TensCare Flexistim IF User manual

Flexistim IF
Instructions For Use
Please read carefully

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Contents
1.0 Introduction ................................................................................................................. 4
2.0 Contraindications, Warnings and Cautions ............................................................. 5
3.0 IFT: What It Is and How It Works .................................................................................. 9
4.0 Keypad and Display.................................................................................................. 11
5.0 Contents ..................................................................................................................... 15
6.0 How to Assemble Your Unit ...................................................................................... 16
7.0 Operation................................................................................................................... 18
8.0 Programmes............................................................................................................... 22
9.0 Electrode Pad Placement........................................................................................ 23
10.0 Further Clinical Information and Treatment Protocols........................................... 26
11.0 Care of Electrodes .................................................................................................... 26
12.0 Charging the Battery ................................................................................................ 27
13.0 Troubleshooting ......................................................................................................... 29
14.0 Cleaning..................................................................................................................... 29
15.0 Consumables and Servicing .................................................................................... 30
16.0 Warranty..................................................................................................................... 31
17.0 Disposal of Waste Electrical and Electronic Products (WEEE) .............................. 32
18.0 Specifications ............................................................................................................ 32
19.0 EMC Precautions ....................................................................................................... 34

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Symbols Used
TYPE BF APPLIED PART: Equipment providing a degree of protection against electric
shock, with isolated applied part. Indicates that this device has conductive contact with
the end user.
This symbol on the unit means “Refer to instructions for use”.
Temperature Limitation: indicates the temperature limits to which the medical device
can be safely exposed.
Lot Number: indicates the manufacturer’s batch code so that the batch or lot can be
identified.
Humidity Limitation: indicates the humidity limits to which the medical device can be
safely exposed.
Serial Number: indicates the manufacturer’s serial number so that a specific medical
device can be identified.
Do not dispose in household waste.
Catalogue Number: indicates the manufacturer’s catalogue number so that the device
can be identified.
Atmospheric Pressure: indicates the atmospheric limits to which the medical device can
be safely exposed.
Manufacturer Symbol
Date of Manufacture: indicates the date which the medical device was manufactured.
This is included within the serial number found on the device (usually on the back of the
devic
e), either as “E/Year/Number” (YY/123456) or “E/Month/Year/Number”
(MM/YY/123456).
CE Mark
Medical Device

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This medical device is indicated for home use.
A Contraindication is used when a device should not be used because the risk of use
clearly outweighs any foreseeable benefits and may result in serious injury or death.
A Warning is used when failure to follow the instructions may result in serious injury or
death.
A Caution is used when failure to follow the instructions may result in a minor or moderate
injury, or damage to the device or other property.
Notes are used to provide clarification or recommendation.

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1.0 Introduction
Intended Use
IF stands for Interferential Stimulation. IF is indicated for symptomatic relief of chronic
intractable pain.
The Flexistim IF is intended for use in both the Hospital and Home Healthcare
Environments.
Flexistim IF provides interferential therapy to treat conditions where inflammation is a
problem such as Back Pain, Osteoarthritis, Rheumatoid Arthritis, Muscular Pain / Strain,
and Sports injuries, or where deep penetration of low frequency stimulation isrequired.
Flexistim IF produces a low frequency current treatment that uses two medium frequency
currents, which “interfere” with each other to produce a beat frequency that the body
recognizes as a low frequency energy source.
The aim is to overcome the problems caused by low-frequency currents, while maintaining
their claimed therapeutic effect. Unlike TENS, which delivers intermittent pulses to
stimulate surface nerves and block the pain signal, Interferential Current Therapy delivers
continuous stimulation deep into the affected tissue.
The actual stimulation is produced by crossing two alternating currents with medium
frequencies simultaneously to a targeted body region. As a result, these two currents will
superimpose to form a new low frequency current deep within the tissue.
Flexistim IF Features
Flexistim IF includes many of the features of a professional desk-top unit in a compact,
portable, battery operated device.
1. Power Supply
Removeable, rechargeable Li-ion battery, with option of operation through external
mains power adaptor.
2. Output
60mA Peak to Peak pure sinusoidal carrier wave with constant energy (modified constant

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current) control and 40mA safety override for home use.
3. Flexible Programmes
3 preset and 3 adjustable programmes give a wide selection of treatment options.
4. Memory
Flexistim IF allows you to save and recall a particular programme setting and has a
Usage Timer to record the time it has been used.
2.0 Contraindications, Warnings and Cautions
Contraindications
•Do NOT use this device on patients who have a cardiac pacemaker, implanted
defibrillator, or other implanted electronic devices, because this may cause electric
shock, burns, electrical interference, or death.
•Do NOT use this device on patients whose pain syndromes are undiagnosed.
•Do NOT apply stimulation over the pregnant uterus.
Warnings
•Do NOT apply stimulation over the neck or mouth because this could cause severe
muscle spasms resulting in closure of the airway, difficulty in breathing, or adverse
effects on heart rhythm or blood pressure.
•Do NOT apply stimulation across the chest, because IFT currents penetrate deep into
the tissue and the introduction of electrical current into the chest may cause rhythm
disturbances to the patient’s heart, which could be lethal.
•Do NOT apply stimulation over open wounds or rashes, or over swollen, red, infected,
or inflamed areas or skin eruptions (e.g. phlebitis, thrombophlebitis, varicose veins).
•Do NOT apply stimulation over, or in proximity to, cancerous lesions.
•Do NOT apply stimulation in the presence of electronic monitoring equipment (e.g.
cardiac monitors, ECG alarms), which may not operate properly when the electrical

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stimulation device is in use.
•Do NOT apply stimulation when in the bath or shower.
•Do NOT apply stimulation while driving, operating machinery, or during any activity
in which electrical stimulation can put the patient at risk of injury.
•Do NOT use simultaneously with high frequency hospital diagnostic/therapeutic
equipment. Doing so may result in burns at the site of the electrodes and possible
damage to device.
•Do NOT apply near the thorax because the introduction of electrical current may
increase the risk of cardiac fibrillation.
•Stimulation should not be applied across or through the head, directly on the eyes,
covering the mouth, on the front of the neck (especially the carotid sinus), or from
electrodes placed on the upper back or crossing over the heart.
•Consult with your physician before using this device, because the device may cause
lethal rhythm disturbances to the heart in susceptible individuals.
•Apply stimulation only to normal, intact, clean, healthy skin.
•Using the device directly over metallic implants could cause the currents to focus
over a small area, causing tissue burns. If you have metal implants, do not place the
pads near, or across the implant, and adjust the intensity with care.
•Caution should be observed when using the Flexistim IF at high strength settings.
Flexistim IF has a Yellow LED light on output socket which means Flexistim is capable
of delivering outputs >10 mA (RMS) averaged over 1s. Prolonged use at high settings
may cause muscle injury or tissue inflammation.
•Prolonged use at high settings may cause muscle injury or tissue inflammation.
•There are no user serviceable parts. No modification of this equipment is allowed.
Cautions
•Since the effects of stimulation of the brain are unknown, stimulation should not be
applied across the head and electrodes should not be placed on opposite sides of
the head.
•The safety of electrical stimulation during pregnancy has not been established.
•Some patients may experience skin irritation or hypersensitivity due to the electrical

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stimulation or electrically conductive medium (gel).
•Patients with suspected or diagnosed heart disease should follow precautions
recommended by their physicians.
•Patients with suspected or diagnosed epilepsy should follow precautions
recommended by their physicians.
•Use caution when the patient has a tendency to bleed internally, such as following
an injury or fracture.
•Use caution following recent surgical procedures when stimulation may disrupt the
patient’s healing process.
•Use caution if stimulation is applied over areas of skin with less than normal sensitivity.
•Keep this device out of the reach of children. Long cord - risk of strangulation in
infants.
•Do not permit use by children unable to understand the instructions or persons with
cognitive disabilities, i.e.: Alzheimer’s disease or dementia.
•Caution Not intended for use in an oxygen rich environment.
•Caution Not intended for use in conjunction with flammable anaesthetics or
flammable agents.
•Caution The patient is an intended operator.
•Caution Do not service and maintain the device while in use with a patient.
•Caution Maintenance and all repairs should only be carried out by an authorized
agency. The manufacturer will not be held responsible for the results of maintenance
or repairs by unauthorized persons.
•Caution: Strong electromagnetic fields (electro-surgery/ microwave cookers/
mobile phones) may affect the correct operation of this unit. If it appears to behave
unusually, move it away from these devices.
•If necessary, we will provide circuit diagrams, component part lists or other
information that will assist authorized service personnel to repair the device.
•Keep away from pets and pests.
Adverse Reactions
•Patients may experience skin irritation and burns beneath the stimulation

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electrodes applied to the skin.
•Patients may experience headache and other painful sensations during or following
the application of electrical stimulation near the eyes and to the head and face.
•Patients should stop using the device and should consult with their physicians if they
experience adverse reactions from the device.
General Warnings
•Do not immerse any part of the unit in water
•Do not place the unit close to excessive heat.
•Do not use any electrodes which are less than 50 mm x 50 mm.
•Use only the specified battery: 1 x 3.7 volt rechargeable lithium battery. The use of
any other battery could damage the unit.
•Remove battery if unit is not used for a long period of time.
•Do not use the unit while asleep.
•Do not put the lead wire on, or wrapped around the neck.
•Use this device only with the leads, electrodes and accessories recommended by
the manufacturer. Use of other parts materials supplied by the manufacturer can
degrade minimum safety and invalidate the warranty.
•After inserting plugs into both CH1 and CH2 sockets, please do not remove the
plugs when the unit is working. Ensure that the unit is switched OFF before removing
the plugs.
•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.
•Keep the device away from a fireplace or radiant heater, as the heat may affect
the device.
•Keep the device away from nebulizer or steam kettle, as the moisture may affect
thedevice.
•Keep the device away from sunlight, as long-term exposure to sunlight may affect the
rubber causing it to become less elastic and crack.
•Keep the device away from lint and dust, as long-term exposure to lint or dust may
affect the sockets or cause the battery connector to develop a bad contact.

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•Temperature & Relative Humidity of storage: -25°C–+70°C, 10%--93% R.H.
•Temperature & Relative Humidity of transportation: -25°C–+70°C, 10%--93% R.H.
3.0 IFT: What It Is and How It Works
Many users will be familiar with TENS, which delivers intermittent pulses to stimulate
surface nerves and block the pain signal. Unlike TENS, Interferential Therapy delivers a
continuous stimulation deep into the affected tissue.
IFT achieves this deep penetration by using a 4000 Hz carrier wave to overcome the
skin impedance. TENS signals travel around the top 1cm of the skin surface. IFT signals
travel almost directly between the electrodes.
Interferential Therapy uses two medium frequency 4000 Hz currents that ‘interfere’ with
each other to produce a beat frequency that the body recognises as a low frequency
energy source.
10Hz
12Hz

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The range of this beat frequency in the Flexistim IF is 1 to 160Hz.
Unlike TENS, which delivers intermittent pulses to stimulate surface nerves and block the
pain signal, IFT delivers continuous stimulation deep into the affected tissue. In
addition to providing pain relief by the same mechanism that TENS uses, most
physiotherapists consider that IFT’s major role is to accelerate the inflammatory or
healing rate.
IFT is believed to work by stimulating parasympathetic nerve fibres to give increased
blood flow and oedema reduction and by-passing currents across cell membranes;
these currents vary depending upon the tissue involved. By using particular
frequencies in the range, different systems within the body can be stimulated or used
to increase the blood supply, which in turn hastens the healing rate. IFT is used to treat
almost any condition where inflammation is a problem. For example, sports injuries;
arthritic conditions; bruising and swellings, back pain, arthritis and muscular pain.
Many practitioners use a “Sweep” treatment which uses constantly changing
interference pulse frequency. Practical clinical experience suggests therapeutic
benefits for these sweeps in addition to those of conventional nerve stimulation.

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ON/OFF
4.0 Keypad and Display
Keys
ON/OFF Key (On top of unit)
This key switches the unit on or off. Press once for 2 sec and the unit is on, the
LCD display located at the front of the unit will light up. There will be no feeling from
either lead at this point as the intensity always starts at zero. Press this key again and
the unit will switch off.
Frequency
Programme
Battery State
Lock
Channel 1
Intensity mA
Warning
Pause
Timer
Channel 2
Intensity mA

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Programme Selection
Press the “Prog” key to select the programme you require (see section 8)
Parameter Menu Selection
Press these keys to select the following parameters one by one:
Programme P1:
Treatment Timer (min)
FREQUENCY (Hz)
Programmes P2-P4:
Treatment Timer (min)
Programmes P5-P6:
Sweep is between High Frequency and Low Frequency over the set cycle
time in seconds
HIGH FREQUENCY (Hz)
LOW FREQUENCY (Hz)
CYCLE TIME (Sec)
Treatment Timer (min)
Parameter Adjustment Controls
Press these keys to increase or decrease the value of the parameter which
you have selected with the MENU keys.
Intensity Controls
Press either left or right hand keys to adjust the intensity
I.F. signals penetrate deep into the tissue. Positioning pads across the chest or
head could be dangerous - see section 9
For your safety, when intensity reaches 40mA, the warning triangle flashes

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and intensity cannot be increased.
Check electrode pad position. If you are certain that the pads are positioned safely,
press the SKIP key to override. The triangle will stop flashing and intensity can be
increased to 60mA.
Note that the two channels ADD intensity, so that max effective IF intensity is 120mA.
Memory Mode
Pressing the MODE button enters Memory Mode
The Usage time will be accumulatively recorded when the output level is
above zero. The accumulative treatment time in minutes and the number of
uses are displayed.
Press Mode key again to return back to the previous normal display
Pressing “CH2▼” key and “Mode“ key together for 3 seconds will clear the treatment
time to zero.
When a programme is running, this key also acts a PAUSE button. The PAUSE symbol II
will be displayed, and the programme timer will stop. Pressing again resumes the
programme and the intensity gradually returns to the set value.
SKIP Key
High intensity I.F. can be harmful if electrodes are placed so that the current
goes directly through the chest or across the head. For your safety, when
intensity reaches 40mA, the warning triangle flashes, and intensity cannot
be increased.
Manual Programme Lock
When “Manual” is showing, you can protect the manual settings by pressing
and holding this key for 3 seconds.
The key symbol will flash, and you will be unable to change the manual
settings.

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Press and hold for 3 seconds to unlock programme.
Automatic keypad lock
There is an automatic keypad lock if no button is used for 10 seconds. Key symbol
appears. Press the Intensity Down button for either channel to unlock.
Treatment Timer
When the Treatment Timer has been set, it begins to count down in minutes and the
time remaining is displayed on the LCD. When it reaches zero, the device
automatically shuts off.
Power Supply
The Flexistim IF may be operated from the re-chargeable battery, or directly
from the power adaptor. When the adaptor is plugged in to the Flexistim IF,
the internal battery is automatically disconnected. The battery cannot be
charged while in the unit, only in the charging cradle supplied.
The rechargeable battery will give about 1 hours use at 50% intensity.
If you need to make more than one treatment you may either:
a) Purchase and recharge additional batteries
b) Connect to mains power using the mains adaptor
Warning: The power adaptor supplied has special medical grade isolation. Use
of any mains adaptor other than the one supplied with the device could
compromise electrical safety.
Other Features
•The LCD is backlit. To save energy the back light will switch off if the keypad is not
used for 30 secs. Pressing any key will re-activate it.

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•When the unit is turned on, if you do not press any of the keys, or intensity is set to
zero, for > 5 mins it will automatically shut off.
•When you turn the unit on, it will automatically enter the mode that you used last.
•When you change Programme, the output level will reset to zero immediately.
•When the battery is low, the battery icon will flash indicating that the batteries
should be recharged.
5.0 Contents
Your Flexistim IF pack should contain the following:
•1 × Flexistim IF Unit
•2 × Leads
•4 × Self-Adhesive Electrodes with Connectors (Size: 50mm × 50mm)
•1 × 3.7V Rechargeable Lithium Battery (BL-6F)
•1× AC Power Cord
•1× Battery Charging Cradle
•1 x Detachable belt clip
•1 x Storage pouch
•1 x Instructions for use

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6.0 How to Assemble Your Unit
Your Flexistim IF has been designed to be simple and easy to use. Assembly of the
Flexistim IF unit is very simple and requires only five steps.
STEP 1: Battery
Slide belt clip down to access battery
cover.
Remove the battery cover and insert the
battery (as shown on the diagram) inside
the battery compartment. Replace the
battery cover.
Note: Fully charge battery before initial use. See “Charging the Battery” on
page 27.
Caution: There is a risk of explosion if the battery is fitted incorrectly. Replace
only with the correct 3.7 volt lithium battery. Do not dispose of the battery in a
fire and keep it out of reach of children. The battery must be removed from the unit if
unit is not used for a long period of time.

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STEP 2: Leads
If only using one lead, insert into one socket. If using two leads,
insert into both sockets.
A: Insert the lead wires
B: Turn the plug on the lead wire 90° to lock it between the
main body and handle of the unit.
This prevents accidental disconnection during treatment.
STEP 3: Electrodes
Remove electrodes from the bag and connect to the leads.
STEP 4: Placement of electrodes
Ensure wherever you
intend to place the
electrodes, the skin is
clean and thoroughly
dry. Remove the
electrodes from the
clear plastic shield and
position on your body
as required.

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STEP 5: Reading
Read sections 11 to 16 and decide how to use the unit for the treatment.
Note: After Use
Always ensure that the unit is switched OFF before removing the electrodes. After use,
return the electrodes to the clear plastic shields and seal them in the PVC bag. There
is no need to separate the lead wires from the electrodes.
Life of the electrodes:
The electrodes are water based and can dry out if left outside of the PVC storage
bag. If the electrodes lose their adhesive quality in this way, it is possible to reactivate
their adhesiveness by applying a fine spray of water.
Replace the electrodes when they stop sticking well. This can affect the efficiency of
the unit and may lead to skin irritation.
7.0 Operation
After assembling and connecting the device:
7.1 Turn on the device
Press ON/OFF KEY.
LCD displays when the device is on. The LCD is backlit. To save energy the back light
will switch off if the keypad is not used for 30 seconds. Pressing any key will re-activate

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it. Always switch the device off before removing electrodes from the skin.
7.2 Select a Programme
Use Programme Selection Key to choose a desirable programme from P1 to P6.
The output intensity resets to zero when you change a treatment program.
7.3 Set Treatment Timer
The Treatment Timer defaults to 20 minutes.
To set a Treatment Time, press either of the Parameter Selection keys.
The Timer symbol will flash
Use the Parameter Adjustment Controls +/- to select your desired treatment
period ranging from 1 to 90 minutes. You can also select C Continuous
operation but should use this setting with caution.
Press any intensity key or wait 10 seconds to return to the main screen.
The Treatment Timer starts counting as soon as you increase the intensity above zero.
At this point, the display begins to count down from its preset value.
When the preset treatment period is elapsed, the device switches off its output.
7.4 Attach the Electrode Pads
Attach the leads as shown in section 6 and position the electrode pads as shown in
section 9.