Mettler Electronics Sys*Stim 226 User manual

Sys*Stim®226
Instruction Manual
®
1333 South Claudina Street
Anaheim, CA 92805, U. S. A.
Toll Free: (800) 854–9305
Telephone: [phone] • FAX: [phone]
Web site: www.mettlerelectronics.com • email: [email protected]
IR7–79 Rev. D_11/09
Copyright © 1997, 2009 by Mettler Electronics Corp.—Anaheim, CA

Mettler Electronics Corp.— Rev. D_11/09
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Sys*Stim 226 Instruction Manual— Rev. D_11/09
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Table of Contents
Section Title Page
1 Introduction 5
1.1 Introduction to the Sys*Stim 226 5
1.2 Introduction to this Manual 6
1.3 Safety Precautions 6
1.4 Caution 6
1.5 Shipping Damage 6
1.6 Package Contents 7
1.7 Limited Warranty 7
2Symbol Glossary and List of Abbreviations 9
2.1 Symbol Glossary 9
2.2 List of Abbreviations 11
3Installation 13
3.1 Installation Instructions 13
4Operating Instructions 15
4.1 A Note About Electrodes 16
4.2 Operating Instructions 17
4.3 Electrode Positioning 22
4.4 Combination Therapy Using the Sys*Stim 226 and the Sonicator 25
5Indications, Contraindications, Precautions and Adverse
Reactions
27
5.1 Indications 27
5.2 Contraindications 27
5.3 Warnings 28
5.4 Precautions 28
5.5 Side Effects/Adverse Reactions 29
6Maintenance and Troubleshooting 31
6.1 Cleaning the Sys*Stim 226 31
6.2 Routine Maintenance 31
6.3 Troubleshooting the Sys*Stim 226 31
7 References 33
8 Specifications 35
8.1 General Specifications 35
8.2 Waveform Specifications 35
8.3 Amplitude Modulation Specifications 38
9Accessories 39
9.1 Ordering Information 39
9.2 Sys*Stim 226 Accessories 39

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List of Figures
No. Title Page
1.1 Sys*Stim 226 and Accessories 5
3.1 Sys*Stim 226, Bottom view—Mains Power Switch and Line cord
connections
13
4.1 Front membrane panel and LED indicators 15
4.2 Electrode Sizes and Current Density 16
4.3 Quadpolar Electrode Placement Technique 23
4.4 Bipolar Electrode Placement Technique 23
4.5 Monopolar Electrode Placement Technique 24
4.6 Using the Pencil Electrode 24
4.7 Combination Therapy 26
4.8 Application of Combination Therapy 26
8.1 Interferential Waveform 35
8.2 Premodulated Waveform 36
8.3 Medium Frequency (Russian) Waveform 37
8.4 Biphasic Waveform 37

Sys*Stim 226 Instruction Manual— Rev. D_11/09
Section 1: Introduction
1.1 Introduction to the Sys*Stim 226
Thank you for purchasing the Sys*Stim 226 neuromuscular stimulator from Mettler
Electronics Corp. The microprocessor controlled Sys*Stim 226 provides interferential,
premodulated, medium frequency and symmetrical biphasic waveforms with enhanced
reliability and ease of use.
The two–channel Sys*Stim 226 allows you to utilize two different waveforms using two
different treatment timers simultaneously. You can choose between several different
amplitude modulation options such as the surge, reciprocation and amplitude modulation
(interferential only, vector rotation). The interferential and premodulated modes offer
frequency modulation as well as a fixed frequency.
The membrane panel provides one touch entry for treatment parameters. An audible tone
provides you with further reinforcement that you have made a selection. LED’s guide you
through the easy setup routine.
Use the lightweight and portable Sys*Stim 226 in home health as well as in the clinic.
Teamed up with a Mettler Electronics Sonicator, the Sys*Stim 226 can provide combination
therapy. Add the optional treatment cart along with a Sonicator®therapeutic ultrasound to
create a mobile treatment center in your office.
Figure 1.1— Sys*Stim 226 and Accessories
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1.2 Introduction to This Manual
Read the contents of this manual before treating patients with the Sys*Stim 226.
This manual has been written to assist you with the safe operation of the Sys*Stim 226. It is
intended for use by the owners and operators of the Sys*Stim 226. The goal of this manual
is to direct the correct operation and maintenance of this unit.
The specifications and instructions presented in this manual are in effect at the time of its
publication. These instructions may be updated at any time at the discretion of the
manufacturer.
1.3 Safety Precautions
The Sys*Stim 226 operates with high voltages. Servicing of the Sys*Stim 226 should be
performed by qualified biomedical technicians with experience in neuromuscular
stimulator service or it should be returned directly to the factory. To maximize safety
during use, the unit should be plugged into a grounded wall outlet of proper voltage only.
General safety guidelines for medical electronic equipment should be followed.
A maintenance manual for the Sys*Stim 226 is available from Mettler Electronics Corp. for
a small fee. For more information, contact Customer Service by calling toll free at (800)
854–9305, telephone: [phone], Fax: [phone] or via email,
[email protected].
1.4 Caution
Federal law restricts the sale of this device to, or on the order of a physician, dentist,
veterinarian or any other practitioner licensed by the law of the state in which he practices.
Use of controls or adjustments or performance of procedures other than those specified
herein or use of unauthorized accessories with this device may result in exposure to
hazardous electrical current and possible burns caused by abnormal current levels.
The electric energy delivered by this device may possibly be lethal. Treatment should be
administered only under the direct supervision of a health care professional.
1.5 Shipping Damage
Your new Sys*Stim 226 is shipped complete in one carton. Upon receipt, please inspect the
carton and the unit for visible and hidden damage. If you discover any damage, hold all
shipping materials, including the carton, and call the shipping agent who delivered the
unit.
The carton in which your new Sys*Stim 226 was received is specially designed to protect
the unit during shipping. Please retain all shipping materials in the event that you will
need to return your unit for servicing. NOTE: All warranty repairs are to be performed by
Mettler Electronics Corp. or an authorized Mettler Electronics warranty repair center.

Sys*Stim 226 Instruction Manual— Rev. D_11/09
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1.6 Package Contents
Your new Sys*Stim 226 comes complete with all the necessary components to perform
neuromuscular electrical stimulation. Below is a list of items that are included in the
shipping carton.
1. Sys*Stim 226
2. Two electrode cable sets, (ME 2260)
3. Two gray pin to banana adapters, (ME 2027)
4. One package each EZ Trodes, 2" diameter (ME 2221) and 3" diameter (ME 2222)
5. Detachable U.L. listed, hospital–grade line cord, (ME 7293)
6. Instruction Manual and Warranty Card
1.7 Limited Warranty
The Sys*Stim 226 neuromuscular electrical stimulator is warranted against defects in
materials and workmanship for a period of two years from date of purchase. During the
applicable warranty period Mettler Electronics Corp. will, at its discretion, either repair or
replace the Product without charge for these types of defects.
For service under this warranty, the Product must be returned by the buyer within the
applicable warranty period to Mettler Electronics Corp. Shipping charges to Mettler
Electronics Corp. under this warranty must be paid by the buyer. The buyer must also
include a copy of the sales receipt or other proof of the date of purchase. If the Product
is returned without proof of the date of purchase, it will be serviced as an out–of–
warranty product at Mettler Electronics Corp.'s prevailing service rates.
Alteration, misuse, or neglect of the Product voids this warranty. Except as specifically
set forth above, Mettler Electronics Corp. makes no warranties, express or implied,
including without limitation any implied warranty of merchantability or fitness for a
particular purpose, with respect to the Product. If any implied warranties apply as a
matter of law, they are limited in duration to one year.
Mettler Electronics Corp. shall not be liable for any indirect, special, consequential or
incidental damages resulting from any defect in or use of the Product.
Any legal action brought by the buyer relating to this warranty must be commenced
within one year from the date any claim arises and must be brought only in the state or
federal courts located in Orange County, California.
Some states do not allow limitations on how long an implied warranty lasts, or the
exclusion or limitation of incidental or consequential damages, so the above limitations or
exclusions may not apply to the buyer. This warranty gives the buyer specific legal rights,
and the buyer may also have other rights which vary from state to state.

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Sys*Stim 226 Instruction Manual— Rev. D_11/09
Section 2—Symbol Glossary
and List of Abbreviations
2.1 Symbol Glossary
Time display
12
Channel timer indicator LED’s. Example: Indicator LED for channel 1
will be lit when the time displayed is for channel 1 in the 2-timer mode.
Both indicators will be lit when the time displayed applies to both
channels. Channel 1 or 2 LED will blink to indicate “adjust intensity for
the selected channel” in the reciprocation and surge modes.
μ
Hz
s
s
These LED’s will illuminate to prompt the clinician to input either time
in seconds or microseconds or frequency in Hz. The time or the
frequency will be displayed in the numeric time display.
00.00
smin
Time display LED’s. Displays treatment time and numeric values for
frequency, phase duration and on/off times.
1 Numeric keypad for time, frequency or phase duration entry.
Starts treatment, stimulation output activated.
Stops treatment in the channel displayed in timer window or acts as an
“Enter” button during treatment setup.
Stops all stimulation output from both channels.
Interferential waveform selector—LED is illuminated when this function
is activated.
Premodulated waveform selector—LED is illuminated when this
function is activated.
Medium frequency waveform selector—LED is illuminated when this
function is activated.
Symmetrical biphasic waveform selector—LED is illuminated when this
function is activated.
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Mettler Electronics Corp.— Rev. D_11/09
μs Phase duration control selector—Press this button during a biphasic
treatment to display phase duration.
Hz Frequency control selector—Press this button during a biphasic
treatment to display frequency.
Amplitude modulation, used for interferential waveform only. LED is
illuminated when this function is activated.
12
Stimulation output being displayed
mA mA
00 00
LED’s that display the output intensity during a treatment. When the
unit is in the “Hold” mode, “-- --“ will be displayed.
Stimulation output intensity controls—intensity may be adjusted at any
time with the continuous mode for all waveforms. It may be adjusted up
or down during the “On” phase of the surge and recip modes. And it
may be adjusted down at any time when vector rotation is active in the
interferential mode.
•Increase output intensity
•Decrease output intensity
12
Switches timer display and programming control from channel 1 to
channel 2 or vice versa when the two timer option is selected (LED on).
Continuous stimulation, no amplitude modulation selector—LED is
illuminated when this function is activated.
Amplitude modulation (surge) selector—Press this button during a
treatment to display surge “on / off” times. LED is illuminated when
this function is activated.
Reciprocation selector (two channels only) —Press this button during a
treatment to display reciprocation “on / off” times. LED is illuminated
when this function is activated.
Use two timers. Allows clinician to program two different treatment
protocols under the control of two different timers. LED is illuminated
when this function is activated.
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Sys*Stim 226 Instruction Manual— Rev. D_11/09
IMains On.
O Mains Off.
Refer to instruction manual for directions.
2.2 List of Abbreviations
cm² — square centimeters
Hz — Hertz (pulses per second)
LED — Light Emitting Diode
mA — milliampere (1/1000 ampere)
min — minutes
ms — millisecond (1/1000 second)
s — seconds
S/N — Serial Number
μs — microsecond (1/1,000,000 second)
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Mettler Electronics Corp.— Rev. D_11/09
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Sys*Stim 226 Instruction Manual— Rev. D_11/09
Section 3—Installation
3.1 Installation Instructions
1. Connect the line cord to the bottom of the Sys*Stim 226. (See Figure 3.1)
2. Plug the line cord into a grounded wall outlet that has 115 VAC, 50/60 Hz. Your
power supply must match the voltage requirements listed on the serial number label of
your device. Do not connect the Sys*Stim 226 to a power supply rated differently
than that described above.
3. The line cord comes equipped with a standard 3–prong plug. This plug provides
grounding for the Sys*Stim 226. Do not defeat its purpose by using 3–to–2 prong
adapters or any other means of attaching to a wall outlet.
4. The Sys*Stim 226 may be susceptible to interference originating from shortwave
diathermy units operating in close proximity to it. Avoid operating the Sys*Stim 226
adjacent to and simultaneously with operating shortwave devices.
5. Do not use sharp objects to operate the membrane panel switches. If the tough outer
layer of the membrane is broken, moisture may leak into the switches resulting in
switch failure.
+
+
Line Cord Connection
Mains On/Off Switch
Figure 3.1— Sys*Stim 226, Bottom view—Mains Power Switch and Line cord connection
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Sys*Stim 226 Instruction Manual— Rev. D_11/09
Section 4—Operating
Instructions
00 00
00.00
Hz
μ
Hz
s
s
s
3
6
9
min
21
54
87
0
2
1
mA mA
Hz -Hz
1-150 Hz
80-150 Hz
1-15 Hz
Hz
μs
12
12
12
SYS STIM®
*®
Figure 4.1—Front membrane panel and LED indicators
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Mettler Electronics Corp.— Rev. D_11/09
4.1 A Note About Electrodes
To ensure safe operation of the Sys*Stim 226, follow the recommendations listed below:
1. We strongly encourage careful maintenance of the electrode system. This includes the
lead wires as well as the pads themselves. Worn cables and/or poor pads (or the
wrong sized pads) can have a significant impact upon treatment results.
2. Do not exceed the number of recommended uses listed on the instructions for
EZ Trodes or other reusable self–adhesive electrodes.
3. Make sure that the entire surface of the electrode is contacting the patient.
4. Do not use moist hot packs to secure electrodes.
5. To avoid skin irritation due to high current density, do not use electrodes smaller in
surface area than the 2" in diameter EZ Trode®self-adhesive electrode (ME 2221).
6. Do not use conductive carbon electrodes with this product.
7. Whenever clinically possible, utilize the largest possible pads to reduce local increases
in current density. In situations where small pads are required, use the lowest
stimulation intensity necessary to achieve the desired clinical results.
The table below illustrates the relationship between electrode diameter and current
density. As you can see the current density increases rapidly when diameter decreases.
Diameter
inches Surface Area Square inches Current Density mA/sq in (for 10mA)
1.25 1.2 8.2
2.00 3.1 3.2
3.00 7.1 1.4
1.25 inch
diameter
2.00 inch
diameter
3.00 inch
diameter
Figure 4.2—Electrode Sizes and Current Density
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Sys*Stim 226 Instruction Manual— Rev. D_11/09
4.2 General Operating Instructions:
Before you start:
a) Review precautions, contraindications and side effects/adverse reactions
listed in Section 5.
b) Use Mettler Electronics electrodes to ensure safe and effective operation.
c) Verify connection of the line cord to a grounded wall receptacle and the
Sys*Stim 226.
d) Note: Descriptions of the symbols used on controls are in Section 2.
1. Turn on the mains power switch by pressing “I” icon
on switch.
!
1 2 226
2. Insert the connectors attached to the electrode cables
(ME 2260) into the electrode cable receptacles
illustrated on the left.
3. Attach electrodes to electrode cables. Apply the
electrodes to the patient after reviewing “A Note
about Electrodes”.
3
6
9
21
54
87
0
4. Select the desired treatment time by pressing a
hen a
re
g a
ithout a set time, do not enter a time value.
number(s) on the numeric keypad. Unit beeps w
button is pressed. Only whole minutes may be
selected. Treatment times from 1 to 60 minutes a
valid. Time is displayed in the time window. Durin
treatment time remaining is displayed in minutes and
seconds.
To treat w
The timer will count up to indicate time elapsed since
the beginning of the session.
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5. Select the waveform for this treatment session. The
default waveform is the interferential waveform.
Hz
Hz -Hz
1-150 Hz
80-150 Hz
1-15 Hz
12
150
Hz
μs
250 μs
Hz
80
Hz
6. Set treatment phase duration (biphasic only) and
frequency. Please note: Medium frequency has a fixed
phase duration and frequency so no adjustments are
necessary.
•Select frequency modulation for the Interferential or
Premodulated modes by pressing the button labeled
“Hz” until the LED to the left of the desired
selection is illuminated. For “Hz1–Hz2” input any
value from 0–250 for Interferential mode or 1–250
for Premodulated mode using the numeric key
pad and then press . Repeat the same procedure
for the second frequency in the range. For a fixed
treatment frequency, input the same value twice.
•Select phase duration in μs. Enter any value from
50–300 μs using the numeric key pad and then
press . The Sys*Stim 226 stores the value of the
last phase duration used and displays it in the
timer window. If the displayed value is the one
you want either press or the button labeled
“μs”.
•Select frequency in Hz. Enter any value from
1–120 Hz using the numeric keypad and then
press . The Sys*Stim 226 stores the value of the
last frequency used and displays it in the timer
window. If the displayed value is the one you
want either press or the button labeled “Hz”.
•Interferential
•Premodulated
(Bipolar)
•Medium
Frequency
(Russian)
•Biphasic
•Interferential
•Premodulated
(Bipolar)
•Biphasic

Sys*Stim 226 Instruction Manual— Rev. D_11/09
19
10 10 s
10 s
7. Select the amplitude modulation method for this
treatment session for the Premodulated, Medium
Frequency and Biphasic modes only. The default is
continuous.
Surge Mode
•Press the “Surge” button to select on and off
times. The up and down ramps are fixed to 3
seconds up and 2 seconds down. The preset
on/off times (in seconds) are: 10 on/10 off, 10
on/20 off, 10 on/30 off, 10 on/40 off, 10 on/50
off and 10 on/60 off. On/Off times are
displayed in the timer window.
•Continue pressing the “Surge” button until the
desired on/off time is displayed in the timer
window. Then Press to enter that on/off
time.
•To select a custom on/off time, press the
“Surge” button one more time after “10 60” is
displayed. A single number is displayed in the
timer window. This is the on time. Use the
numeric keypad to select an on time in seconds
from 1 to 240. Press to enter the on time. A
second single number is displayed in the timer
window. This is the off time. Use the numeric
keypad to select an off time in seconds from 1
to 240. Press to enter the off time.
•To review an on/off time during a treatment,
press the “Surge” button. Surge on/off time
will be displayed briefly in the timer window.
Reciprocation Mode
•Press the “Reciprocation” button to select
reciprocation times between channels one and
two. The up and down ramps are fixed at
1 second. A single number is displayed in the
timer window. Use the numeric keypad to
select a reciprocation time in seconds from 2 to
240. Press to enter the reciprocation time.
Each channel will be on and off for the time set
in a reciprocal fashion.
•To review an on/off time during a treatment,
press the “Reciprocation” button.
Reciprocation time will be displayed briefly in
the timer window.
•For reciprocation with unequal on and off
times first press the reciprocation button and
•Continuous
•Surge

Mettler Electronics Corp.— Rev. D_11/09
then press . Press the surge button and then
follow the instructions to set on/off times in
the surge mode. First channel one will be on
for the set on time and then channel two will
come on during the set off time.
•To review an on/off time during a treatment,
press the “Reciprocation” button.
Reciprocation time will be displayed briefly in
the timer window.
00.00
smin
21
12
8. Use the two timer option to use two different
treatment protocols or two different treatment times
simultaneously. Individual treatments can be setup,
started and stopped independently. This option is
available with the premodulated, medium frequency
and biphasic modes. Use the two timer mode with the
“Continuous” and “Surge” amplitude modulation
options. The indicator LED will be lit for the channel
that is being displayed at any one time. Program the
single channel just like you would program the
Sys*Stim 226 for two-channel operation.
•To switch between the two channels either during
setup or during a treatment press the button
shown at the left. The time and the treatment
protocol are displayed for the channel whose
indicator LED is lit.
9. Press after all treatment parameters have been set
to begin treatment.
00 00
mA mA
10. “-- --“ is displayed in the mA display followed by
double zeroes indicating that the channels are active.
In the two timer mode of operation, the active channels will
display 00’s. If either channel is off its display will show
“--“. Press the “Up” or “Down” arrows to adjust
treatment intensity. The numbers in the display will
increase as the “Up” arrow is depressed. If you press
an arrow one time the intensity will increase or
decrease in small increments. If you hold an arrow
down, the Sys*Stim 226 will beep three times and
then the intensity will increase rapidly until the
button is released.
•In the “Surge” mode, the Sys*Stim 226 allows you
to adjust the treatment intensity before beginning
the “On/Off” cycle that you selected. The green
LED’s above the time window will blink on and
off to alert you to adjust treatment intensity. Use
the “Up” or “Down” arrows for both channels to
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