Rehabmart UStim User manual

UStim
Neuro Muscular Electrical
Stimulation Unit
User’s manual
Rev.2 (10/19/2012)
Manufactured for:
Pain Management Technologies

CONTENTS
1. Introducing EMS .................... 2
2. Muscular Stimulation techniques
with EMS ................................ 5
3. Contraindications..................... 18
4. Instructions for Use ................ 20
5. Practical use of UStim ........... 28
6. Starting a session .................. 33
7. Specifications ......................... 42
8. Placement of Electrodes ........ 46
9. Programs inside UStim
.......... 62
10. General Information ............. 65
11. Warranty .............................. 67
1

1. Introducing EMS
E.M.S. stands for Electrical Muscle
Stimulation.
Following pain management, the
stimulated muscular contraction is the
next most popular application of
electro-therapy.
After many years, E.M.S. has been
used to treat and prevent the
localized muscular hypotony,in the
rehabilitation field. Now it has become
a recognized and well-proven aid to
physical exercise.
Research, technology and quality
engineering have made EMS a safe
and highly effective muscular training
system, as a complementary way to
perform a selective muscular training.
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How USTIM can help you?
If you need to recover the muscular
tone of a defined area of your body,
after a period of immobility, USTIM
can help you.
If you need to regain your shape, but
you don’t have enough time for
regular exercise, USTIM can help
you.
If you need to improve the
performance of specific muscles and
the effectiveness of the physical
exercises, USTIM can help you.
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11. WARRANTY
In addition to your statutory rights, the
Manufacturer agrees that if any defect
in materials or workmanship appears in
this product within two years after the
original date of consumer purchase, it
will be repaired or at it ’s option, replace
the product in question free of charge.
This applies only if the product has been
used for domestic purposes and has not
been damaged through misuse, accident
or neglect and has not been modified or
repaired by anyone other than the
Manufacturer or its authorized agents.
If a defect appears, please make sure
that the unit is being used in accordance
with the instructions, if so, return it with
this warranty and the proof of purchase
to your nearest USTIM dealer. Note:
only our authorized service agents
should carry out Repairs of the USTIM
units.
Exclusion: The batteries and electrode pads are not
considered covered by this warranty.
How does USTIM work?
Through a couple of self-adhering
electrodes, stimulation pulses are
applied over the muscle; as a result,
the muscle will alternatively contract
and relax, exactly as it happens
during the physiological activity but
with the advantage of avoiding the
general sense of fatigue.
The correct positioning of the pads is
important, so various body maps
have been included to show the
electrodes positioning, in order to
achieve maximum effectiveness.
Benefits cannot be expected after
one session. The most important
benefits will be obtained after
repeated treatment sessions and
over an extended period of time.
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2. Muscular Stimulation
techniques with EMS
At the first approach of muscular
electro stimulation, the most
frequently asked questions are the
following:
Which is the most suitable wave
shape?
Which frequency shall be used?
What is the pulse width?
and which is the best value?
Which intensity level must be
used?
Where to place the electrodes?
IMPORTANT: Read at least the text
in bold characters; it will be very
useful for obtaining the best
effectiveness through the use of
the unit.
Electrodes maintenance
The electrodes supplied with
unit are self-adhesive and can be used
several times, by the same patient.
Being intended for personal use, they
don’t require any cleaning nor
disinfection procedure. Skin must be
allowed to breathe, so the pads should
be removed periodically. When not in
use, the pads should be placed onto the
clear plastic shield. The condition of the
pads does affect the conductivity and
the performance of the unit. When the
pads initially lose their adhesive quality,
it is possible to reactivate their
adhesiveness by applying a fine spray of
water. Once the pads have finally lost
their adhesive quality, new Pads should
be purchased.
Allergic reactions to the self – adhesive
pads can occur, even though they are
hypoallergenic.
·Do not apply to broken skin.
·Do not apply a pad to skin that does not
have normal sensation. If the skin is
numb, stimulation will not be felt and too
great an intensity might then be used
accidentally.
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10. GENERAL INFORMATION
Statement: This unit is FDA
approved, and according to the FDA
regulations, it is classified a Medical
Device class IIa.
PRECAUTIONS
1.Do not immerse the unit in water
2.Do not place the unit close to
excessive heat
3.Use only the specified batteries: 2x
1.5volt AA Alkaline. Using of any other
battery could damage the unit.
4.Do not use the unit while asleep.
5.Remove the batteries from the unit, when it
is not used for a long time.
6.Keep the unit away from sources of high
magnetic fields such as TV’S, microwave
ovens and hi-fi speakers, as these may affect
the LCD screen.
7. Temperature & Relative Humidity of storage
and transport: -20°C to +80°C, 8% to 80%
R.H.
The wave shape
To obtain a stimulated muscular
contraction, we are obliged to
produce a depolarization of one or
more motor units.
The better way is to apply a current
flow on a motor point, that is to say
the point where the nervous fiber
innervates the muscle fiber.
As the human tissues very similar to a
capacitor, from the electric point of
view, the better effectiveness for the
electro stimulation is obtained by
using a pulse wave, having a very
steep rising front. The pulse width
should match the chronaxy value of
the muscle to be stimulated.
A mono-phasic pulse could be used,
but it has been demonstrated that a
biphasic pulse is more comfortable,
without reduction of the effectiveness.
The biphasic pulse has no galvanic
effect, so that it is also suitable to be
used over areas including metallic
prosthesis.
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Different types of biphasic pulses could
be generated:
In the drafts below, we can see pictures of
the biphasic symmetrical pulses and
the biphasic alternated pulses.
USTIM unit can generate true biphasic
symmetrical pulses (galvanic-free),as
well as symmetrical alternated pulses.
The biphasic symmetrical pulses
are generally the most suitable for
treating a single
muscle. The electrode
connected to the
positive (red) wire will
betheactiveelectrode. ※A means “biphasic Alternated wave”
The symmetrical alternated pulses are B means “Biphasic symmetrical wave"
most suitable to treat a couple of
muscles with the same channel.
making equal the effect
under each
electrode.
PRESET programs
P14 - EXPLOSIVE FORCE 1(under USTIM®)
100 250 3 20 0 0 2 B15
P15 - EXPLOSIVE FORCE 2(under USTIM®)
110 200 2 20 0 0 1 B15
P16 - EXPLOSIVE FORCE 2(under USTIM®)
120 150 1 20 0 0 1 B15
P17-RECUPERATION
9-1 250 40 0 0 0 0 B18
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PRESET programs
P4 - WARM-UP
5 250 60 0 3 3 0 B5
P5 - AEROBIC RESISTANCE
10 250 30 2 2 1 3 B40
P6 -AEROBIC RESISTANCE (under USTIM®)
20 250 20 3 2 1 3 B60
P7 - TONIFYING
30 200 6 4 3 2 3 A* 20
P8 - HARDENING
40 250 3 2 0 0 3 A
20
P9 - FORCE + RESISTANCE
50 250 8 4 1 1 8 B25
P10 - FORCE + RESISTANCE (under USTIM®)
60 250 6 3 1 1 6 B25
F
Hz
P
μs

Work

Rest

Rise  Fall F
Wave 
Total
P11 - FORCE 1(under USTIM® control)
70 250 6 12 0 0 5 B15
P12 - FORCE 2(under USTIM®control)
80 200 4 6 0 0 4 B15
P13 - FORCE 3(under USTIM®control)
90 150 4 10 0 0 3 B15
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The stimulation frequency
(also called Pulse Rate)
After defining the wave shape to be
used, a single pulse could also
produce a momentary contraction like
a “wriggle”; however, to obtain a
sustained contraction, we must
supply a pulse train, characterized by
a “frequency”. Frequency (also called
“pulse-rate”) is the repetition rate of
pulses in a second.
The frequency to be used will depend
on the type of fibers to be stimulated.
Any muscle includes slow fibers
characterized by an aerobic
metabolism, and fast fibers
characterized by anaerobic
metabolism. If we want to stimulate
a muscle of which slow fibers are
dominant, we have to use low
frequencies (1 to 30 Hz). On the
other hand, if we want to stimulate
muscles having fast fibers
dominance, we have to use higher
frequencies (50 to 120 Hz.).
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The frequency of pulses can also
define the aim of the electro
stimulation, as passive training.
Physiological and metabolic
characteristics of a muscle, in fact,
can be modified by the electrical
stimulation.
The high frequency stimulation can
partially “convert” the tonic fibers in
phasic fibers, these last
characterized by a higher
development of instantaneous force,
with the prejudice of muscular
resistance.
A very low frequency (1 to 10 Hz)
will be always accepted, like a
massage and it will not produce
fatigue. The physiological effect is
related to the blood flow
improvement, bringing to a better
tissue feeding and facilitation in
the catabolic drainage (absorption).
A low frequency is suitable for starting
a session, allowing a muscular
warm-up, and for ending a session,
allowing a fatigue recover.
9. Programs loaded in
your USTIM
Manual programs
F
Hz
P
μs

Work 
Rest

Rise  Fall F
Wave 
Total
Free program 0-without USTIM®control
5 250 10 0 3 0 0 -- 5
Free program 1-under USTIM®control
18 250 10 2 2 0 5 -- 15
Free program 2-under USTIM®control
35 250 6 4 1 0 5 -- 15
Free program 3- under USTIM® control
60 250 5 8 0 0 4 -- 15
PRESET programs
F
Hz
P
μs

Work  Rest  Rise  Fall F

Wave

Total
P1-DECONTRACTURATING
1 300 30 0 2 20 0 B* 8
P2 – MYORELAXING
3 250 60 0 2 2 0 B10
P3 – CAPILLARIZATION
8 250 60 0 2 2 0 B10
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Example of electrodes placement
over the GLUTEI + WAIST
Wave: ALTERNATED
The Pulse WIDTH
According to scientific research, the
most appropriate waveform to get a
muscular contraction is the
symmetrical biphasic pulse. The
pulse-width must be such to allow a
transfer of sufficient energy to excite
the muscular fibers. A wider
pulse-width doesn’t carry any
advantages; instead, it can create an
useless bother to the patient, through
the involvement of the nervous fibers
which carry the signal “pain”. The
ideal pulse-width corresponds to
the CHRONAXY value of the
muscle to be stimulated.
Each muscle is characterized by a
value of chronaxy that
basically expresses the
neuro-muscular composition and
the functional destination of the
same muscle.
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Table 1 - Examples of values (min. and
max.) of CHRONAXY, statistically
observed on some muscles of a healthy
subject.
Muscle Chronaxy
min.(µsec)
Chronaxy
max.(µsec)
Deltoids 80 130
Pectoral 80 150
Biceps 70 100
Abdominals 90 180
Rectos femoral 100 600
Quadriceps 100 500
Hamstring 180 2000
Gluteus 100 150
Tibia 500 1000
Calves 100 800
Peroneal 200 1700
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Example of electrodes placement
over the GLUTEI
Wave: simple BIPHASIC
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Example of electrodes placement
over the THIGHS
Wave: ALTERNATED
The four phases of the
electro stimulation
The muscular electro-stimulation, as
well as the voluntary contraction,
must foresee an ACTIVATION phase
(stimulation), followed by a REST
phase (pause). The REST phase is
very important for the muscle; in fact
during the contraction, the capillary
circulation comes necessarily
hindered and, if the muscle stays in
contraction for a long time, without a
congruous phase of rest, it may cause
the so-called “ischemia,” that is to say a
limitation of the local blood circulation,
very harmful for any human tissues.
The blood capillary flow, hindered
during the contraction, but facilitated
during the rest, constitutes the main
feeding way for muscles; the muscles,
particularly, draw some of all the
elements for the production of energy
(oxygen, proteins and varied
enzymes).
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The criterions of selection of
STIMULATION time and PAUSE
time are fairly simple, also if
necessarily empirical: the higher is
the stimulation level, the smaller
will be the ACTIVATION phase with
respect the REST time. For
example: if I want to stimulate a
muscle to get a maximal
contraction, I have to limit the
contraction time to very few
seconds and have to introduce,
between each contraction. A REST
period equivalent to at least 5
times the contraction period.
To simulate the voluntary
contraction, or simply to make less
annoying the stimulation, it could
be beneficial to introduce a
PROGRESSION phase and a
REGRESSION phase; we’ll call the
two new phases respectively RISE
time and FALL time
Example of electrodes placement
over the ABDOMEN + WAIST.
Wave: ALTERNATED
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Example of electrodes placement
over the ABDOMINALS .
Wave: ALTERNATED
The stimulation level
Mathematical formulas for
determining the optimal level of the
electric stimulation don’t exist. The
intensity must be suitable to provoke
the level of the aimed contraction, but
without bother or straight pain for the
patient. Furthermore it is important
not to forget that the quantity of
muscular fibers recruited depends
not only on the applied intensity
but, above all, on the positioning of
the electrodes. Very often it is
enough by moving an electrode few
millimeters, to get a better
contraction.
The principle to carry the electro
stimulation to maximal levels, often
above of the pain threshold, is a
practice to be performed with extreme
caution; although the harmlessness of
the high level electro stimulation
doesn’t have solid foundation of
scientific research, and not sufficient
studies have been carried out to
evaluate some possible secondary
effects of muscular degenerative
damages due to over-stimulation.
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We don’t know if a high level of
stimulation, above the subjective
tolerance limit, could be harmful
for the muscular or nervous fibers.
Usually, during a “strengthening”
session, the patient is instructed
to increase the intensity each 3 or
4 contractions; that becomes
almost essential, in consideration
of the progressive fatiguing of the
fast twitch fibers. If you try, to
“compensate” the smaller level of
strength produced, due to the
unexcitability of some fatigued
fibers, with the recruitment of
other muscular fibers, showing an
higher excitement threshold.
WARNING! An involuntary
analgesic effect takes place during
the electro stimulation, through
the stimulated per-production of
endorphins. A pain, in case
provoked by the electro
stimulation, that in any cases
could constitute a safeguard
threshold, has attenuated by the
analgesic effect of the electro
stimulation. The wisdom of
moderation always is the best
guide!
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Example of electrodes placement
over the BREAST (pectorals).
Wave:simpleBIPHASIC
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HAMSTRINGS HAMSTRINGS
(biphasic) (alternated)
Electrodes positioning
We know that an electrical generator
for producing a current flow must be
“closed” on a load. The load, in the
electro stimulation, is represented by
the muscle to be stimulated. The
connection between the generator and
the treatment area (load) will be
performed by means of a pair of
conductive electrodes, having the job
to transfer the electrical potential
(voltage) to the load (muscle). A
closed circuit needs at least a pair of
electrodes; it is impossible to obtain a
current flow with only one electrode. A
current flow must always have an input
point and an output point.
If the aim of the electrical stimulation is
to produce a muscle contraction, at
least one of the two electrodes must
be placed on that muscle, but where is
the best position?
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The better responding point, in a
muscle, is the “motor point”; by
stimulating on the motor point that
we can obtain a better muscular
recruitment with less energy. The
other electrode, theoretically,
could be applied anywhere, but in
practice; it is advisable to place it
proximally, on the same muscle.
If we have to stimulate two
contralateral parts (two limbs), it is
also possible to place the
electrodes of the same circuit, over
the two-contralateral motor points
(avoiding transtoracic stimulation).
The motor point is the better
responding point to the electro
stimulation, so the better way to
find it, is to try different near
points.
Example of electrodes placement
over the GLUTEI muscles.
Wave: simple BIPHASIC
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Example of electrodes placement
over the SPINAL muscles.
Wave: ALTERNATED
3. CONTRAINDICATIONS
BEFORE USE PLEASE READ
THE FOLLOWING:
Who shouldn’t use EMS?
Do not use USTIM unit under the
following circumstances:
WARNNINGS!!!
(1) During the first 3 months of
pregnancy, nor at anytime, on the
abdomen during pregnancy.
(2) If you have a heart
pacemaker or serious heart
rhythm problem.
(3) If you are driving or
operating machinery.
Who should be cautious
using EMS?
1. If you have epilepsy, consult your
doctor before using USTIM.
2. For children under 12, apply only
under medical supervision.
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Where should electrodes NOT
be placed?
1. On the carotid sinuses located at
the sides of the neck (Where a doctor
feels for a pulse), or over the eyes.
2. On both sides of the head at the
same time.
3. On broken skin or on areas where
normal sensation is absent.
4. On the heads of children under12.
IF IN DOUBT, PLEASE CONSULT
YOUR DOCTOR.
Example of electrodes placement
over the DORSAL muscles.
Wave: simple BIPHASIC
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