth Ache

17

2

NeuroTrac™ TENS & AcuStim Operation Manual

+ = Red - = Black

Sciatic Pain (2 Positions)

1

2

Epicondylitis

Shoulder Pain

Feet Pain

Ankle Pain

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NeuroTrac™ TENS & AcuStim Operation Manual

Care & Maintenance Control Unit: * *

Wipe the surface once a week with a damp cloth or antiseptic wipe Do not use cleaning sprays or alcohol based cleaning solutions

Battery: * * * *

Check periodically for any discharge from the battery Remove battery completely from unit if not in use for any extended period of time (typically one week) Low battery indicator of 6.9 volts shown on LCD display When flashing change battery for a new one Preferably use a PP3 alkaline battery

Lead Wires * * * *

The lead wires should be handled carefully and never stretched, as this can cause the stimulation to function below normal standards or not at all Examine lead wires before each treatment for loose connections or damage Avoid stretching and twisting the lead wires Store the lead wires carefully after each use

Self-Adhesive Electrodes * *

Check the short connectors have not become separated from the electrodes Replace electrodes onto plastic film after use. If they drop onto the floor debris will adhere to conductive gel rendering the electrodes ineffective Caution: Static electricity may damage this product

Note:

Only Verity Medical Ltd or appointed distributors/importers are approved to undertake servicing.

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NeuroTrac™ TENS & AcuStim Operation Manual

Conditions that respond to TENS

* * * * * * * * * *

Arthritis Post Operative Pain Lumbago Sports injury Phantom Limb Pain following Amputation Skeletal Pains Neuralgia Whiplash Rheumatoid and Osteo Arthritis

* * * * * * * * *

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Period Pain Cancer Pain Back Pain General Pain Sciatica Muscular Shoulder Aches Travel Sickness Tension Nausea