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Electrotherapy
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Electrotherapy
Overview Electrotherapy Overview
Introduction
Contraindications Introduction
Precautions
Indications
Pain Management Contraindications
Relaxation of Muscle
Spasms
Muscle Strengthening
Precautions
Muscle Re-Education
Increasing Circlulation
Edema Management Indications
sEMG +Stim
Waveforms
Product Overview Waveforms
Features and Functions
Program Navigation
Notes/References Product Overview
Notes/References
Electrotherapy
Overview Introduction
Introduction
What is Electrotherapy?
Contraindications
Precautions The application of exogenous electrical stimulation transmitted
Indications
through the body via electrodes for a therapeutic purpose
Pain Management
Relaxation of Muscle What does it do?
Spasms
Muscle Strengthening The waveform current flows through the body from one
Muscle Re-Education electrode to the other and causes different physiological
reactions depending on the type of current selected, the
Edema Management
parameters of the selected current and the output intensity
sEMG +Stim
Waveforms
Product Overview
Program Navigation
Notes/References
Electrotherapy
Overview Forms of Electrotherapy
Introduction
Contraindications NMES (Neuromuscular Electrical Stimulation)
Precautions
Stimulation through an intact peripheral
Indications
Pain Management
nerve with therapy goals of increasing
Relaxation of Muscle muscle strength or to recover motor
Spasms
control
Muscle Re-Education
Increasing Circlulation EMS (Electrical Muscle Stimulation)
Edema Management
Direct stimulation of membranes of
sEMG +Stim
Waveforms
devenerated muscle. Treatment goal is
Product Overview to retard muscle atrophy, improve local
Features and Functions blood flow
Program Navigation
Notes/References
Electrotherapy
Overview Forms of Electrotherapy
Introduction
Contraindications FES (Functional Electrical Stimulation)
Precautions
NMES to facilitate a function (i.e. walking,
Indications
Pain Management
grasping etc.)
Relaxation of Muscle Stimulation delivered in timed manner
Spasms
Difficult to achieve coordinated
Muscle Re-Education movement
Edema Management TENS (Transcutaneous Electrical Nerve
sEMG +Stim Stimulation)
Waveforms
Product Overview For pain management
Features and Functions Externally applied
Program Navigation Portable
Notes/References
Electrotherapy
Overview Current Flow
Introduction
Contraindications Flow of charged particles between electrodes
Precautions Current flow is measured in mille-Amperes (mA)
Indications
Neurons in the path of current flow depolarize when critical
Pain Management
threshold is reached
Spasms
Muscle Re-Education
Edema Management
sEMG +Stim
Waveforms
Product Overview
Program Navigation
Notes/References
Electrotherapy
Overview Polarity
Introduction
Difference in electrical charge between two sides of a
Contraindications
membrane
Precautions
Indications
Nerve cell
Pain Management
Positive outside
Spasms Negative inside
Muscle Re-Education
Edema Management
sEMG +Stim
Waveforms
Product Overview
Program Navigation
Notes/References
Electrotherapy
Overview Depolarization
Introduction
Polarity reverses temporarily
Contraindications
Precautions Positive inside
Indications
Negative outside
Pain Management
Spasms
Muscle Re-Education
Edema Management
sEMG +Stim
Waveforms
Product Overview
Program Navigation
Notes/References
Electrotherapy
Overview Action Potential
Introduction
Depolarization travels muscle
Contraindications
and or spine resulting in:
Precautions
Indications Contraction
Pain Management Sensation
Spasms
Muscle Re-Education
Edema Management
sEMG +Stim
Waveforms
Product Overview
Program Navigation
Notes/References
Electrotherapy
Overview Current Intensity (Amplitude)
Introduction
Increasing the intensity (current flow) will do
Contraindications
the following:
Precautions
Indications Increase the depth of penetration
Pain Management Increase the number of neurons depolarized
Spasms both superficially and deeper
Muscle Re-Education
Edema Management
sEMG +Stim VS
Waveforms
Product Overview
Program Navigation
Notes/References
Electrotherapy
Overview Ohms Law
Introduction
Contraindications Current flow (intensity/amplitude) changes with changing
Precautions resistance
Indications
Ohms law (I = V/R) governs the relationship between intensity
Pain Management
and resistance
Spasms
Muscle Strengthening I= Current
Muscle Re-Education
Edema Management
sEMG +Stim
V = Voltage R = Resistance
Waveforms
Product Overview
Program Navigation
Notes/References
Electrotherapy
Overview CV or CC
Introduction
Constant Voltage
Contraindications
Precautions Machine keeps voltage constant regardless of changing
Indications
resistance
Pain Management
Intensity level can fluctuate (and therapeutic effect )
Spasms
Ideal for dynamic, high intensity applications since risk of
discomfort is low
Muscle Re-Education
Constant Current
Edema Management
sEMG +Stim Machine keeps intensity constant by changing the voltage to
Waveforms
compensate of changing resistance
Product Overview
Very constant stimulation
Program Navigation Possible discomfort with small electrodes
Notes/References
Electrotherapy
Overview Constant Current (CC)
Introduction
Contraindications When Current is needed to
Precautions remain Constant
Indications
If Resistance (skin
Pain Management
impedance, electrode
Spasms issues, etc.) goes up
What does Voltage have
Muscle Re-Education
to do to keep Current
Edema Management Constant? C = Current V = Voltage R = Resistance
sEMG +Stim Voltage has to increase when Resistance goes up in order to

Waveforms
keep Current Constant
Product Overview
Features and Functions Therefore, when in CC, the Voltage level will increase as the Resistance
Program Navigation level increases
Notes/References
Electrotherapy
Overview Constant Voltage (CV)
Introduction
Contraindications When Voltage is needed to remain Constant
Precautions If Resistance (skin impedance, electrode issues, etc.) goes up
Indications
What does Current have to do to keep Voltage Constant?
Pain Management
Current has to decrease when Resistance goes up in order to
Spasms keep Voltage Constant
Muscle Re-Education Therefore, when in CV, the Current level will decrease as the Resistance
level increases, thus making CV a potentially more comfortable form of
delivery.
Edema Management
sEMG +Stim
Waveforms
Product Overview
Program Navigation
Notes/References C = Current V = Voltage R = Resistance
Electrotherapy
Overview Pulse
Introduction
Contraindications Isolated electrical event separated by a finite time from the
Precautions next event
Indications
Pulse duration usually measured in microseconds (s)
Pain Management
Each Pulse contains one or more phases
Spasms Phase duration determines which size neuron is stimulated
Muscle Re-Education
Edema Management
sEMG +Stim
Waveforms
Product Overview
Program Navigation
Notes/References
Electrotherapy
Overview Pulse and Size Principle
Introduction
< 150s
Contraindications
Precautions Sensory - touch, vibration and
Indications
proprioception
Pain Management
Large Motor - fast twitch
Spasms
contractions
Muscle Re-Education
150 250s
Edema Management Small motor - slow twitch
sEMG +Stim contractions
Waveforms
Sensory - pinprick, intense heat or cold
Product Overview
> 250s
Program Navigation
Notes/References Nociceptive noxious slow pain
Electrotherapy
Overview Frequency
Introduction
Contraindications Number of pulses per second
Precautions Expressed as pulses per second
Indications
(pps) or Hertz (Hz)
Pain Management
Determines which neurons are
Spasms stimulated most effectively
Large neurons 80-150 Hz
Muscle Re-Education Frequency
A sensory
Edema Management Fast twitch motor
sEMG +Stim Slow twitch motor neurons: 25-35Hz
Waveforms Small myelinated A sensory neurons: 1-10Hz
Product Overview
Program Navigation
Notes/References
Electrotherapy
Overview Electrodes
Introduction
Contraindications Always clean and prepare the skin prior to
Precautions use and monitor throughout treatment
Indications
Electrodes should be placed so the flow of
Pain Management
current can reach the target tissue
Spasms Should have low impedance
Conduct current uniformly
Muscle Re-Education
Maintain uniform contact
Edema Management Allow for movement of the skin and
sEMG +Stim muscle
Waveforms
The farther apart the deeper the
Product Overview
penetration
Program Navigation
Placed to close the potential exists for greater concentration
Notes/References superficially this can result in discomfort or burn
Electrotherapy
Overview Contraindications
Introduction
Contraindications Should not be used for pain relief unless the etiology is established
Precautions or pain syndrome has been diagnosed
Indications When cancerous lesions are present in the treatment area
Pain Management There should not be any use of any TENS waveforms or powered
Spasms muscle stimulators on patients with cardiac demand pacemakers
Muscle Strengthening Stimulation should not be applied over swollen, infected, inflamed
Muscle Re-Education areas of skin eruptions (e.g. phlebitis, thromobophlebitis, varicose
Increasing Circlulation veins, etc.
Edema Management
Electrode placement must be avoided that apply current to the
sEMG +Stim
carotid sinus region (anterior neck) or trancerebrally (through the
Waveforms
head)
Product Overview
Safety has not been established for the use of therapeutic
Program Navigation electrical stimulation during pregnancy
Notes/References
Electrotherapy
Overview Precautions
Introduction
Contraindications Individuals who cannot give clear feedback or over anesthetic skin
Precautions Patient can not indicate when current is hurting
Indications Over areas of peripheral vascular disease (PVD) or thrombophlebitis
Pain Management Strong contractions may trigger the release emboli
Relaxation of Muscle In patients with pacemakers or other implanted electrodes
Spasms
Electrical field may interfere with function of implanted device
Extreme caution in patients with ICD
Muscle Re-Education
Over areas of excess adipose tissue
High intensity stimulation may be required to overcome resistance of
Edema Management
fat may lead to adverse autonomic response
sEMG +Stim
In conditions where active motion is contraindicated
Waveforms
Stimulation may cause movement through muscle contraction
Product Overview
In known seizure disorders
Program Navigation
Stimulation may trigger a seizure
Notes/References
Over open wounds, unless specifically treating the wound
Except for specialty electrodes, electrodes are usually not sterile
Electrotherapy
Overview FDA Cleared Indications
Introduction
Contraindications Pain Management
Precautions Acute
Indications Chronic
Pain Management
Relaxation of Muscle Spasms
Spasms Maintaining/Increasing Joint Range of Motion
Prevent/Retard Muscle Atrophy
Muscle Re-Education
Muscle Re-Education
Edema Management
Increase Local Blood Circulation
sEMG +Stim Stroke Muscle Re-Education (sEMG +Stim)
Waveforms
Product Overview
Program Navigation
Notes/References
Electrotherapy
Overview Pain Management
Introduction
Pain Modulation
Contraindications
Precautions Melzack and Wall first to
Indications
formulate the Gate Control
Pain Management
Theory 1965
Spasms
Refinement and research
identified two mechanisms of
Muscle Re-Education
pain modulation in the dorsal
Edema Management column of the spinal cord
sEMG +Stim Gate System through peripheral
Waveforms neural activity
Product Overview
Opiate System through central
neural activity
Program Navigation
Notes/References
Electrotherapy
Overview Gate System
Introduction
Contraindications Large diameter
Precautions myelinated peripheral
Indications
sensory nerves (A-Beta)
Pain Management
respond to electrical
Spasms stimulation and inhibit
the transmission of pain
Muscle Re-Education
signals
Edema Management
sEMG +Stim This occurs in the spinal
Waveforms
cord
Product Overview
Program Navigation
Notes/References
Electrotherapy
Overview Opiate System
Introduction
Contraindications Peripheral sensory neurons (A-delta)
Precautions stimulate endorphin release (CNS)
Indications
Pain Management
Released endorphins stimulate
Spasms descending neurons to spinal cord
Muscle Re-Education
These stimulate inhibitory spinal neurons
Edema Management
sEMG +Stim
Waveforms
Product Overview
Program Navigation
Notes/References
Electrotherapy
Overview Gate vs. Opiate
Introduction
Contraindications
Gate System Opiate System
Precautions
Indications Therapy Goal: Immediate Therapy Goal: Long term
Pain Management analgesia analgesia
Spasms Stimulating A fibers in the Stimulating the A fibers in the
Muscle Strengthening segment of pain general area of pain
Muscle Re-Education Low to medium intensity High to noxious stimulation
stimulation Frequency: 1-10 Hz
Edema Management
Frequency: 50-100 Hz Therapeutic effect; Slow
sEMG +Stim
Waveforms Therapeutic effect: onset pain relief of long
Product Overview Immediate pain relief of short duration
Features and Functions duration
Program Navigation
Notes/References
Electrotherapy
Overview Sensory Level Electroanalgesia Protocol
Introduction
Contraindications
Parameter Setting
Precautions
Mechanism of Gate System
Indications effect
Pain Management Target Neurons A in pain dermatome
Spasms Waveform IFC or Premod
Muscle Strengthening Frequency >80 Hz or sweep 80-150

Hz
Muscle Re-Education
Increasing Circlulation Duty cycle Continuous
Edema Management Duration of Rx 20 minutes or longer as

determined by
sEMG +Stim clinician
Waveforms Intensity Perceptible tingling, no
Product Overview motor or pain
response should be
Features and Functions elicited
Program Navigation Current mode CV
Notes/References Electrode In dermatome of pain
Location
Electrode Placement
Dermatome Distribution
Electrotherapy
Overview Notes and References
Introduction
Notes:
Contraindications
Precautions This Rx is believed to relieve pain through the Gate Control Theory of
Indications Pain Modulation via hyperstimulation of A-beta nerves 1,2
Pain Management
The literature reports little residual pain relief post Rx ( 1 hour). Pain
Spasms relief beyond this time may occur if the pain-spasm cycle has been
Muscle Strengthening interrupted
Muscle Re-Education To dose to correct amplitude: turn up to the point of producing
muscle twitch and then back off slightly. No observable, palpable, or
Edema Management
perceptible muscle contraction
sEMG +Stim
This Rx can be performed using pulsed current, interferential current
Waveforms
Product Overview
(AC), Premodulated current (AC), and high volt pulsed current
References (Sensory level electroanalgesia):
Program Navigation 1. Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965;150:971-976.
2. Wall PD. The gate control theory of pain mechanisms: a reexamination and restatement. Brain. 1978;101:1-18
Notes/References 3. Gallo JA. Analysis of strength duration in 20 subjects. Unpublished data. 2005
Electrotherapy
Overview Motor Level Analgesia Protocol
Introduction
Contraindications
Parameter Setting
Precautions
Mechanism of Opiate System
Indications effect
Pain Management Target Neurons A (sensory, pinprick)
Spasms Waveform IFC or Premod
Muscle Strengthening Frequency 1-10 Hz

Muscle Re-Education Sweep Yes Electrode
Increasing Circlulation Duty cycle Continuous Placement
Bracketing Area
Edema Management Duration of Literature suggests 30-45 of Pain
Option A: Four
sEMG +Stim Treatment minutes. 2-3 times per day if used electrodes
at home. Clinically 20 minute Option B: Two
Waveforms treatments are more commonly electrodes
Product Overview used.
Features and Functions Intensity Strong visible rhythmical

contraction
Program Navigation
Current mode CV
Notes/References
Electrode Bracketing area of pain Electrode
Location Placement Bracketing Area of
Pain
Electrotherapy
Introduction
Notes
Contraindications
Precautions This Rx is believed to relieve pain through the activation of endogenous
Indications opiates.
Pain Management
The literature reports greater carry over of pain relief when compared to
sensory level stimulation. Up to several hours of pain relief.
Spasms Research suggests that stronger contractions may produce greater
Muscle Strengthening analgesia.
Muscle Re-Education Not indicated over areas of acute pain/injury.
This Rx can be performed using pulsed current, interferential (AC), and
Premodulated current (AC).
Edema Management
sEMG +Stim
Waveforms
References (motor level electroanalgesia)
1. Karla A, Urban MO, Sluka KA. Blockade of opioid receptors in rostral ventral medulla
Product Overview prevents antihyperanalgesia produced by transcutaneous electrical nerve stimulation
(TENS). J Pharmacol Exp Ther. 2001;298:257-263.
Features and Functions 2. Robinson AJ, Snyder-Mackler L. Clinical Electrophysiology. 2nd ed. Baltimore, Md:
Williams & Wilkins;1995.
Program Navigation
Notes/References
Electrotherapy
Overview Recent Literature Reviews:
Introduction
Pain Management
Contraindications
Precautions Johnson, M. and M. Martinson (2007). Efficacy of electrical nerve stimulation for
Indications chronic musculoskeletal pain: a meta-analysis of randomized controlled trials.
Pain Management Pain 130(1-2): 157-65.
Relaxation of Muscle Brosseau, L., et al. (2002). Efficacy of the transcutaneous electrical nerve
Spasms
stimulation for the treatment of chronic low back pain. Spine 27(6): 596-603.
Chesterton, L. S., et al. (2002). Sensory stimulation (TENS): effects of parameter
Muscle Re-Education manipulation on mechanical pain thresholds in healthy human subjects. Pain 99:
Increasing Circlulation 253-262.
Edema Management Chen, C., et al. (2008). Does the pulse frequency of transcutaneous electrical
sEMG +Stim nerve stimulation (TENS) influence hypoalgesia? A systematic review of studies
Waveforms using experimental pain and healthy human participants. Physiotherapy 94(1): 11-
Product Overview 20.
Features and Functions Chesterton, L. S., et al. (2003). Effects of TENS frequency, intensity and
Program Navigation stimulation site parameter manipulation on pressure pain thresholds in healthy
Notes/References human subjects. Pain 106: 73-80.
Electrotherapy
Overview Relaxation of Muscle Spasms
Introduction
Contraindications Myofascial pain with associated trigger
Precautions points. These painful areas may
Indications result from muscle strain and result in
Pain Management increased metabolizism and decreased
Spasms circulation.
Muscle Strengthening Muscles or areas of muscle in spasm
Muscle Re-Education have ischemic pain due to decreased
Increasing Circlulation circulation and waste buildup in the
Edema Management
muscle.
sEMG +Stim
Electrical stimulation is an option to
Waveforms
assist in breaking the muscle spasm
Product Overview
pain cycle by increasing local blood
Program Navigation circulation and inhibiting pain to allow
Notes/References the administration of manual techniques
Electrotherapy
Overview Relaxation of Muscle Spasms
Introduction
Contraindications As far back as 1986 research
Precautions was carried out on the use
Indications
of electrical stimulation in
Pain Management
chronic angina pectoris noting
Spasms improved lactate metabolism
and improved blood flow to the
Muscle Re-Education
stimulated area.
Edema Management Motor level stimulation is cited
sEMG +Stim to enhance local blood circulation
Waveforms Sensory level stimulation is cited to increase blood circulation
Product Overview Pulsed current most frequently noted in the literature
High Volt Pulsed Current
Program Navigation
Notes/References
VMS - Symmetrical Biphasic Pulsed Current
Electrotherapy
Overview Relax Muscle Spasm Protocol
Introduction
Sensory Stimulation
Contraindications
Precautions
Indications Parameters Settings
Pain Management Waveform HVPC
Relaxation of Muscle Polarity Negative

Spasms
Cycle Time Continuous
Muscle Re-Education Frequency 80 -120 Hz
Increasing Circlulation Sweep Yes
Edema Management Ramp 2 seconds
sEMG +Stim Amplitude To sensory tolerance. Sensory stimulation is

cited to increase blood flow
Waveforms
Duration of Rx 20 to 60 minutes depending on clinician and Electrode Placement
Product Overview patient needs The treating electrode (lead wire
with red ending) positioned over
Features and Functions Current mode CV the muscle in spasm
The return electrode (lead
Program Navigation wire with the black ending)
Electrode The treating electrode (lead wire with red ending)
placement positioned over the muscle in spasm positioned close by
Notes/References Electrode Size: Muscle size
The return electrode (lead wire with the black
ending) positioned close by dictates electrode size
Electrode Size: Muscle size dictates electrode size
Electrotherapy
Overview Relax Muscle Spasm Protocol
Introduction
Motor Level Stimulation
Contraindications
Precautions
Pain Management Waveform VMS
Relaxation of Muscle Mode Synchronous

Spasms
Cycle Time 1:1 (10 seconds on 10 seconds off)
Muscle Re-Education Frequency 80-120 Hz
Increasing Circlulation Ramp 2 seconds
Edema Management Current Mode CV
sEMG +Stim Amplitude Motor level stimulation is cited to

increase blood flow
Waveforms
Duration of Rx 20 min to 60 minutes Electrode Placement
Product Overview Locate areas of tenderness (trigger
Electrode Locate areas of tenderness (trigger points). Bracket area of muscle
Features and Functions spasm with anatomy specific sized
Placement points). Bracket area of muscle
electrodes
Program Navigation spasm with anatomy specific sized
electrodes
Notes/References
Electrotherapy
Overview Trigger Point
Introduction
Relax Muscle Spasm Protocol
Contraindications
Precautions
Pain Management Waveform VMS or Asymmetrical biphasic
Relaxation of Muscle Mode Synchronous

Spasms
Cycle Time 1:1 (10 seconds on 10 seconds off)
Muscle Re-Education Frequency 10 Hz
Increasing Circlulation Phase Duration 250 microseconds
Edema Management Ramp 2 seconds
sEMG +Stim Current Mode CV

Waveforms Amplitude Very strong to noxious; moderate
Product Overview muscle contraction may be visible
Features and Functions Duration of Rx 10 minutes daily
Program Navigation Electrode Locate areas of tenderness

Placement (trigger points). Place one smaller Electrode Placement
Notes/References electrode on trigger point and one Smaller electrode over trigger point
Larger electrode 4 away
larger electrode 4 away
Electrotherapy
Introduction
Relax Muscles In Spasm
Contraindications
Precautions Notes:
Indications
Pain Management
Muscle spasms and trigger points in an area of sympathetic
Relaxation of Muscle hyperactivity, usually within a muscle characterized by
Spasms
hypertonus, ischemia, referred pain and local point pain on
Muscle Re-Education palpation
Increasing Circlulation Electrical stimulation will help increase local blood flow
Edema Management Instruct patient to relax during electrotherapy session
sEMG +Stim
Gently stretch muscles after trigger point activity has
Waveforms
Product Overview
decreased
Features and Functions References
Program Navigation 1. Travell JG Mysofscial Pain and Dysfunction
2. Baker A., NeuroMuscular Electrical Stimulation A Practical Guide. 3rd Edition 1993. Rehabilitation Engineering
Notes/References Program, Los Amigos Research & Engineering Institute, Rancho Los Amigos Medical Center. Pages 67-72.
3. Gersh MR, ed: Electrotherapy in Rehabilitation. FA Davis Co, Philadelphia, PA, 1992. Pages 242-244
Electrotherapy
Introduction
Relax Muscles In Spasm
Contraindications
Precautions References (continued):
Indications 4. Nelson RM, Currier DP, eds: Clinical Electrotherapy: Appleton & Lang, Norwalk, CT, 1987. Pages 126-130
5. Hecox B, Physical Agents A Comprehensive Text for Physical Therapists: Appleton & Lang Norwalk, CT, 1994.
Pain Management Pages 286-289
6. Morris L, Newton RA, Use of High voltage Pulsed Galvanic Stimulation for Patients with Levator Ani Syndrome,
Relaxation of Muscle Physical Therapy, Volume 67, Number 10, October 1987. Pages 1522-1525
Spasms 7. Sohn N, et.al, The Levator Syndrome and its Treatment with High-Voltage Electrogalvanic Stimulation. The
American Journal of Surgery, Volume 144, 1982
Muscle Strengthening 8. Avoiding ischemia in latissimus dorsi muscle grafts: electrical prestimulation versus vascular delay. Ann Thorac
Surg. 2002 Jun;73(6):1927-32. Woo EB, Jarvis JC, Hooper TL, Salmons S.
Muscle Re-Education
Edema Management
sEMG +Stim
Waveforms
Product Overview
Program Navigation
Notes/References
Electrotherapy
Overview Muscle Focused Indications
Introduction
Contraindications Prevent or retard muscle atrophy
Precautions Muscle re-education
Indications
Maintaining or increasing joint range of motion
Pain Management
Stroke muscle re-education (sEMG +Stim)
Spasms
Muscle Re-Education
Edema Management
sEMG +Stim
Waveforms
Product Overview
Program Navigation
Notes/References
Electrotherapy
Overview Muscle Strengthening
Introduction
Muscle Strength / Prevent or Retard Muscle Atrophy / Increasing Joint ROM
Contraindications
Precautions Two broad approaches using
Indications
electrotherapy for muscle
Pain Management
reeducation and to facilitate
Spasms
strength
Strengthening the static postural
Muscle Re-Education
strength
Edema Management Slow twitch muscle fibers
sEMG +Stim Endurance fibers
Waveforms Improved joint stability
Product Overview
Strengthening of the explosive strength
Fast twitch muscle fibers
Program Navigation
Increase speed of contraction
Notes/References
Increase bulk strength
Electrotherapy
Overview Muscle Fiber Types
Introduction
Contraindications
Precautions Muscle contains two types of muscle fibers
Indications
Type I (slow twitch)
Pain Management
Type II (fast twitch)
Spasms
Muscle Re-Education
Edema Management
sEMG +Stim
Waveforms
Product Overview
Program Navigation
Notes/References
Electrotherapy
Overview Muscle Fiber Types
Introduction
Contraindications
Precautions
Indications Type I Slow Twitch Type II Fast Twitch
Pain Management Contraction speed Slow Fast
Relaxation of Muscle Endurance High Low

Spasms
Fatigue Slow Fast
Muscle Re-Education Strength Low High
Increasing Circlulation Function Static, postural Dynamic, explosive
Edema Management
sEMG +Stim Normal muscle:
Size of Type II is
Waveforms approximately twice
the size of Type I
Product Overview
Program Navigation
Notes/References
Electrotherapy
Overview Disuse Muscle Atrophy
Introduction
Contraindications
Precautions Most condition seen in rehab exhibit some form or muscle atrophy
Indications
Muscle atrophy occurs in muscle after a period of reduced activity
Pain Management
Most obvious/visual change is decrease in bulk and size of type II
Spasms
muscle fibers
Muscle Re-Education Type II Muscle
Increasing Circlulation Fibers
Edema Management
sEMG +Stim
Waveforms
Type I
Product Overview Muscle
Features and Functions Fibers
Atrophied muscle type II now half the size
Program Navigation
of type I
Notes/References
Electrotherapy
Overview Muscle Recruitment
Introduction
Muscle Strength / Prevent or Retard
Contraindications
Muscle Atrophy / Increasing Joint ROM
Precautions
Indications
During normal muscle contraction
muscle fibers are recruited according
Pain Management
to the size-principal
Spasms Small type I muscle fibers are
recruited first
Large type II muscle fibers are
Muscle Re-Education
recruited later when effort increases
Increasing Circlulation Practical implication of size principal in
Edema Management rehabilitation
sEMG +Stim Type I muscle fibers receive primary
Waveforms benefit from typical therapeutic
exercise
Product Overview
Larger type II muscle fibers only
benefit from exercise which calls
Program Navigation for their recruitment which is rare in
Notes/References rehab
Electrotherapy
Overview Muscle Recruitment with Electrotherapy
Introduction
Contraindications
Precautions Recruitment patterns during electrical
Indications stimulation are reversed
Pain Management
Type II muscle fibers are recruited first
to contract
Spasms Type I muscle fibers contract only when
Muscle Strengthening there is volitional activation or when
Muscle Re-Education the pulse width and intensity are raised
Increasing Circlulation above a certain threshold
Edema Management Impact of recruitment pattern
sEMG +Stim with electrical stimulation and
Waveforms exercise
Product Overview Voluntary exercise should

occur simultaneously to
electrical stimulation
Program Navigation
Muscle contraction should be
Notes/References
in a functional pattern
Electrotherapy
Overview Slow Twitch Muscle Fiber Protocol
Introduction
Lumbar Stabilization: Retrain transverse abdominis and multifidus
Contraindications
Precautions Parameter Setting
Indications Target neurons Slow twitch muscle fibers
Pain Management
Waveform VMS (symmetrical biphasic)
Spasms Frequency 35 Hz
Muscle Strengthening Duty Cycle 1:1 (10 sec. 10 sec. off)

Muscle Re-Education Pulse Duration 300 To 400 microseconds
Increasing Circlulation Rise/fall Time 2 seconds
Edema Management Duration of Rx Clinician decision commonly 5 to 10
sEMG +Stim minute sessions
Amplitude Sub-max motor - patient should activate

Waveforms
the transverse abdominus and multifidus
Product Overview muscles - (use of Pressure Biofeedback
device can help facilitate contraction)
Current mode CC Electrode Placement
Program Navigation Lumbar Stabilization
Electrode Channel 1 on abdominals lateral to linea Channel 1: Abdominals
Notes/References Placement semiluminaries just inferior to 12th rib Channel 2: Lower Lumbar
Channel 2 lower lumbar over erector spine
superior to PSIS
Electrotherapy
Overview Fast Twitch Muscle Fiber Protocol
Introduction
Quadriceps Strength Augmentation
Contraindications
Precautions Parameters Settings
Indications Waveform Russian
Pain Management
Carrier 2,500 Hz
Relaxation of Muscle Frequency
Spasms
Frequency 75 burst/second (bps)
On/Off Time 10 seconds on 50 seconds off (10/50)
Muscle Re-Education
Ramp 2 sec up and 2 sec down
Electrode Proximally over the upper vastus lateralis
Edema Management Placement and distally over the vastus medialis
sEMG +Stim Patient Position This protocol uses a modified position of
supine or long-sitting with the knee fully
Waveforms
extended rather than braced isometrically
Product Overview at 60 degrees knee extension, as in
Snyder-Mackler protocol
Amplitude Maximum tolerated. Additional criteria:
Program Navigation Tetanic contraction (no fasciculations),
and observable superior glide of the Electrode Placement
Notes/References patella Vastus Lateralis
Vastus Medialis
Duration of Rx 15 minutes
Electrotherapy
Introduction
Muscle Strength Prevent or retard muscle atrophy Increasing joint ROM
Contraindications
Precautions Notes:
Indications
Pain Management
Not as great of strength gains as traditional Snyder-Mackler
Relaxation of Muscle protocol. However, Fitzgerald et al showed 75.9% quad
Spasms
recovery in NMES/ex group compared to 67.0% in comparison
Muscle Re-Education group (exercise only) at 12 wks S/P ACL Recon.
Increasing Circlulation It was previously believed that portable battery powered NMES
Edema Management devices were not capable of producing muscle contraction
sEMG +Stim
forces 50% MVC.
Waveforms
Product Overview References
1. Fitzgerald et al. A modified neuromuscular electrical stimulation protocol for quadriceps training following ACL
Features and Functions reconstruction. J Orthop Sports Phys Ther. 2003;33:492-501.
2. Lyons et al. Differences in quadriceps femoris muscle torque when using a clinical electrical stimulator versus a
Program Navigation portable electrical stimulator. Phys Ther. 2005;85:44-51.
Notes/References
Electrotherapy
Overview Treatment of the Hemiparetic Subluxed Shoulder
Introduction
Slow Twitch Muscle Fiber Protocol
Contraindications
Indications Waveform VMS
Pain Management
Phase Duration 200 to 400 microseconds
Spasms Frequency 25 pps
Muscle Strengthening On/Off Time 2 seconds

Muscle Re-Education Current Format CV
Increasing Circlulation Electrode Use 2 small electrodes (2 X 2)
Placement One at supraspinatus muscle Electrode Placement
Edema Management Supraspinatus
One at posterior deltoid muscle
Posterior Deltoid
sEMG +Stim
Amplitude Progress to sufficient intensity to
Waveforms produce palpable reduction of
humeral head
Product Overview
Duration of Rx Progress from 30-minute sessions to
Features and Functions six hours per day. Progress gradually
and monitor to avoid electrically
Program Navigation fatiguing shoulder muscles.
Notes/References
Electrotherapy
Introduction
Muscle Strength Prevent or retard muscle atrophy Increasing joint ROM
Contraindications
Precautions Notes:
Indications
Pain Management
Baker et al used similar parameters to show an average
Relaxation of Muscle reduction of 6mm in subluxation over 6-week period (from
Spasms
14.8mm to 8.6mm). Phys Ther 1986;66:1930-1937.
Muscle Re-Education Re-adjust the electrode over supraspinatus if excessive upper
Increasing Circlulation trap contraction is noted.
Edema Management Lower frequency (25pps) is used to prevent excessive fatigue of
sEMG +Stim
shoulder muscles.
Waveforms
Product Overview References
1. Baker et al Phys Ther 1986;66:1930-1937.
Features and Functions 2. Currier DP, Mann R. Pain Complaint: Comparison of Electrical Stimulation with Conventional Isometric Exercise.
The Journal of Orthopedics and Sports Physical Therapy, Volume 5, Number 6, 1984. Pages 318-323
Program Navigation 3. Faghri PD, et.al. The Effects of Functional Electrical Stimulation on Shoulder Subluxation, Arm Function Recovery,
and shoulder Pain in Hemiplegic Stroke Patients. Archives of Physical Medicine and Rehabilitation, Volume 75,
Notes/References
January 1994. Pages 73-79
Electrotherapy
Overview Muscle Reeducation
Introduction
Muscle Reeducation
Contraindications
Precautions Neuromuscular control may be
Indications impaired after a neurological
Pain Management
lesion such as a stroke. In
Spasms some instances there may be a
Muscle Strengthening significant spastic component
Muscle Re-Education impeding normal movement.
Current thinking with spasticity
Edema Management
is that muscle weakness of the
sEMG +Stim
spastic muscle group may at
Waveforms
Product Overview
least partly be responsible for the reactive spasticity.
Features and Functions Functional exercise and strengthening of the spastic muscle group
Program Navigation is therefore important to normalize balance between agonist and
Notes/References antagonist muscle groups.
Electrotherapy
Introduction
Muscle Reeducation
Contraindications
Precautions EMG studies have demonstrated
Indications that agonist/antagonist muscle pairs
Pain Management
co-contract during movements in
Spasms predictable patterns
Muscle Strengthening In these contraction patterns
Muscle Re-Education agonist and antagonist muscles
show alternating bursts of activity to
Edema Management
initiate, sustain and finally stop the
sEMG +Stim
movement.
Waveforms
Product Overview
Program Navigation
Notes/References
Electrotherapy
Overview Sensory Level Muscle Reeducation
Introduction
Muscle Reeducation
Contraindications
Indications Waveform options Premodulated or Interferential
Pain Management
Carrier frequency 5000 Hz (equal to a cycle duration of 200 microseconds)
Spasms Frequency 50-150 Hz
Muscle Strengthening Amplitude Sensory level. Tingling sensation. No motor response.

Muscle Re-Education On/Off Time None
Increasing Circlulation Duration of Rx 20-60 minutes TID
Edema Management Electrode Placement Dermatomes, peripheral nerves, spinal nerve roots of the spastic
sEMG +Stim muscle, or the nerve innervating the antagonist muscle are all options.
Waveforms
Product Overview
Program Navigation
Notes/References
Electrotherapy
Introduction
Muscle Reeducation
Contraindications
Precautions Notes:
Indications Sensory level e-stim can be applied to dermatomes, peripheral nerves, or spinal
Pain Management nerve roots corresponding to the spastic muscle(s).
Relaxation of Muscle Sensory e-stim may also be administered to the nerve innervating the antagonists
Spasms of the muscle(s).
Muscle Strengthening Parameters are similar to those for sensory level electroanalgesia.
Bajd et al demonstrated a decrease in spasticity of the quadriceps in subjects
Muscle Re-Education
with spinal cord injury via sensory stimulation (20 minutes) to the dermatome
Increasing Circlulation associated with the same level as the spastic muscle(L3, L4). However, the
Edema Management reduction in spasticity was not present at a post test 2 hours later.1,2
sEMG +Stim
Levine et al demonstrated a decrease in spasticity of the plantarflexors, in
subjects with hemiplegia, via sensory level stimulation to the nerve innervating
Waveforms
the antagonists to the spastic muscle (common peroneal n.). Fifteen daily 60
Product Overview minute sessions were applied over 3 weeks.
Features and Functions Decreased spasticity of the plantarflexors and increased voluntary dorsiflexion
was noted.3
Program Navigation
Notes/References
References
1. Arch Phys Med Rehab. 1985;66:515-517.
2. J Physiol. 1984.
3. Electroenceph Clin Neurophys. 1992;85:131-142.
Electrotherapy
Overview Muscle Reeducation Phasic Muscle
Introduction
Muscle Reeducation
Contraindications
Indications Waveform VMS FR
Pain Management
Current format CC
Spasms Frequency 80 pps
Muscle Strengthening Phase Duration 300 microseconds

Muscle Re-Education Burst Duration 100-200 microseconds
Increasing Circlulation Duty cycle On/off time 1:5 (10 seconds on 30 seconds off)
Edema Management Duration of Rx 20 minutes
sEMG +Stim Amplitude Sensory level minimal muscle
contraction
Waveforms Weak dorsiflexors/evertors
Electrode Placement Channel 1: Agonist : 2 large
Product Overview Channel 1: Dorsiflexors/evetors
electrodes over each end of the
Channel 2: Plantarflexors
Features and Functions spastic muscle group Channel 2:
Antagonist : 2 large electrodes over Step 1: increase extensor tone for
Program Navigation each end of the of the flaccid muscle 10 mins (min-mod intensity)
group
Notes/References Step 2: do functional task (step
through, sit to stand, etc) in sync
with Burst Duration and On/Off
ratio
Electrotherapy
Introduction
Muscle Reeducation
Contraindications
Precautions Neither muscle group is ever totally
Indications silent during any phase of the
Pain Management movement
Relaxation of Muscle VMS FR waveform mimics this muscle
Spasms
activity to facilitate the return of normal
muscle movement in conditions where
Muscle Re-Education
neuromuscular control is impaired
Agonist channel initiates movement
Edema Management
with a brief burst of power, then
sEMG +Stim
decreases
Waveforms
Antagonistic channel follows with
Product Overview
brief burst of full output to slow down
the initial acceleration of the agonist,
Program Navigation
followed by a low output to regulate
Notes/References
the movement of the agonist
The movement is completed by a final
burst of output in both channels
Electrotherapy
Overview Increasing Local Blood Circulation
Introduction
Contraindications
Precautions The FDA allows
Indications
manufacturers to claim
Pain Management
6 indications for the
Spasms
use of powered muscle
stimulators
Muscle Re-Education
One being Increasing
Edema Management Local Blood Circulation
sEMG +Stim High Volt Pulsed Current
Waveforms
is the waveform most
Product Overview
commonly referenced in the literature
Program Navigation
Notes/References
Electrotherapy
Overview Increasing Local Blood Circulation
Introduction
Contraindications
Precautions Blood flow increase to a
Indications
muscle is implied
Pain Management
HVPC can be used to increase
Spasms
blood flow to target tissues
such as ischemic tissue in a
Muscle Re-Education
clinical setting
Edema Management HVPC increases
sEMG +Stim microcirculation by a fast
Waveforms
response and a slow response
Product Overview
Program Navigation
Notes/References
Electrotherapy
Overview Fast Response
Introduction
Contraindications
Precautions Transient increase in skin perfusion during a single
Indications
electrotherapy session.
Pain Management
Mawson et al. (Effect of high voltage pulsed galvanic stimulation
Spasms on sacral transcutaneous oxygen tension levels in the spinal cord
Muscle Strengthening injured. Paraplegia 1993)
Muscle Re-Education
For these subjects 30 minute sessions applied between T6 &
Edema Management
T12 caused a significant but transient 35% increase in sacral
sEMG +Stim TcPO2. The controls demonstrated no increase
Waveforms A fast response is an immediate increase in perfusion or skin
Product Overview
oxygenation
Program Navigation
Notes/References
Electrotherapy
Overview Slow Response
Introduction
Contraindications
Precautions Gradual increase in skin oxygenation over multiple treatment
Indications
sessions
Pain Management
Lundenberg et al. Effect of electrical stimulation on healing of
Spasms
ischemic skin flaps. Lancet 1988
A slow response is a gradual increase in perfusion or skin
Muscle Re-Education
oxygenation over multiple treatment sessions
Edema Management
sEMG +Stim
Waveforms
Product Overview
Program Navigation
Notes/References
Electrotherapy
Overview Increase Local Blood Circulation
Introduction
Contraindications
Indications Waveform High Volt Pulsed Current (HVPC)
Pain Management
Polarity Negative or positive depending
Relaxation of Muscle upon target tissue needs
Spasms
Frequency 100 to 120 Hz
Muscle Re-Education
Ramp 2 seconds
Increasing Circlulation Electrode Placement
Amplitude To sensory tolerance. Sensory
Edema Management The treating electrode
stimulation is cited to increase blood (lead wire with red ending)
flow (i.e. 100-150 volts)
sEMG +Stim positioned over the target
tissue
Duration of Rx 60 minutes depending on clinician
Waveforms The return electrode (lead
wire with the black ending)
Electrode placement The treating electrode (lead
Product Overview positioned close by
wire with red ending) positioned Electrode Size: target tissue
Features and Functions directly into the target tissue or size dictates electrode size
just adjacent to
Program Navigation The return electrode (lead wire
with the black ending) positioned
Notes/References close by
Electrode Size Muscle size dictates electrode size

Electrotherapy
Introduction
Notes
Contraindications
Precautions Electrical stimulation can enhance local blood flow in target
Indications
tissue
Pain Management
High Volt Pulsed current most commonly sited in the literature
Spasms
Muscle Strengthening References
Muscle Re-Education 1. Electrical stimulation for wound healing: a review of evidence from in vitro studies, animal experiments, and
clinical trials. Kloth LC Int. J Extrem Wounds March 2005
2. How to use electrical stimulation used in wound healing Klith LC Nursing 2002 Dec 32 (12) 17
Edema Management
3. Electrotherapy Reoxygenates Infamalleolar Ischemic Wounds on Diabetic Patients. Goldman et al. Advances in
sEMG +Stim Skin and Wound Care May/June 2002
Waveforms 4. Lundenberg et al. Effect of electrical stimulation on healing of ischemic skin flaps. Lancet 1988
Product Overview 5, Claeys et al. Transcutaneous oxygen pressure as a predicative parameter for ulcer healing in end stage vascular
patients treated with spinal cord stimulation. International Angioplasty 1996
Program Navigation
Notes/References
Electrotherapy
Overview Edema Management
Introduction
Two methods commonly in use
Contraindications
Precautions Indirect method
Indications
Muscle pump
Pain Management
Use any waveform capable of getting a muscle contraction
Spasms Good literature support
Muscle Re-Education
Direct method
Drive edema away with negative polarity
Edema Management
Need monophasic waveform
sEMG +Stim
Waveforms
Less evidence to support this method
Product Overview
Program Navigation
Notes/References
Electrotherapy
Overview Indirect Method
Introduction
Edema
Contraindications
Precautions Drive edema away with muscle pumping
Indications
action
Pain Management
Over large muscles proximal to edema
Spasms
1-5Hz eliciting a non-tetanic contraction
(twitch)
Muscle Re-Education
Best supported method in literature
Edema Management
sEMG +Stim
Waveforms
Product Overview
Program Navigation
Notes/References
Electrotherapy
Overview Direct Method
Introduction
Edema
Contraindications
Precautions Drive edema away with
Indications
polarity
Pain Management
Directly over edema
Spasms No contraction required
Need monophasic
Muscle Re-Education
waveform
Edema Management
Less support in
sEMG +Stim literature
Waveforms
Product Overview
Program Navigation
Notes/References
Electrotherapy
Overview Muscle Pumping Protocol
Introduction
Edema
Contraindications
Indications Waveform VMS
Pain Management
Mechanism Muscle pumping to promote
Relaxation of Muscle lymphatic and venous return
Spasms Muscle contractions to pump the
vessels
Phase Duration 300 microseconds
Muscle Re-Education
Frequency 5 pps
Cycle Time 1:1 5 sec. on 5 sec. off
Edema Management
Electrode Placement
Electrode One electrode over the proximal
sEMG +Stim One electrode over the proximal muscle
Placement muscle belly or over the motor belly
Waveforms nerves that promote contraction of
the target tissue
Product Overview
Amplitude Progress to submaxial motor
Features and Functions rhythmical muscle pumping. If using
on an extremity try to elevate as able
Program Navigation
Duration of Rx Twenty minutes of stimulation
Notes/References
Electrotherapy
Introduction
Notes
Contraindications
Precautions Rhythmically induced electrical muscle contractions of the
Indications
muscles around the deep veins supplying an area of chronic
Pain Management
edema are reported in the literature to serve as a Muscle
Spasms
Pump to increase venous or lymphatic drainage and pump
away excess fluid. The current amplitude setting should be
Muscle Re-Education
sufficient to produce a comfortable motor response.
Edema Management
sEMG +Stim Supporting Literature:
Lindstrom, B et al., 1982; Doran, FSA, Drury, M, & Syver, 1964, Packman-Braun, 1992, Shapiro, S, 2003,
Waveforms
Product Overview
Program Navigation
Notes/References
Electrotherapy
Overview Ion Repelling Protocol
Introduction
Edema
Contraindications
Indications Waveform High Volt Pulsed Current
Pain Management
Mechanism Reduce the leakage of large protein
Relaxation of Muscle molecules and fluid from the blood,
Spasms through the walls of the small blood
vessels into the interstitium
Polarity 300 microseconds
Muscle Re-Education
Frequency 120 pps
Edema Management
Electrode Cathode (negative) electrode
sEMG +Stim
Placement placed over the site of injury.
Waveforms Should be smaller in size than
the positive or anode (positive)
Product Overview electrode
Anode (positive) placed in a
Features and Functions convenient site. Does not need
to be proximal as the effects are
Program Navigation Electrode Placement
local effects
Notes/References Negative electrode over area of
Amplitude 10% below motor threshold
inflammation
Duration of Rx Thirty minutes up to 4 times per day Positive electrode close by
Electrotherapy
Introduction
Notes
Contraindications
Precautions Fish, Mendel and others published extensively from 1990 through 1997
Indications on electrical stimulation and edema
Pain Management HVPC waveform to a sensory level with the cathode at the site of injury
Relaxation of Muscle retardsdoes not reduce the formation of edema
Spasms
The application of High-Volt Pulsed Current is reported in the literature
Muscle Re-Education
to retard the amount of edema formed following acute injury
The current amplitude should be sufficient to produce a comfortable
Edema Management
sensation without a motor response
sEMG +Stim Mechanism of effectReduce the leakage of large protein molecules
Waveforms and fluid from the blood, through the walls of the small blood vessels
Product Overview into the interstitium
Program Navigation References
Notes/References 1. Supporting literature includes Bettany, Fish & Mendel, 1990; Fish, Mendel & Burton, 1992; Cook et al., 1994;
Karnes, Mendel & Fish 1992; Taylor, Mendel, fish, Hard & Burton, 1997
Electrotherapy
Overview sEMG
Introduction
Contraindications Surface electromyography (SEMG)
Precautions is the recording of muscle action
Indications potentials with surface skin electrodes
Pain Management Muscle tissue like nerves generate
Relaxation of Muscle electrical signals called Action
Spasms
Potentials
Summation of action potentials arriving
Muscle Re-Education
at the motor end plates under the
electrodes
Edema Management
Provides patient and clinician with
sEMG +Stim
objective feedback about muscle
Waveforms
activity
Product Overview
Program Navigation
Notes/References
Electrotherapy
Overview sEMG
Introduction
Why to consider sEMG
Contraindications
Precautions Patients with impaired motor and
Indications sensory skills need more and objective
Pain Management feedback about movement to be able
Relaxation of Muscle to improve motor patterns
Spasms
A Clinical Tool to monitor skeletal
Muscle Re-Education
muscle activity for purposes of
evaluation and training
Edema Management
Evaluation
sEMG +Stim Down-training (inhibition)
Waveforms Reduce muscle hyperactivity
Product Overview Up-training (recruitment)
Features and Functions Facilitate weakened or diseased/
Program Navigation injured muscle
Notes/References Coordination training
Learn to obtain correct balance between agonist and antagonist
Electrotherapy
Overview Protocol: Shoulder Instability
Introduction
Contraindications
Parameters Settings
Precautions
Therapy Goal Increase recruitment
Indications of infraspinatus and
supraspinatus during
Pain Management abduction
Relaxation of Muscle Target muscle Infraspinatus

Neutral
Spasms Active
Channel Single channel
Muscle Re-Education Volume High
Increasing Circlulation Audio Constant
Edema Management Alarm Below
sEMG +Stim Electrode Infraspinatus

Placement
Waveforms
Product Overview Infraspinatus
Program Navigation
Notes/References
Electrotherapy
Introduction
Setup Process
Contraindications
Precautions 1. Clean skin, apply electrodes and set parameters
Indications 2. Observe readout during abduction
Pain Management 3. Press Capture Target
Relaxation of Muscle 4. Press Begin Capture
Spasms
5. Ask patient to abduct to 90 few times
Muscle Re-Education
6. Press End Capture
7. Press to increase target to 110%
Edema Management
8. Press to accept new target
sEMG +Stim
Waveforms Note: adjust target manually upward or downward later if need be
Product Overview
Program Navigation
Notes/References
Electrotherapy
Introduction
Contraindications Begin by teaching patient to make
Precautions sound go away
Indications
Pain Management
Progress to keep sound away while you
Spasms raise your arm
Muscle Re-Education
Gradually progress to include
Edema Management Full ROM
sEMG +Stim Carrying object
Waveforms Reaching for objects at certain height
Product Overview Various open chain exercises
Program Navigation
Notes/References
Electrotherapy
Introduction
Jobe FW, Pink M: Classification and treatment of shoulder dysfunction in the overhead
Contraindications
athlete. J Orthop Sports Phys Ther 1993 Aug; 18(2): 427-32
Precautions
Indications McCann PD, Wootten ME, Kadaba MP, Bigliani LU: A kinematic and electromyographic
study of shoulder rehabilitation exercises. Clin Orthop 1993 Mar; (288): 179-88
Pain Management
Relaxation of Muscle Moseley JB Jr, Jobe FW, Pink M, Perry J, Tibone J: EMG analysis of the scapular
Spasms
muscles during a shoulder rehabilitation program. J Sports Med 1992 Mar-Apr; 20(2):
Muscle Strengthening 128-34
Muscle Re-Education
Jobe FW, Tibone JE, Perry J, Moynes D: An EMG analysis of the shoulder in throwing
and pitching. A preliminary report. Am J Sports Med 1983 Jan-Feb; 11(1): 3-5
Edema Management
sEMG +Stim Cain PR, Mutschler TA, Fu FH, Lee SK: Anterior stability of the glenohumeral joint. A
Waveforms dynamic model. Am J Sports Med 1987 Mar-Apr; 15(2): 144-8
Product Overview
Mahaffey BL, Smith PA: Shoulder instability in young athletes. Am Fam Phys 1999,
Features and Functions 59(10):2773-2782
Program Navigation
Notes/References
Warner JJP, et al: Effect of joint compression on inferior stability of the glenohumeral
joint. Jnl Shld Elbow Surg 1999, 8(1):31-36
Electrotherapy
Overview Protocol: Facilitate VMO
Introduction
Contraindications Problem: VMO inhibited and
Precautions weak due to pain and disuse
Indications
Goal: increase recruitment VMO
Pain Management
during extension to ratio of 1:1
Spasms with VL
Method:
Muscle Re-Education
sEMG over VMO
Edema Management
Teach patient to recognize VMO
sEMG +Stim activity
Waveforms Teach patient to increase activity
Product Overview during knee extension
Program Navigation
Notes/References
Electrotherapy
Introduction
Contraindications
Parameters Settings
Precautions
Therapy Goal Increase recruitment of VMO
Indications during extension
Pain Management Target muscle VMO
Relaxation of Muscle Channel Single channel

Spasms
Volume High
Audio Constant
Muscle Re-Education
Alarm Above
Target Average
Edema Management
Electrode Single channel VMO
sEMG +Stim
Placement
Waveforms
Product Overview
Program Navigation
Notes/References
Electrotherapy
Introduction
Setup Process
Contraindications
Pain Management 3. Press Capture Target
Relaxation of Muscle 4. Press Begin Capture
Spasms
5. Ask patient to extend to 0 few times
Muscle Re-Education
6. Press End Capture
7. Press to increase target to 110%
Edema Management
8. Press to accept new target
sEMG +Stim
Waveforms Note: adjust target manually upward or downward later if need be
Product Overview
Program Navigation
Notes/References
Electrotherapy
Introduction
Protocol Process
Contraindications
Precautions Begin by teaching patient when
Indications sound will occur: when VMO fires
Pain Management right
Spasms
Teach patient keep sound on while
Muscle Re-Education
extending knee to 0
Edema Management
sEMG +Stim Various closed and open chain
Waveforms movement patterns
Product Overview Lunges, gait, jumps, etc.
Program Navigation
Notes/References
Electrotherapy
Introduction
Powers CM. Rehabilitation of patellofemoral joint disorders: A critical review. J Orthop
Contraindications
Sports Phys Ther. 28:345-354, 1998.
Precautions Fulkerson JP, Shea KP. Mechanical Basis for Patellofemoral Pain and Cartilage
Indications Breakdown. In: Ewing JW (ed) Articular Cartilage and Knee Joint Function: Basic
Science and Arthroscopy, pp 93-101, New York: Raven Press, 1990.
Pain Management
Outerbridge R, Dunlop J: The problem of chondromalacia patellae. Clinical
Relaxation of Muscle Orthopedics 110, 1975
Spasms
Douchette SA, Gobel EM: The effects of exercise on patellar tracking in lateral patellar
Muscle Strengthening compression syndrome. Am J Sports Med 20:434-440, 1999
Muscle Re-Education Papagelopoulus PJ, Sim FH: Patellofemoral pain syndrome: Diagnosis and management.
Orthopedics 20:148-157, 1997
Lieb FL, Perry J: Quadriceps function: An electromyographic study under isometric
Edema Management
conditions. J Bone Joint Surg 53A:1535-1548, 1968
sEMG +Stim Gruber M: The conservative treatment of chondromalica patellae. Orthopaedic Clinic of
Waveforms North America 10: 105-115, 1979
Powers C. Rehabilitation of patellofemoral joint disorders; a critical review. JOSPT,
Product Overview
1998
Features and Functions Kasman and Cram, Introduction to surface electromyography. Aspen publishing 1998
Program Navigation Reynolds L, Levin TA. EMG activity of the vastus medialis oblique and the vastus
Notes/References
lateralis in the role of patella alignment. American J Physical Medicine. 62, 1983
Mariani PP, Caruso I. An electromyographic investigation of subluxation of the patellae.
J Bone and Joint Surgery 61B, 1979
Electrotherapy
Overview sEMG Triggered Stimulation
Introduction
Contraindications Surface EMG triggered
Precautions stimulation requires
Indications
the CVA patient to
Pain Management
voluntarily contract a
Spasms group of muscles for
movement in order for
Muscle Re-Education
electrical stimulation to
Edema Management be provided. The sEMG
sEMG +Stim of the active contraction
Waveforms
serves as a control to initiate electrical stimulation and help
Product Overview
supplement the patients active contraction.
Program Navigation
Notes/References
Electrotherapy
Overview sEMG Triggered Stimulation
Introduction
Contraindications In the electrotherapy product
Precautions EMG triggered Muscle
Indications
Stimulation is a protocol that
Pain Management
requires a patient to voluntarily
Spasms contract a muscle or group of
muscles to initiate a certain
Muscle Re-Education
movement. The measured EMG
Edema Management level generated by the muscles
sEMG +Stim triggers the system to deliver
Waveforms
electrical stimulation to these
Product Overview
same muscles (through the same
Program Navigation
electrodes), thereby assisting
Notes/References them during functional movements and exercises.
Electrotherapy
Overview Protocol: Facilitate Use of Flaccid Hand
Introduction
Contraindications Flaccid or weak hand and wrist extension status post stroke
Precautions
Indications
Problem: difficulty in using hand during ADL
Pain Management
Spasms Goal: increase recruitment of hand extensors during ADL
Muscle Re-Education
Method:
Edema Management sEMG over hand and wrist extensors
sEMG +Stim Capture threshold close to max activation
Waveforms Teach patient to reach threshold before starting functional activity
Product Overview
Program Navigation
Notes/References
Electrotherapy
Introduction
Contraindications
Parameters Settings Neutral Active
Precautions
Therapy Goal Increase recruitment of
Indications hand extensors during
ADL
Pain Management
Target muscle Wrist extensors
Spasms Channel Single channel A
Target MAX Capture threshold
Muscle Re-Education close to max activation
Teach patient to reach
Increasing Circlulation threshold before
starting functional
Edema Management activity
sEMG +Stim Volume High
Waveforms Audio Constant
Product Overview Alarm Above
Features and Functions Electrode Wrist extensors
Placement
Program Navigation
Notes/References
Electrotherapy
Introduction
Protocol Process
Contraindications
Pain Management 3. Ask for maximum contraction
Relaxation of Muscle 4. Press Capture Target
Spasms
5. Press to accept 100%
Muscle Re-Education
6. Press Edit Stim
7. Set Phase Duration to 150s
Edema Management
8. Set cycle time to 5/5
sEMG +Stim 9. Frequency: 50Hz, Ramp: 0.5 sec
Waveforms 10. Increase intensity until good contraction with full extension is
Product Overview achieved
Features and Functions 11. Press Edit sEMG
Program Navigation 12. Press Start sEMG + Stim
Notes/References
Note: adjust target manually upward or downward later as needed
Electrotherapy
Introduction
Protocol Process
Contraindications
Precautions Begin by demonstrating
Indications
to patient what occurs
Pain Management
when threshold is reached
Spasms Teach patient to initiate
Muscle Strengthening movement as soon as
Muscle Re-Education machine indicates Go
Increasing Circlulation Gradually progress to
Edema Management include
sEMG +Stim
Various functional
Waveforms
movement patterns
Product Overview
Reaching for objects, etc.
Program Navigation
Notes/References
Electrotherapy
Overview Protocol: Drop Foot
Introduction
Contraindications Flaccid or weak ankle
Precautions dorsiflexion and
Indications eversion status post
Pain Management stroke
Relaxation of Muscle Problem:
Spasms
Trace strength tibialis
anterior and peronei
Muscle Re-Education
Impaired gait pattern
Edema Management
sEMG +Stim
Goal: increase
Waveforms recruitment affected
Product Overview muscles during gait
Method:
Program Navigation
sEMG over tibialis anterior and peronei
Notes/References
Capture threshold close to max activation
Teach patient to reach threshold before starting functional activity
Electrotherapy
Introduction
Contraindications
Parameters Settings
Precautions
Therapy Goal Increase recruitment affected muscles
Indications during gait
Pain Management Target muscle Tibialis anterior, Peronei
Relaxation of Muscle Channel Channel A and B

Spasms
Target MAX
Muscle Re-Education Volume High
Edema Management Audio Constant
sEMG +Stim
Alarm Above
Waveforms
Product Overview Electrode Placement Channel A: Peronei
Channel B: Tibialis anterior
Program Navigation
Notes/References
Electrotherapy
Introduction
Protocol Process
Contraindications
Indications 2. Observe readout during dorsiflexion and eversion
Pain Management 3. Ask for maximum contraction
Relaxation of Muscle 4. Press Capture Target
Spasms
5. Press to accept 100%
Muscle Re-Education
6. Press Edit Stim
7. Set Phase Duration to 150s
Edema Management
8. Set cycle time to 5/5
sEMG +Stim 9. Frequency: 50Hz, Ramp: 0.5 sec
Waveforms 10. Increase intensity until good contraction with full dorsiflexion or
Product Overview eversion
Features and Functions 11. Press Edit sEMG
Program Navigation 12. Press Start sEMG + Stim
Notes/References
Note: adjust target manually upward or downward later as needed
Electrotherapy
Introduction
Protocol Process
Contraindications
Precautions Begin by demonstrating to patient what
Indications occurs when threshold is reached
Pain Management
Relaxation of Muscle Teach patient to initiate movement as
Spasms
soon as machine indicates Go
Muscle Re-Education
Various functional movement patterns
Edema Management
sEMG +Stim
Gait, stepping, etc.
Waveforms
Product Overview
Program Navigation
Notes/References
Electrotherapy
Introduction
1. Electromyographic biofeedback in the treatment of the hemiplegic hand: a
Contraindications
placebo-controlled study. Armagan O, Tascioglu F, Oner C. Am J Phys Med
Precautions
Rehabil. 2003 Nov;82(11):856-61.
Indications
Pain Management
2. Two coupled motor recovery protocols are better than one:
Spasms electromyogram-triggered neuromuscular stimulation and bilateral
Muscle Strengthening movements. Cauraugh JH, Kim S. Stroke. 2002 Jun;33(6):1589-94.
Muscle Re-Education
3. Chronic stroke motor recovery: duration of active neuromuscular
Edema Management
stimulation. Cauraugh JH, Kim SB. J Neurol Sci. 2003 Nov 15;215(1-2):13-9.
sEMG +Stim
4. Progress toward motor recovery with active neuromuscular stimulation:
Waveforms
muscle activation pattern evidence after a stroke. Cauraugh JH, Kim S.
Product Overview
Neurol Sci. 2003 Mar 15;207(1-2):25-9.
Program Navigation
Notes/References
Electrotherapy
Overview Waveforms
Introduction
Electrotherapy Offering
Contraindications
Precautions Interferential
Indications
Premodulated
Pain Management
High Volt Pulsed Current
Spasms
VMS
VMS Burst
Muscle Re-Education
VMS FR
Edema Management Russian
sEMG +Stim Symmetrical Biphasic
Waveforms
Asymmetrical biphasic
Product Overview
Microcurrent
Program Navigation
Direct Current
Notes/References
Electrotherapy
Overview Interferential
Introduction
Interferential Current
Contraindications
Precautions Two medium frequency currents passed through the tissue
Indications
simultaneously set up so their paths cross or interfere resulting
Pain Management
in a beat frequency.
Spasms Channel 1: 5,000 Hz
Channel 2: 5,100 Hz
Muscle Re-Education
Resulting Beat Frequency: 100 Hz
Edema Management
sEMG +Stim
Waveforms
Product Overview
Program Navigation
Notes/References
Electrotherapy
Introduction
Application
Contraindications
Precautions Quadpolar
Indications
Four (4) electrodes Two (2) channels
Pain Management
Treatment field is where currents cross
Spasms
Bipolar
Muscle Re-Education
Premodulated
Two (2) electrodes one (1) channel
Edema Management
sEMG +Stim
Modulated in the machine
Waveforms
Product Overview
Program Navigation
Notes/References
Electrotherapy
Introduction
Contraindications Scan Variations in peak amplitude in a series of pulses or
Precautions cycles
Indications
Sweep Variations in frequency in a series of pulses or cycles
Pain Management
Spasms Clinical Benefits
Comfortable
Muscle Re-Education
Large area of coverage
Edema Management
sEMG +Stim Literature Support
Waveforms Pain control: Yes
Product Overview Increase blood circulation: Yes
Features and Functions Muscle strengthening: No
Program Navigation
Notes/References
Electrotherapy
Overview Premodulated
Introduction
Contraindications The two (2) medium frequency alternating sine waves are mixed
Precautions in the system and delivered to the patient with two electrodes.
Indications
Clinical Benefits
Pain Management
Comfortable
Spasms Easy to set up a two pad placement
Muscle Strengthening Easily applied to smaller areas
Muscle Re-Education
Edema Management
sEMG +Stim
Waveforms
Product Overview
Program Navigation
Notes/References
Electrotherapy
Overview Interferential and Premodulated
Introduction
Contraindications Compared to other waveforms
Precautions Physiological response to issues is same as for low frequency
Indications waveforms
Pain Management
Higher carrier frequencies can penetrate the skin and tissue to a
Spasms much greater depth
Muscle Strengthening Higher total current load: possible heating effect under electrode
Muscle Re-Education Patients often describe comfortable rhythmical sensation
Literature Support
Edema Management
Pain management Yes
sEMG +Stim
Muscle strengthening No
Waveforms
Product Overview
Increase local blood circulation - Yes
Program Navigation
Notes/References
Electrotherapy
Overview Russian Current
Introduction
Contraindications Sinusoidal pulsed alternating current with a 2,500 Hz carrier frequency.
Precautions Current modulated at 50 Hz
Indications This waveform became popular in the 1970s as it was described by
Pain Management a Russian scientist Yaakov Kots to produce muscle contractions of
Spasms 110-130% MVIC (maximum voluntary isometric contraction) with no
Muscle Strengthening discomfort.
Muscle Re-Education
Edema Management
sEMG +Stim
Waveforms
Product Overview
Clinical Benefits
Program Navigation Comfortable stimulation
Notes/References Strong muscle contraction
Sine wave is reported to cause less fatigue
Minimum to moderate muscle weakness
Electrotherapy
Overview Russian Current
Introduction
Contraindications Compared to other waveforms
Precautions Muscle strengthening effects are better
Indications Stimulation can be more uncomfortable at higher intensities
Pain Management
Spasms Literature Support
Muscle Strengthening Pain management Weak
Muscle Re-Education Muscle strengthening Yes
Edema Management
sEMG +Stim
Waveforms
Product Overview
Program Navigation
Notes/References
Electrotherapy
Overview Biphasic Current
Introduction
Two types:
Contraindications
Precautions Asymmetrical Waveform: One or
Indications
more of the waveform variables
Pain Management
of the phase are unequal
Spasms
Symmetrical Waveform: All
waveform variables (amplitude,
Muscle Re-Education
duration etc.) are identical
Edema Management
sEMG +Stim Balanced or unbalanced
Waveforms
Unbalanced and asymmetrical
Product Overview
are more aggressive
Program Navigation
Notes/References
Electrotherapy
Overview Biphasic Current
Introduction
Compared to other waveforms
Contraindications
Precautions Short pulse duration lowers skin resistance
Indications
Suitable for high intensity and or long term applications
Pain Management
Portable pain management
Spasms NMES applications
FES applications
Muscle Re-Education
Literature Support
Edema Management
sEMG +Stim Pain management Yes
Waveforms Muscle strengthening Yes
Product Overview
Increasing blood circulation - Yes
Edema management Yes
Program Navigation
Notes/References
Electrotherapy
Overview VMS
Introduction
Contraindications
Precautions VMS: Variable Muscle Stimulation is a symmetrical biphasic square
Indications waveform with a 100 microsecond interphase interval between the
Pain Management
positive and negative phases.
Spasms
Muscle Re-Education
Edema Management
sEMG +Stim
Waveforms
Product Overview
Program Navigation
Notes/References
Electrotherapy
Overview VMS
Introduction
Contraindications
Precautions Interphase interval commonly associated with patient comfort
Indications Suitable for high intensity and or long term applications
Pain Management
NMES applications
Spasms Portable pain management
Muscle Strengthening FES applications
Muscle Re-Education
Increasing Circlulation Literature Support
Edema Management
sEMG +Stim
Pain management Yes
Waveforms Muscle strengthening Yes
Product Overview Increasing blood circulation - Yes
Features and Functions Edema management Yes
Program Navigation
Notes/References
Electrotherapy
Overview VMS - FR
Introduction
The VMS FR waveform is delivered
Contraindications
through two (2) channels in a
Precautions
co-contraction application ,
Indications typically channel 1 on agonistic
Pain Management and channel 2 on the antagonistic
Relaxation of Muscle muscle groups.
Spasms When the Start button is pressed
Muscle Strengthening the channels will deliver the
Muscle Re-Education current in a preset sequence as
Increasing Circlulation follows:
1. The agonistic channel initiates
Edema Management
the movement with a brief burst
sEMG +Stim
of power (100% of established
Waveforms
intensity) followed by a period of
Product Overview sustained activity in this channel
Features and Functions to complete the movement.
Program Navigation 2. The antagonistic channel will have
Notes/References
a brief burst of full output to slow down the initial acceleration of the agonist,
followed by a low output to regulate the movement of the agonist.
3. The movement is completed by a final burst of output in both channel
Electrotherapy
Overview VMS - FR
Introduction
Contraindications
EMG studies have demonstrated
Precautions
that agonist/antagonist muscle pairs
Indications co-contract during movements in
Pain Management predictable patterns
Relaxation of Muscle In these contraction patterns agonist
Spasms and antagonist muscles show
Muscle Strengthening alternating bursts of activity to initiate,
sustain and finally stop the movement
Muscle Re-Education
Neither muscle group is ever totally
Increasing Circlulation silent during any phase of the
Edema Management movement
sEMG +Stim
VMS FR waveform mimics this muscle activity to facilitate the return of
normal muscle movement in conditions where neuromuscular control is
Waveforms impaired
Product Overview
Features and Functions Literature Support
Program Navigation
Muscle strengthening Emerging
Notes/References Spasticity management Emerging
Electrotherapy
Overview High Volt Pulsed Current
Introduction
Contraindications
High Volt Pulsed Current is a rapid succession of two brief high voltage
Precautions impulses. The current flows in only one direction, which is determined
Indications by the selection of either a positive or negative polarity setting.
Pain Management
Spasms
Muscle Re-Education
Edema Management
sEMG +Stim
Waveforms
Product Overview
Program Navigation
Notes/References
Electrotherapy
Overview High Volt Pulsed Current
Introduction
Contraindications
Application
Precautions
Indications Usually one smaller active electrode and one dispersive
Pain Management electrode proximal or close to it
Spasms
Muscle Strengthening Literature support
Muscle Re-Education
Increase local blood circulation in wound tissue Yes
Edema management - Yes
Edema Management
sEMG +Stim Spasticity control Yes
Waveforms Muscle strengthening Weak
Product Overview Pain management weak
Program Navigation
Notes/References
Electrotherapy
Overview Microcurrent
Introduction
Contraindications Continuous or pulsed monophasic waveform at very low amplitudes
Precautions (<1mA)
Indications Becker (1967) proposed model of tissue healing based on studies of a
Pain Management current of injury
Spasms Normal healing tissue, unlike non-healing tissue, contains characteristic
Muscle Strengthening of electrical current
Muscle Re-Education Current is in the microamperage range
Increasing Circlulation Externally applied current may theoretically stimulate healing
Edema Management
sEMG +Stim
Waveforms
Product Overview
Program Navigation
Notes/References
Electrotherapy
Overview Microcurrent
Introduction
Application
Contraindications
Precautions One electrode (on or in ) target/treatment tissue one electrode close
Indications to it
Pain Management
Polarity reversal is recommended
Spasms
Muscle Strengthening Literature Support
Muscle Re-Education
Increasing local blood circulation in wounds Yes
Edema Management Trigger points Yes
sEMG +Stim Tendonitis- Yes
Waveforms Edema management Yes
Product Overview
Program Navigation
Notes/References
Electrotherapy
Overview Product Overview
Introduction
Contraindications Patient Card for LCD color display
Precautions treatment recording
Indications
Pain Management Organized access ports
Hand help therapy for channel and modality
Relaxation of Muscle remote control access
Spasms (optional)
Muscle Re-Education Efficiently designed storage
System has the cart with six (6) storage bins
Increasing Circlulation ability to have up to 6
Edema Management modalities on board
sEMG +Stim Electrotherapy

Ultrasound
Waveforms
Combination
Product Overview sEMG
sEMG + Stim
Features and Functions Laser
Program Navigation
Notes/References
Electrotherapy
Overview Unit Overview
Introduction
Contraindications
LCD color display
Precautions
Indications
Patient Card Tactile Key Mat to
Pain Management for treatment select onscreen items
recording
Spasms Clinical file folder home
of Clinical Protocols
Muscle Strengthening User Protocols
Home Screen Sequence
Muscle Re-Education Button Graphics Library button
Back one screen
Edema Management
sEMG +Stim
Efficiently located
Waveforms Start, Stop and Tactile Amplitude
Pause control knob
Product Overview
Program Navigation
Notes/References
Electrotherapy
Overview Unit Overview
Introduction
Contraindications Clinical File Folder
Precautions
Indications
Provides access to:
Pain Management Clinical Protocols
Uer Protocols
Relaxation of Muscle Sequencing
Spasms
Graphics Library
Muscle Re-Education
Edema Management
sEMG +Stim
Waveforms
Product Overview
Program Navigation
Notes/References
Electrotherapy
Overview Program Navigation
Introduction
Contraindications
Electrotherapy
Precautions
Indications Indications
Pain Management
Spasms
Ultrasound
Muscle Strengthening sEMG
Muscle Re-Education
sEMG + Stim
Edema Management
sEMG +Stim Clinical Protocols
Waveforms
Product Overview
Program Navigation
Notes/References
Electrotherapy
Overview Electrotherapy
Introduction
Contraindications STEP 2: Select STEP 3: Review
STEP 1: Select
Precautions Electrotherapy Waveform and/or Edit
Indications
Pain Management
Spasms
Muscle Re-Education
Edema Management
sEMG +Stim
Waveforms
Product Overview STEP 4: Set
Features and Functions Amplitude, then
Program Navigation
press START
Notes/References
Electrotherapy
Overview Ultrasound
Introduction
Contraindications STEP 2: Review STEP 3: Review
STEP 1: Select
Precautions Ultrasound and/or Edit and/or Edit
Indications Parameters Parameters
Pain Management
Spasms
Muscle Re-Education
Edema Management
sEMG +Stim
Waveforms
Product Overview
Features and Functions STEP 4: Set
Program Navigation Intensity, then
Notes/References press START
Electrotherapy
Overview Indications
Introduction
Contraindications STEP 2: Select STEP 3: Review
STEP 1: Select
Precautions Indications the desired selected waveform
Indications electrotherapy parameters
Pain Management
indication
Spasms
Muscle Re-Education
Edema Management
sEMG +Stim
Waveforms
Product Overview
Program Navigation
Notes/References Indications is a operating format. All indications are cleared by FDA and associated waveforms
and parameters are evidence based
Electrotherapy
Overview sEMG
Introduction
Contraindications STEP 2: Review and STEP 3: Proceed
STEP 1: Select
Precautions sEMG proceed or Edit with sEMG
Indications sEMG parameters
Pain Management
Spasms
Muscle Re-Education
Edema Management
sEMG +Stim
Waveforms
Product Overview
Features and Functions STEP 4: Capture
Program Navigation sEMG training Target
Notes/References and press START
Electrotherapy
Overview sEMG Electrode Placement
Introduction
Contraindications STEP 2: Select the STEP 3: Review
STEP 1: Select
Precautions Electrode body area sEMG will electrode
Indications Placement be administered placement
Pain Management
Spasms
Muscle Re-Education
Edema Management
sEMG +Stim
Waveforms
Product Overview
Electrode Placement is a feature to assist the clinician understanding general sEMG electrode
Program Navigation placement.
Notes/References
Electrotherapy
Overview sEMG + Stim
Introduction
Contraindications STEP 2: Review STEP 3: Review
STEP 1: Select
Precautions sEMG + Stim Application and understand
Indications Description clinical application
Pain Management
Spasms
Muscle Re-Education
Edema Management
sEMG +Stim
Waveforms
Product Overview
sEMG + Stim is an active form of electrical stimulation requiring the patient to contract the target
Program Navigation muscle to a predefined level prior to the inclusion of electrical stimulation
Notes/References
Electrotherapy
Overview sEMG + Stim
Introduction
Contraindications STEP 2: Review and STEP 3: Set
STEP 1: Select
Precautions sEMG + Stim proceed or Edit sEMG sEMG target and
Indications + Stim parameters stimulation levels
Pain Management
Spasms
Muscle Re-Education
Edema Management
sEMG +Stim
Waveforms
Product Overview
Features and Functions STEP 4: Capture sEMG
Program Navigation training Target and set
Notes/References stimulation levels and
press START
Electrotherapy
Overview Clinical Protocols
Introduction
Contraindications STEP 1: Press the STEP 2: Select STEP 3: Select
Precautions button body area being the clinical
Indications treated application to be
Pain Management
administered
Spasms
Muscle Re-Education
Edema Management
sEMG +Stim
Waveforms
Product Overview
Clinical Protocols is an operating format that allows the clinician to select body specific clinical
Program Navigation applications to help them progress the patient through the patients path of care. All clinical
protocols are FDA cleared and evidence based
Notes/References
Electrotherapy
Overview Clinical Protocols Notes and References
Introduction
Relax Muscle Spasms
Contraindications
1. Baker A., NeuroMuscular Electrical Stimulation A Practical Guide. 3rd Edition 1993.
Precautions Rehabilitation Engineering Program, Los Amigos Research & Engineering Institute, Rancho Los
Indications Amigos Medical Center. Pages 67-72.
Pain Management 2. Gersh MR, ed: Electrotherapy in Rehabilitation. FA Davis Co, Philadelphia, PA, 1992. Pages 242-
244
Spasms
3. Nelson RM, Currier DP, eds: Clinical Electrotherapy: Appleton & Lang, Norwalk, CT, 1987.
Muscle Strengthening Pages 126-130
Muscle Re-Education
4. Hecox B, Physical Agents A Comprehensive Text for Physical Therapists: Appleton & Lang
Increasing Circlulation Norwalk, CT, 1994. Pages 286-289
Edema Management 5. Morris L, Newton RA, Use of High voltage Pulsed Galvanic Stimulation for Patients with Levator
sEMG +Stim Ani Syndrome, Physical Therapy, Volume 67, Number 10, October 1987. Pages 1522-1525
Waveforms 6. Sohn N, et.al, The Levator Syndrome and its Treatment with High-Voltage
Product Overview 7. Electrogalvanic Stimulation. The American Journal of Surgery, Volume 144, 1982
Program Navigation
Notes/References
Electrotherapy
Introduction
Disuse Muscle Atrophy and Muscle Reeducation
Contraindications
1. Mohr T, et.al, Comparison of Isometric Exercise and High Volt Galvanic Stimulation on Quadriceps Femoris
Precautions Muscle Strength. Physical therapy, Volume 56, Number 5, 1985. Pages 606-612
Indications 2. Mohr T, et.al, The Effect of High-Volt Galvanic Stimulation on Quadriceps Femoris Muscle Torque, The Journal of
Orthopedic and Sports Physical Therapy, Volume 7, Number 6, May 1996. Pages 314-318
Pain Management
3. Snyder-Mackler L. Use of Electrical Stimulation to Enhance Recovery of Quadriceps Femoris Muscle Force
Relaxation of Muscle Production in Patients Following Anterior Cruciate Ligament Reconstruction. Physical Therapy Volume 74,
Spasms Number 10, October 1994. Pages 901-907
Muscle Strengthening 4. Laughman R, et.al. Strength Changes in the Normal Quadriceps Femoris Muscle as a Result of Electrical
Stimulation. Physical Therapy, Volume 63, Number 4, April 1983. Pages494-499
Muscle Re-Education
5. Delitto A, et.al. Electrical Stimulation Versus Voluntary Exercise in Strengthening Thigh Musculature After
Increasing Circlulation Anterior Cruciate Ligament Surgery. Physical Therapy Volume 68, Number 5, May 1988. Pages 660-663
Edema Management 6. Delitto A, et.al. Electrically Elicited Co-contraction of Thigh Musculature After Anterior Ligament Surgery A
Description and Single-Case Experiment. Physical Therapy, volume 68, Number 1, 1988. Pages 45-50
sEMG +Stim
Waveforms Currier DP, Mann R. Pain Complaint: Comparison of Electrical Stimulation with Conventional Isometric Exercise.
The Journal of Orthopedics and Sports Physical Therapy, Volume 5, Number 6, 1984. Pages 318-323
Product Overview
Faghri PD, et.al. The Effects of Functional Electrical Stimulation on Shoulder Subluxation, Arm Function
Features and Functions Recovery, and shoulder Pain in Hemiplegic Stroke Patients. Archives of Physical Medicine and Rehabilitation,
Volume 75, January 1994. Pages 73-79
Program Navigation
Notes/References
Electrotherapy
Introduction
Increase Local Circulation
Contraindications
1. Heath ME, High Voltage Pulsed Galvanic Stimulation: Effects of Frequency of Current on Blood
Precautions Flow in the Human Calf Muscle. Clinical Sciences, Number 82, 1992. Pages 607-613
Indications
2. Nelson RM, Currier DP, eds: Clinical Electrotherapy: Appleton & Lang, Norwalk, CT, 1987.
Pain Management Pages 165-180
Spasms 3. Griffin JW, Efficacy of High Voltage Pulsed Current for Healing of Pressure Ulcers in Patients
with Spinal Cord Injury, Physical Therapy volume 71, Number 6, June 1991. Pages 433-444
4. Gentzkow GD, Electrical Stimulation to Heal Dermal Wounds, Journal of Dermatology. Surg.
Muscle Re-Education
Onclo. 1993, Number 19, Pages 753-758
5. Karnes JL, Effects of Low voltage Pulsed Current on Edema Formation in Frog Hind Limbs
Edema Management Following Impact Injury, Physical Therapy, Volume 72, Number 4, April 1992. Pages 273-278
sEMG +Stim
6. Ross CR, High Voltage Galvanic Stimulation-An Aid to Post-Operative Healing. Current
Waveforms Podiatry, May 1981.
Product Overview 7. Kloth LC, Feedar JA, Acceleration of Wound Healing with High Volt Monophasic, Pulsed
Features and Functions Current, Physical therapy Volume 68, Number4, April 1988. Pages 503-508
Program Navigation
Notes/References

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Electrotherapy

sEMG +Stim Voltage has to increase when Resistance goes up in order to

Muscle Strengthening Frequency >80 Hz or sweep 80-150

Edema Management Duration of Rx 20 minutes or longer as

Muscle Strengthening Frequency 1-10 Hz

Product Overview used.

Features and Functions Intensity Strong visible rhythmical

Pain Management Waveform HVPC

Relaxation of Muscle Polarity Negative

Increasing Circlulation Sweep Yes

Edema Management Ramp 2 seconds

sEMG +Stim Amplitude To sensory tolerance. Sensory stimulation is

Pain Management Waveform VMS

Relaxation of Muscle Mode Synchronous

Increasing Circlulation Ramp 2 seconds

Edema Management Current Mode CV

sEMG +Stim Amplitude Motor level stimulation is cited to

Pain Management Waveform VMS or Asymmetrical biphasic

Relaxation of Muscle Mode Synchronous

Increasing Circlulation Phase Duration 250 microseconds

Edema Management Ramp 2 seconds

sEMG +Stim Current Mode CV

Features and Functions Duration of Rx 10 minutes daily

Program Navigation Electrode Locate areas of tenderness

Pain Management Contraction speed Slow Fast

Relaxation of Muscle Endurance High Low

Increasing Circlulation Function Static, postural Dynamic, explosive

Features and Functions

Muscle Strengthening Duty Cycle 1:1 (10 sec. 10 sec. off)

Amplitude Sub-max motor - patient should activate

Muscle Strengthening On/Off Time 2 seconds

Muscle Strengthening Amplitude Sensory level. Tingling sensation. No motor response.

Muscle Strengthening Phase Duration 300 microseconds

Electrode Size Muscle size dictates electrode size

Relaxation of Muscle Target muscle Infraspinatus

Increasing Circlulation Audio Constant

Edema Management Alarm Below

sEMG +Stim Electrode Infraspinatus

Pain Management Target muscle VMO

Relaxation of Muscle Channel Single channel

Pain Management Target muscle Tibialis anterior, Peronei

Relaxation of Muscle Channel Channel A and B

sEMG +Stim Electrotherapy

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