MTR+ DuoBravo U User manual

Operators Manual
Biofeedback & EMG-triggered stimulation
DuoBravo U
Medical Device
Please read this manual before using the device!

Operators Manual
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Content
Please read the Operators Manual carefully
before using the device and pay attention
to all references !
In the following you’ll nd all information directly necessary for performing the treatment
with grey background.
Page
I. Biofeedback- / ETS-device DuoBravo
Delivery & Accessories / Medical Device Reporting 4
Technical Data 5
Explanation of Symbols 6
Safety Adjustments 6
Introduction – What is DuoBravo ? 7
Indication 8
Contraindication 9
Warnings 10
Advice on Application of Electrodes 11
Maintenance 12
Warranty 12
II. Display and Operating Elements
Operating Elements 13
Battery Compartment 13
Connections 14
The Display 15
The Info-Line 16
III. Preparation of DuoBravo
Basic Settings 17
Setup Real Time Clock 18
Setup Language 18
Preparation of Therapy 19

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Content
Page
IV. Therapy with DuoBravo
The Dierent Phases 20
Use of pre-set programs 21
Therapy in a phase with pure stimulation 22
Therapy in an EMG-phase 23
Therapy in an ETS-phase 24
Therapy in combined programs 24
V. Additional Options for Conguration of DuoBravo
Conguration of Free Programs 25
Parameters of Free Programs 26-29
Programming PC1 26
Programming PC2 27
Programming PC3 28
Programming PC4 29
Lock-Button 30
Threshold 30-31
Setting of threshold before start of treatment 30
Automatic adjustment of threshold during treatment 31
VI. Therapy-Control
Therapy-Control 32-33
Statistics 34-35
Trouble Shooting Guide 36
VII. Programs
Programs Urology 37-40
Anatomy 41
Conguration 42
Waste Disposal / Recycling of Batteries / Literature / Copyright 43
Electromagnetic Compatibility 44-46
Graphics 47

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Included in the delivery:
REF: 010E-089: 1 unit DuoBravo U (Urology), 2 dual pin lead wires to connect the electrodes,
1 single pin reference lead wire, 8 self-adhesive electrodes (40 x 40 mm), 1 stand, 4 batteries
type AA and 1 operators manual
With regular average use, the expected service life of DuoBravo is 5 years. The battery life
is approximately 12 hours or more at 20 mA per channel. The batteries can be stored for
approximately 2 years. The service life (expiry date) of electrodes, probes and electrode jelly is
printed on each package.
Accessories:
REF
011E-006: 1 unit self adhesive electrodes 40x40 (4 pieces)
011E-007: 1 unit self adhesive electrodes 40x80 (4 pieces)
011E-008: 1 vaginal probe “IncoProbe V”
011E-009: 1 rectal probe “IncoProbe R”
011E-017: 1 vaginal probe “Probe V plus”
011E-018: 1 rectal probe “Probe R plus”
Spare parts:
REF
012E-120: 1 lead wire to connect the electrodes
012F-037: 1 tube electrode jelly for probes
012E-086: 1 carrying case
012E-083: 1 single pin reference lead wire
052F-805: 4 batteries type AA
012E-081: 1 operators manual DuoBravo
DuoBravo shall only be used with original accessories.
Medical Device Reporting:
If there is a serious deterioration in the state of your health when using the medical device,
report this to your distributor or to the manufacturer and to the competent authorities of your
country.
Delivery & Accessories

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1. EMG
1.0 Dual Channel
1.1 EMG Range: 0.2 to 2000 µV RMS (continuous)
1.2 Sensitivity: 0.l µV RMS
1.3 Selectable Bandpass lter - 3db Bandwidth,
a. Wide: 18 Hz +/- 4 Hz to 370 Hz +/- 10% - Reading below 235 microvolts
10 Hz +/- 3 Hz to 370 Hz +/- 10% - Reading above 235 microvolts
b. Narrow: 100 Hz +/- 5 Hz to 370 Hz +/- 10%
1.4 Notch lter: 50 Hz - 33 dbs
1.5 Common Mode Rejection Ratio: 130 dbs Minimum @ 50 Hz
1.6 Batteries: 4 x AA
1.7 Work / Rest periods: 2-99 seconds
1.8 Number of Trials: 2-99
2. Neuromuscular Stimulation
2.1 Dual Channel
2.2 0 - 90 mA into 500 ohm load, 70 mA maximum into 1000 Ohm load, 46 mA
maximum into 1500 Ohm load. (Indication only, actual intensity varies
depending on condition of skin electrodes).
2.3 Type: Constant current
2.4 Waveform: Symmetrical, rectangular, bi-phasic with net zero
DC current
2.5 Pulse width selection: 50-450 µS
2.6 Pulse Rate Selection: 1-100 Hz
2.7 Work / Rest periods: 0,5-99 seconds
2.8 Time 1 - 99 minutes
2.9 Ramp up time: 0.1 - 9.9 seconds
2.10 Preset and user programmable treatment programs
2.11 Automatic output shut o with detection of open electrode (> 0,5 mA)
The graphics of the waveform and of the intensity depending on resistance can be found on
page 91.
Dimensions: L 141,6 mm / W 74 mm / H 40,4 mm - Weight of the device: 275 g (incl. batteries)
Firmware version 3.1B or later
Wireless Link:
RF Frequency Range: 2.4000 GHz to 2.4835 GHz / RF Default Output Power: <= 1,0 mW
RF Maximum Output Power: <= 2,52 mW / Antenna Gain: 0 dBi
Max. environmental conditions for transportation: -25 to +70 degree centigrade, 0-93%
atmospheric humidity. Recommended environmental conditions for storage: -25 to +40 degree
centigrade, 0-93% atmospheric humidity. The device shall not to be stored in direct sunlight.
Allow up to one hour for the device to return to normal operating temperature if stored in
conditions below +5°C or above +40°C.
Environmental conditions for use: +5 to +40 degree centigrade, 0-93% atmospheric humidity,
air pressure 700-1060 hPa. During use the surface temperature of the device can be 41°C or
higher, but never exceeds 48°C.
The DuoBravo is protected against debris larger than 12.5 mm in diameter from entering the
cabinet and is not water resistant and rated IP20.
Technical Data

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Explanation of Symbols
Safety Adjustments
1. The +buttons become inactive after one minute running time of a stimulation program to
avoid an unintentional increase of intensity . This lock is switched o again, by pressing the
+button three-times repeatedly. Now an increasing of intensity is possible again for another
minute.
2. If the electrical circuit is interrupted during operation (> 2 mA), for example by
losing an electrode or by a broken lead wire, the device stops stimulating immediately.
3. When a phase ends and the next phase contains stimulation, the intensity is automatically set
to 8 mA and must be set to the desired setting by the user.
4. The DuoBravo features a stimulation circuit failure detection system incorporated into the
device and its software. Four pulses with a pulse width and voltage not exceeding 1µS and
6 volts are triggered before each main pulse to check the integrity of the circuit. These pulses
cannot be felt and do not eect the ecacy of the device. If a failure is detected during this test,
STIM F will display on the LCD. If STIM F is repeatedly displayed on the LCD then the unit
should be returned to the manufacturer for testing. This is an added safety protection system to
ensure each pulse generated by the device is safe for the user.

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Introduction – What is DuoBravo ?
The DuoBravo is a modern device for biofeedback and neuromuscular stimulation. The term
biofeedback refers to a method to perceive biological processes with the help of a technical
device. This instrument measures physical activity - even if there are no visible or no voluntary
muscle contractions - and converts them to optical and/or sound signals. DuoBravo is a
combined two-channel device that can be exibly used for electromyography (EMG) or EMG-
triggered stimulation (ETS) or for neuromuscular stimulation. Doctors and patients are the
intended operators for this unit.
The DuoBravo is available in three dierent versions. DuoBravo U can be used for urologic,
gynecologic and proctologic therapy while DuoBravo N is designed for neurologic and
orthopedic treatments. The combination device DuoBravo U + N contains all programs. Each
version includes preset EMG- and ETS-programs as well as multiple stimulation programs in
dierent modes. Additionally the devices have 4 customizable programs in which individual
STIM-, EMG- and/or ETS-phases and a combination can be set.
The clip on the back of the unit allows the user to fasten the device to the clothes, the unit is
intended to be supported by hand during normal use. The belt clip is for temporary relief only.
During treatment it’s not necessary to hold DuoBravo, since it can stand upright on a at
surface in its stand. This allows the patient to train or to be treated while observing the success
of the individual eorts. The muscle activity is indicated by a yellow-green bargraph on each
side of the screen and by numerical values in the bottom-line of the display.
At the end of each session, the screen automatically displays the average values of muscle
activity in this session. The DuoBravo can be used with or without connection to a personal
computer. The stored treatment data can be transmitted to the PC at a later date using a
separately available documentation tool.
This device is quality controlled and fullls all legal requirements for medical products.
Therefore this device carries the CE-sign „CE 0123“. The serial number is on the rear of the
unit.
Manufacturer: MTR+ Vertriebs GmbH
Kamenzer Damm 78, 12249 Berlin, Germany
www.mtrplus.com

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With advice of a physician or physiotherapist, DuoBravo can be used by the patient without any
help to support muscle training for:
Main indication for DuoBravo U:
• Elimination of light to mid strength faecal incontinence
• Elimination of light to mid strength urinary incontinence
- Urge-incontinence
- Stress-incontinence
- Mixed-incontinence
Side indication for DuoBravo U:
• Improvement of blood ow
• Improvement of muscle spasticity
• Muscle Strengthening
- Avoidance of muscular imbalances
- Activation of muscular bers
- Muscle Fatigue
- Strengthening of atrophied muscles
- Muscle Recovery
• Conservation and extension of mobility
• Release of bodily endorphins
• General Pain Relief and Pain Therapy including but not limited to:
Arthritis
Back Pain including but not limited to:
- Chronic Back Pain
- Cervical Spine Pain
- Thoracic spine Pain
- Lumbar spine Pain
Circulation problems
Fracture Pain
Myalgia
Neuralgia
Phantom Pain
Indications

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Contraindications
DuoBravo may not be used in the following cases:
- By patients with electronic implants like pumps or a pace maker (as functional disturbances
can occur).
- By patients with myocardial damage (damage to the cardiac muscle) or arrhythmia
(inconsistent heart beat).
- In presence of ammable anesthetic mixtures with air or with oxygen or nitrous oxide.
- When operating machinery with a potential of danger.
- While driving a vehicle.
- By patients with epilepsy.
- If severe local inammation or thrombosis is present.
- By patients with mechanical ileus.
- By patients with febrile illnesses or infectious diseases.
- Do not use with a surgical high frequency apparatus because burn marks could occur under
neath the electrodes.
- When using metal-containing contraceptive spirals.
Please pay unconditional attention to the following basic rules:
- Do not stimulate transcerebraly (via the head).
- Do not stimulate via the Carotis-Sinus-Nerve (carotid artery).
- Do not stimulate in the area of the Sinus knot (heart).
- Do not stimulate on the Bulbous (eye).
- Do not stimulate in the Larynx-Pharynx-Area (throat / mouth).
- Do not stimulate in places with skin defects.
- Do not position the electrodes directly on the spine.
Take special care with the use of the electric stimulation:
- if stimulation is located close to osteosynthesis material (metal in the body).
- if after an operation the healing process can be interrupted through a muscle contraction.
- after acute bleeding or bone fractures with a tendency to bleed.
- during menstruation or pregnancy.
- in case of de-sensitization of the skin (damaged nerves).
- if patients cannot use the device properly, due to mental or physical limitations.

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Warnings
- DuoBravo is type BF equipment and may not immersed in liquids.
- If using rechargeable batteries be sure to use a CE approved battery charger. Never connect
the DuoBravo directly to the mains, to a battery charger or to any other mains powered
equipment.
- The operator may not touch the battery contacts & patient simultaneously.
- To avoid the eects of electromagnetic interference never use the DuoBravo in the EMG-
mode, with less than 4 metres distance to a cellular telephone or near any other powerful
radio interference producing equipment that causes electrical signals etc. In the EMG Mode,
the DuoBravo may be susceptible to strong interfering radio type emissions that may lead to
temporally increased EMG microvolt readings. If suspected interference is causing a problem
with EMG readings, change position of the device and move away from any electrical
emitting equipment. The reading will immediately return to the correct value when the
interference ceases.
- The power supply of some laptop computers or devices which do not have an earth connection
may cause signicant interference aecting the DuoBravo. As a precautionary measure
please make sure that the power cord of the laptop or the devices are as far away as possible
from the lead wires of the patient. If interference persists, remove the power cable from your
computer and use it with its battery. Winding the lead wires around a limb (arm or leg) may
also help this interference.
- If device operation occurs close to short wave, microwave, cellular or other wireless
equipment, instability of the values of the stimulator could occur causing a temporary
reduction in current. Move away from the source of interference and continue the program.
- Burn marks could occur underneath the electrodes if used with surgical high frequency
apparatus.
- The application of the electrodes near the thorax can increase the risk of cardiac brillation.
- Patients with metal or electronic implants may only stimulate with permission of an
experienced doctor.
- Stimulation in the area of tumors is allowed only by instruction of an experienced doctor.
- If in the case of treatment with the incontinence probes, pain or irritation appear in the area of
the pelvis, or bleeding in-between menstruation, interrupt the therapy and consult your doctor.
- If high frequency is combined with a wide pulsewidth, please stimulate with low intensity
only.
- If you have swallowed any part of the device or any of its accessories, please contact a doctor
immediately.
- TENS and muscle stimulation should be used during menstruation or by pregnant women as
well as by children under the guidance of a doctor or therapist only.
- Please don’t use a probe during menstrual period or pregnancy.
- The DuoBravo may not be operated if the battery compartment is not closed. Before opening
the battery compartment, make sure that there are no lead wires in the jacks at the head of the
unit.
- Remove batteries and battery cover, drain water from device and allow (DuoBravo) to dry
normally for 48 hours if accidentally submerged in water.
Please, keep this device stored out of the reach of children. Do not leave the lead wires in
reach of children, since strangulation is possible due to the length of the lead wires.

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Advice on Application of Electrodes
Make sure that DuoBravo is turned o (no indication visible on the LCD display).
Now connect the single poled ends of the lead wires with the electrodes.
The output plugs of the electrode lead wires will be plugged into the channels A or B of the
DuoBravo. The reference lead wire will be connected to its jack as well if EMG will be used.
Furthermore make sure, that all plugs t completely into the electrode sockets as well as the
device sockets.
If you are using a probe, lubricate it with water or a gel suitable for electrotherapy.
Please don’t use oil, ointment or cream, since all these have an isolating eect.
Now place the electrodes or the probe according to the instructions of your doctor or
physiotherapist. The self-adhesive skin electrodes are provided with a sticky gel and can be
re-used after removal from the skin. Replace these electrodes when the adhesive force is weak.
Electrodes which are damaged due to careless handling may not be used.
Electrodes with damaged lead wire insulation (e.g. visible copper wire) may not be used.
Electrodes with damaged, missing or stained aluminium coating or carbon layer, also with
insucient adhesive gel may not be used.
Electrodes may not be altered or tampered with (e.g. by scissors or other tools).
Do not pull the electrodes by force on the electrode lead wire. To remove the electrodes from
the skin, please lift the electrode at the edge towards the middle.
Do not use electrodes with ointments or creams (especially which enhance the blood ow or act
as local anaesthesia).
Apply the electrodes on clean and healthy skin only.
In the case of strong bodily hair growth, the hair should be shaved or shortened with scissors.
Neither stretch the skin nor the electrodes when applying the electrodes.
Eective current densities of more than 2 mA/cm2 require an increased attention of the user
with regard to the intensity adjustment.
For standard treatment we recommend the use of our self-adhesive electrodes with a minimum
area of 40x40 mm. This size is suited for the reference electrode as well. For best results please
make sure that it will be placed on a bone near the treatment area, not on muscles.
For treatment of the muscles of the pelvic oor we recommend the use of our vaginal-
(IncoProbe V) or rectal-probes (IncoProbe R).
If using a probe, please clean it carefully before and after use with a mild detergent (without
alcohol) and ensure the probe is rinsed thoroughly to remove all cleaning residues. Ensure the
connectors are not submerged in water as they may corrode. Ensure the probe is completely dry
before storage.
After all electrodes have been removed, wash the skin with mild soap and rinse thoroughly.
Then dry your skin.
All electrodes or probes are for single person use only.
Skin electrodes as well as probes can contain amounts of nickel. Allergy suerers should check
this before using.
Should skin irritation occur whilst using the DuoBravo, please interrupt the application and
inform your doctor, so that an allergic reaction can be excluded.

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Maintenance
Warranty
MTR+ Vertriebs GmbH provides a 24 month warranty, commencing from the date of our
delivery (invoice date), that in case of failure, the DuoBravo will be serviced or replaced free
of charge. All returns must rst be authorised by MTR+ Vertriebs GmbH in advance.
Excluded from this warranty are failures of the DuoBravo which result from excessive use,
careless or improper handling as well as damage by force.
The warranty loses its lawful meaning if the producer MTR+ Vertriebs GmbH has not given
its consent in writing prior to repairworks or servicing being carried out. Without this written
consent the manufacturer will not return the device.
The manufacturer reserves the right of technical changes, which may serve to increase treatment
success, the functionality of the device or its accessories.
DuoBravo has been designed to be maintenance free. Nevertheless, please adhere to the
following advices:
If needed, please clean DuoBravo with a mild detergent, water and a damp cloth. Do not
expose DuoBravo to extreme humidity and do not submerge under water.
You may clean the lead wires with a damp cloth. You may also from time to time treat the lead
wires with talcum powder in order to prevent cracks and to improve the lead wires life.
A clean cloth, moistened with an alcohol free disinfection liquid can be used to clean the device.
Please follow all instructions of the manufacturer of the liquid.
After termination of the therapy, DuoBravo can be re-used by other patients. Please clean the
device with a mild disinfectant cleaner.
The DuoBravo does not require calibration. The DuoBravo is not repairable and contains no
user serveable parts. No modication to the DuoBravo is allowed.

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Operating Elements
The START-button allows the choice of automatic (press) or manual (hold the button for 3
seconds) threshold-setting if an EMG-or ETS-program is chosen. The program will start after
the START-button is released.
Central On-/O-button
+/- buttons for
threshold-setting and
setting of intensity
for channel A, as
well as for selection
of parameters in the
programming-mode
Battery Compartment
LOCK-button for
xing one single
program and for
uploading statistics
to a PC
Scheme for placement of 4 batteries type AA
+/- buttons for
threshold-setting and
setting of intensity
for channel B, as
well as for altering
the parameters in the
programming-mode
SET-button for
basic settings and
conguration of
custom EMG and ETS
programs
PRG-button for choice of program and for
storing the individual parameters. Hold PRG
for one second to select next phase.

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Connections
Jacks to connect the electrode-lead wires of
channel A and/or B, each suited for surface-
electrodes or probes.
Jack for the single pin EMG-reference
lead wire (skin-electrode)
Attention: Even if the device is used with a probe, please always connect the single reference-
lead wire if you are using an EMG-program.

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The Display
After selecting a program with the PRG-button DuoBravo shows information about those
parameters in its “Home Screen” that are used in the rst phase of the program (stimulation fre-
quency, pulse width, number of trials, threshold, etc.). Start the treatment by pressing or holding
START, the display changes to work-screen and shows necessary information for treatment in
the active phase.
Work-Screen (in EMG-mode)
Selected program
Number of active phases in this program
Battery indicator
LOCK-Symbol
Remaining Total-Time
of treatment
Active Mode in this
phase
threshold
channel B
Symbol st
+ arrow up
= prompt for work
Symbol open hand +
arrow down =
prompt for relax
Number of remaining trials in EMG-
or ETS-phases /Remaining minutes in
STIM-phases
Countdown of seconds for
work or rest/ Remaining
seconds in STIM-phases
EMG-level channel A
EMG-level channel B
EMG-Bargraph
threshold
channel A

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The Info-Line
The info line in the upper part of the screen shows always the remaining time of the entire
program during treatment.
Outside a treatment session, it provides more additional information:
- When selecting a program, the target of the treatment is indicated in abbreviations. (REHAB
= Rehabilitation / MIXED = mixed incontinence, etc.).
- If the circuit is interrupted during stimulation, caused by removal of an electrode or a broken
lead wire, the term CABLE ashes in the info line.
- It shows custom values to be set.
The info line displays all custom settings for conguring the device. In the following you nd
all expressions and abbreviations that are used in the programming-loop in alphabetical order:
CH.B. ON / CH.B. OFF: Channel B is switched on or o
DELAY: Possibly delay of current between channel A and B if synchronuous stimulation is
selected
EMG OFF / EMG ON: EMG-measuring during rest-period of STIM-phases
FB. CONT: Continuous acoustic feedback
FB. OFF: No acoustic feedback
FB.ABOVE / FB.BELOW: Feedback above or below the threshold
FREQ.: Number of stimulation pulses per second
INHIB.OF: Inhibition switched o
INHIB.ON: Inhibition of feedback on channel B
NARROW: Narrow bandpass lter used
PC OFF: Connection to PC is switched o
PC SWC: Connection to PC by secured wireless connection
PULSE: Duration of each single pulse in µsec
RAMP DN.: Time needed from the end of complete intensity to complete end of current
RAMP UP: Time to reach complete intensity of stimulation
REST: Duration of rest-sequences in seconds
STIM.TME.: Duration of EMG triggered stimulation in seconds
THRESH: Threshold-adjustment during treatment automatic (AUTO) or manually (MAN)
TIME: Duration of a STIM-phase in minutes
TRIALS: Number of repetitions
TRIGGER: Time that the threshold must be reached to trigger stimulation
VOLUME: Sound volume of beeps and spoken instructions
WIDE: Wide bandpass lter used
WORK: Duration of work-sequences in seconds

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In all programs, even in the preset programs, individual settings can be made as follows.
After you have put in four batteries type AA (s.p. 65) and you have turned on the device with
the ON/OFF-button, you enter the conguration mode by pressing the SET button in the
battery compartment for three seconds. Now you can adjust the settings for the rst phase of
the selected program. To congure the next phase, SET should be pressed again.
The parameter that can be changed is shown in the info line and can be altered by pressing the
+ button of channel B. Pressing the + button of channel A will conrm the choice and the next
variable parameter is displayed. This system - changing settings with B / storage and stepping
forward with A - remains always the same during the entire process.
Please note that the following settings you make here, are automatically stored for all
subsequent phases and all other programs as well. Of course you can change any setting at any
time in the same way again.
STIM-phases
- Channel B can be switched on or o.
- Work Rest phases have these options:
a) Turn on / o measurement of EMG during rest period.
b) Selection of wide or narrow lter.
- PC - Select o or SWC (wireless).
EMG-phases or ETS-phases
- Sound-volume
- Automatic threshold-adjustment on or o
- Wide- or narrow-lter for channel A
- Channel B switched on or o
- Filter for channel B if it is in use
- PC - Select o or SWC (wireless)
In the customizable programs PC1 - PC4 of course you have the ability to set additional
parameters in the same way as described on pages 66-69.
Basic Settings

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Setup Real Time Clock
Before rst use of DuoBravo the integrated “Real Time Clock” should be set. It’s necessary
later for therapy-control. DuoBravo has a small battery that will support the clock with energy
for several years. For this reason, there is no need to set again, even if the 4 main batteries have
been substituted or removed. But we recommend to check and re-adjust periodically.
To set time and date, please select any program and press the SET-button for at least 3 seconds.
You’ll reach the conguration-mode. Now press SET once again for 10 seconds. On screen
HOUR is indicated and you can set the hour with the +button of channel B (00-23).
By pressing the +button of channel A you conrm this choice and step forward to the setting of
MINUTE. This is indicated on the screen as well, giving the opportunity to select the minutes
via +button of channel B in the same way as before.
This way you are able to set one after the other:
- HOUR
- MINUTE
- DAY
- MONTH and
- YEAR
If all settings are nished, please press the ESC-button on the frontside of the device. All values
will be automatically stored and the clock starts working.
Setup Language
DuoBravo is able to show 6 dierent languages. If you are in the setting-mode of the RTC (see
above), please press the SET-button for 10 new seconds once again. Now you can select Ger-
man-, English-, French-, Spanish-, Italian- or Polish-language with the B-buttons. Finally you
store your choice with the ESC-button.

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19
Preparation of Therapy
1. Open the battery compartment at the back by pushing down the lid and insert 4 batteries type
AA by hand according to the instructions on page 51. Then shut the battery-compartment.
2. Please make sure, that DuoBravo is switched o (no indication in LCD-display). Connect
the single pin ends of the electrodes plugs with the surface-electrodes or with a probe.
3. Insert one electrode-lead wire into the jack named A in the head of the device. If you want to
use both channels, insert the second lead wire into jack B.
4. Additionally, please put the black round EMG-reference plug into the bigger round jack,
named “EMG-REF” and connect the other ends to a skin-electrode.
5. Furthermore, make sure that all plugs t completely into the electrode sockets as well as the
device sockets.
6. If you are using a probe, lubricate it with water or a gel suitable for electrotherapy. Don’t use
oil, ointment or cream, since all these have an insulating eect.
7. Now place all electrodes according to the instructions of your therapist on clean and healthy
skin only. If you are using a probe, place the single reference-electrode onto the hip bone and
then insert the probe.
8. Now switch on DuoBravo by pressing the central ON/OFF-button once. You can see the
version of the device for 3 seconds before the last used program appears, showing its
parameters.
9. If the device is not locked to a single program, you can select your kind of treatment by
repeatedly pressing the PRG-button. A great variety of programs with up to ve phases
each are available. Within one single program the phases can be programmed in dierent
modes.
10. After selecting a program, you always see the “Home Screen” rst, with all information
regarding the parameters, that are contained in the rst phase of this program. If the chosen
program has an EMG- or ETS-phase, the manual threshold-setting is possible. In this case,
the treatment starts by holding the START-button for more than 1 second. If you prefer the
automatic threshold-setting, no adjustments have to be done and treatment starts by short
pressure of the START-button. Follow the work/rest prompts, so the device can
automatically select the threshold setting for you.
11. EMG is susceptible for interference. For best results do not use lead wires longer than 1.5 m
and keep the lead wires as close to your body as possible.

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DuoBravo oers programs that can consist of one or more phases. There are basically three
dierent types of these phases which can be therapeutically combined in a useful way.
a) EMG (= Electromyography) - purely active biofeedback training is carried out. The patient
tightens the muscle according to the requirements in the display for the specied time and
then releases it again. The device gives an acoustic and visual feedback about the strength and
duration of contraction and relaxation. If the relaxation is target of the treatment, the positive
signal will be given in the active/work period (that is indicated by the st) as well, if muscle
tension will be below the threshold. In an EMG-phase the device only measures muscle activity
and doesn’t supply any current.
b) STIM - In this phase the muscle is stimulated passively.
- Continuous current (CON), which does not include rest periods. The parameters do
not alter.
- Modulated current, which also ows without a rest, but frequency and pulse
width change in a predetermined rhythm. This creates a feeling of rising and falling
intensity.
- Current in work/rest-rhythm, where a muscle is stimulated in each work period to
cause contraction. In all subsequent rest periods the muscle shall be relaxed as far as
possible, to avoid strain.
The eect of current delivered by the device will vary depending on conguration. It may have
circulatory-enhancing, detoxifying, relaxing, strengthening and pain-reducing eect. During
the stimulation DuoBravo cannot measure EMG, but the muscle tone can be measured in the
relaxation sequences (the rest-period). This control may be necessary to avoid any overstrain of
the treated muscle.
c) ETS (= EMG-triggered stimulation) - this is a combination of active biofeedback training
(see above - EMG) and immediately afterwards triggering passive electrical stimulation (see
above - STIM). If the patients succeed to reach a preset threshold for the muscle tension on
their own, the device automatically transmits current that causes the muscle to contract. The
movement generated by the current, is initiated by the brain using this method. It’s the target to
improve the force of one’s own muscle contraction.
The Dierent Phases