DE / EN. Operating Manual Art.-Nr Amplimove medical NEURO MUSCULAR ELECTRO-STIMULATOR for amplitude modulated. schwa-medico.

Transcription

1 DE / EN Operating Manual Art.-Nr schwa-medico holistic health Amplimove medical NEURO MUSCULAR ELECTRO-STIMULATOR for amplitude modulated medium frequency electro-therapy

2 abbreviatedinstructions 1 Switch to the left side Connecting the mains adapter Connectors for the electrode cables Connector for the mains adapter 2 Switching ON with the key: (ready after approx. 13 s)» 3» Choosing a program keys left: choosing a group / program key: confirming 2

3 abbreviatedinstructions 4»» Starting the stimulation keys left: Increase/decrease the intensity of channel 1 keys right: Increase/decrease the intensity of channel 2 5»» Pausing the stimulation E key: to pause the stimulation key: to restart the stimulation 6 key: Stopping the stimulation Channel 1 Channel 2 3

4 schwa-medico Operating Manual - AmpliMove medical Content 1 Intended Use 5 2 For safe use 5 Safety Instructions 5 Contra-indication 6 Possible side effects 7 3 Description of the AmpliMove medical Device 8 Display of the Start Menu 9 4 Technical Information 10 Description of the symbols 10 Technical Data 11 5 Introduction to Medium frequency Electro-Stimulation 12 General Notes Regarding Medium frequency Currents 12 Further Notes on the Modulation of the Impulse 13 6 Power Mode 16 7 Operating the AmpliMove medical 17 Basic Programs 21 Expert Programs 22 Connecting the Cables 24 Starting the Stimulation 25 8 Description of the programs 32 Basic Programs 32 Expert Programs 33 Pain Management Programs 35 Incontinence Programs 37 Tissue Nutrition Programs 38 Dynamic Programs 39 9 General Information 40 Adjustments, Modifications and Repairs 40 Classification 40 Reference sheet for battery retraction and disposal 40 Warranty 40 Guarantee 41 Maintenance and Cleaning 41 Technical Check 41 Combination with Original Accessories Delivery Content Accessories 42 Mains Adapter and Cables 42 STIMEX Self-Adhesive Electrodes 42 Silicone Electrodes 43 STIMEX-TEX Stimulation Sleeves 44 Vaginal- and rectal electrodes 45 Contact Gel Program List 46 Basic Programs 46 Expert Programs 46 Tissue Nutrition 47 Dynamic Stimulation 47 4

5 English 1 Intended Use The AmpliMove medical device has been designed for the generation of transcutaneous stimulation of muscles and nerves with mid-frequency current on humans and may not be used for any other purposes. 2 For safe use Safety Instructions Please read the operating instructions carefully before using the AmpliMove medical. Health disorders may indicate serious disease. Please consult a physician and/or a physiotherapist and consider the contra-indication and side-effects of the AmpliMove medical. To ensure safe use of the AmpliMove medical: Only use the AmpliMove medical with original accessories. Keep the AmpliMove medical away from water or other liquids. Do not use the AmpliMove medical if it is not working properly or if it has been damaged in any way. The USB connector serves exclusively for software updates. Do not connect any other device (e.g. printer) than a USB flash drive with a software update to the USB connector of the AmpliMove medical device. Do not try to charge an external appliance with the USB connector. Do not treat a patient with AmpliMove medical when using its USB connector. Do not simultaneously connect a patient to AmpliMove medical and to.»» Do not operate the AmpliMove medical close to a high frequency surgical device, another medical unit, a short wave or microwave unit or a mobile telephone system as it can cause fluctuations in the output values of the electric current stimulation unit. Avoid electrodes placement over the anterior chest wall. The electrodes should be positioned in such ways that the current flow will not cross through the heart. The sizes of the electrodes are to be not less than 2 cm². If the applies current density goes below 2 ma/cm², special attention on the patient is required. Only connect one patient to the AmpliMove medical. Do not use the AmpliMove medical during the simultaneous operation of other machines, when driving or when asleep. Do not hold anything in the hand if using the stimulation sleeves STIMEX-TEX on the upper extremities. Remain seated if using the stimulation sleeves STIMEX-TEX on the lower extremities. Do not drop the AmpliMove medical, do not use it inappropriately or expose it to extreme temperatures or high levels of humidity (not less than 10 C or more than 40 5

6 schwa-medico Operating Manual - AmpliMove medical C or a relative humidity of more than 90 %). Be careful when using the AmpliMove medical near or on children. Always store the AmpliMove medical in its case to protect it from damage and dust. Silicone electrodes used for stimulation with the AmpliMove medical should be replaced after 100 therapy sessions in order to avoid burns of the skin underneath the electrodes. Silicone electrodes are losing electrical conductivity with the time. We recommend to let check your silicone electrodes regularly and to apply enough contact gel before each stimulation session. Contra-indication AmpliMove medical should not be used without having checked with a physician if the following applies to you: Patients with electronic implants such as heart pacemakers, defibrillators or pumps, Patients with implants if unpleasant sensation occurs during stimulation, Patients with skin disorders in the vicinity of the electrodes, Patients with inflammation in the region of application. particularly vascular inflammation Patients with recent thrombosis in the region of application. Patients with cardiac rhythm disorders, During pregnancy, Patients subject to seizures, Patients with malignant diseases in the region of application. Stimulation on the stomach region if patient is subject to hernia (rupture) Stimulation on the stomach and pelvic floor region if patient is subject to uterine or vaginal disorders Patients with bone disease involving high fracture risks in the region of application. (e.g. severe osteoporosis), Patients who cannot autonomously control the stimulation due to their age or their psychological condition, Patients under the age of five, Loss of sensitivity which do not allow to feel the stimulation current, Electrode position in the throat area to avoid spasms of respiratory muscles and cardiovascular response. Please further consider the contra-indication of anal and vaginal probes. 6

7 English Possible side effects Paresthesia (abnormal sensation) during or after stimulation. This can result from too high intensity, lack of electrode contact to the skin or in the vicinity of sensitive nerves. Pain enhancement or pain provocation if used for the treatment of pain. Muscular pain after muscle stimulation (muscle soreness). Skin irritation due to the reaction of the electrode material or the current. Cardiac arrhythmia (heart rhythm problems) can occur if electrodes are placed in such way the current is crossing the heart. Electrode placement over the chest should be avoided by patients with heart rhythm problems. Movement limitation due to muscle contractions. The user should take particular care during muscle sustained contractions since the mobility is then reduced. If the electrodes are placed on the chest, this can affect the respiration. 7

8 schwa-medico Operating Manual - AmpliMove medical 3 Description of the AmpliMove medical Device LED light for the charging mode 2 LED light for the main circuit mode 3 ON/OFF key 4 Key to select menu and to increase intensity of channel 1 5 Key to select menu and to decrease intensity of channel 1 6 Confirmation key 7 Information key 8 Edit key 9 Back key 10 Key to select menu and to increase intensity of channel 2 11 Key to select menu and to decrease intensity of channel 2 8

9 English Display of the Start Menu Name of the menu Battery ( Power mode: ) or power supply Time Menu Explanation of the keys The explanation of the keys is noted on the lower side of the display Switch: Operating mode (left) / Charging mode (right) if mains adapter is connected. The switch has no function if the mains adapter is not plugged in. The switch from battery operation to mains operation mode is automatic if the mains adapter is connected. 13 Socket for the mains adapter 14 Socket for the USB flash drive (for software updates) 15 Socket for the electrode cable of channel 2 16 Socket for the electrode cable of channel 1 9

10 schwa-medico Operating Manual - AmpliMove medical 4 Technical Information Description of the symbols Manufacturer Attention: Read accompanying documents, especially user manual! Follow instructions for use Type BF applied part Date of manufacture Catalogue number Serial number Environment Do not dispose of the appliance with the normal household waste at the end of its life, but hand it in at an official collection point for recycling. By doing this you will help to protect the environment. By labelling with CE mark, the manufacturer asserts that the product fulfills all relevant requirements of the respective EC Directives. A conformation assessment process has been successfully completed. The identification number in respect of the conformation assessment process is given in accordance with the CE labelling of the relevant notified body. Stand-by Battery check Polarity of d. c. power connector USB connector Output 10

11 English Technical Data Operating voltage External mains adapter SNT Max. current consumption on 110 VAC / RL = 500 Ω Max. current consumption on 230 VAC / RL = 500 Ω Internal lithium-ion battery Charging time VAC / Hz / 700 ma approx. 120 ma approx. 70 ma 10.8 V / 2200 mah 5 h Output voltage Maximum Output voltage with RL = 500 Ω 75 V peak-to-peak (+/- 8 V) Program parameters Therapy duration 1-99 min (+/- 10 %) in steps of 1 min Carrier frequency 2-10 khz (+/- 10 %) in steps of 0.5 khz Low frequency modulation Hz (+/- 10 %) in steps of 1 Hz Modulation depth % Surge current modulation Rising ramp s (+/- 10 %) Working time 0-25 s (+/- 10 %) Falling ramp s (+/- 10 %) Pause 0-25 s (+/- 10 %) in steps of 0.1 s / 1 s Modulation depth % Contact control Contact control turns on at Size and weight Size (H x B x D) Weight (without accessories) 20 % of maximum intensity 6.5 x 22 x 17 cm 830 g Working conditions Temperature range C Relative humidity % 11

12 schwa-medico Operating Manual - AmpliMove medical Storing conditions Temperature range C Relative humidity % 12 5 Introduction to Medium frequency Electro-Stimulation General Notes Regarding Medium frequency Currents The AmpliMove medical operates with rectangular impulses between 1000 and Hz therefore in the electro-physical medium frequency range which is encompassed between 1000 and Hz. This is quite different from the low frequency range ( Hz), in which, for example transcutaneous electrical nerve stimulation, is located (TENS). A significant characteristic is the pleasing aspect of stimulation in the medium frequency range. Higher frequencies overcome the resistance of the skin, in particular that of the poorly conducting epidermis, much more efficiently. The 4000 Hz frequency which is often used in medium frequency therapy must only overcome a resistance of 40 Ohm; at 50 Hz it is 80 times higher. This enables an effective current flow at reduced sensitivity unpleasantness. Powerful muscular contractions can be triggered and a greater treatment area/treatment volume realized. Particularly electrical current muscular stimulation profits from this effect. It is for this reason that it is a domain for the medium frequency range. The AmpliMove medical provides the requirements for a therapy which is efficient on account of its tolerability and its volume without causing compliance problems which frequently occur in the low frequency range. These advantages have an effect in pain therapy with the AmpliMove medical. There arises one of the transcutaneous electrical nerve stimulation (TENS) comparable to the analgetic effect which is attained via a low frequency modulation of the carrier frequency. The positive characteristics of the medium frequency electro-stimulation remain thereby preserved.

13 English Further Notes on the Modulation of the Impulse The continuous stimulation with higher frequencies hinders the repolarisation on the cell membranes and leads to the depletion of the neurotransmitter reservoirs on the neuromuscular end-plate (Illustration 1).In order to maintain a stimulation effect, the stimulation must be modulated in respect of the frequency or the intensity (that is, the amplitude). The AmpliMove medical operates with amplitude modulation. Traditionally, this has applied in the Nemec s interference current whereby two current circuits with differing frequencies are superimposed in the body. A frequency difference results from the interference of the impulses. The application of 4000 Hz (first current circuit) and 3900 Hz (second current circuit) theoretically leads to a stimulation of 100 Hz. But in practice and on account of the complex electro-physical conditions in the human body, the stimulations results are difficult to predict. However, with the AmpliMove medical the modulations occur within the device so in contrast to interferential current, therapy can proceed with only one channel. The medium frequency alternating current serves as a carrier from two possible modulations which are independent of each other: A low frequency modulation with a frequency range of Hz (Illustration2). The effect of these frequencies differs in respect to those generated by TENS without the medium frequency carrier wave. But general experience gained from low frequency effects can be transferred in respect of their analgetic and muscular stimulating effects. An overlapping envelope curve modulation (Illustration 3), by which in addition, the ramp, working and pause phases are specified. This modulation prevents premature fatigue, especially of the striated musculature. The modulations can proceed in different degrees of 1 to 100 %, whereby a stronger modulation level provides a more intensive stimulus. Both types of modulation can be freely combined with each other. Illustration 1 Unmodulated medium frequency carrier wave Illustration 2 Low frequency amplitude modulation of the medium frequency carrier wave Illustration 3 Overlapping envelope curve modulation 13

14 schwa-medico Operating Manual - AmpliMove medical The Polarity The medium frequency rectangular impulses of the AmpliMove medical are zero line symmetric and trigger, on account of their short width and high frequency, only minimal ion migration in the tissue. Treatment with the AmpliMove medical is therefore gentle on the skin and well tolerated. A polarity and a differential in a cathode and an anode are omitted. Both electrodes function in the same manner. This provides easy electrode placement. Regarding Frequency and Intensity A characteristic of medium frequency is the increasing distance between the motoric and the sensitive threshold with an increase in the frequency. As a result, the motoric threshold declines and has, at Hz, the greatest differential to the sensitive threshold. The motoric stimulation in this frequency range is accompanied by a minimum of sensitive stimulation. By contrast, a reduction in the frequency to 1000 Hz, the threshold draws increasingly nearer. A motoric stimulation is therefore related to an increasing perception of the electrical current. The motoric stimulation effect and the development of power are more pronounced in the lower frequency range, with a maximum of 1000 Hz. With regard to muscle stimulation, the frequency selection represents a compromise between the sensitive stimulation/inconvenience and the required motoric reaction. Many therapists often use the frequency 4000 Hz. For electrical current sensitive patients, a higher frequency could be advisable. If an intensive stimulation is wished, a lower frequency should be selected. Higher frequencies can, on account of their lesser electrical current perception, mislead to the application of enhanced current strength and an increase in the training intensity. This can cause, during and after the stimulation, to a muscular reaction such as fatigue and the occurrence of pain. Current intensity which triggers a visible muscle contraction of the greater part of the muscle is generally sufficient to effect muscular stimulation. Maximum strain on untrained or weak muscles is to be avoided and as a matter of principle, muscular contractions should not be painful. Pain therapy requires muscle contractions only in the lower modulation range of up to 15 Hz. This range is appropriate in particular for the treatment of chronic pain. For higher frequency modulations of up to 100 Hz the sensitive stimulation is decisive for the effect. Muscular contractions are not required here and this enables longer stimulation periods without resulting in muscular fatigue. A lower intensity is selected accordingly. On account of the specific stimulation quality of the medium frequency impulses, muscular reactions and their related application time limitation cannot, however, always be avoided. 14

15 English AmpliMove medical Therapy Programs The programs are indication related. All stimulation parameters are defined up to the individually set current intensities. The parameters can be changed according to requirements and own programs can also be written. A particular program can often be used for further indications which are not noted in the program title. Further indication options are referred to in the accompanying text when a program is selected. A program is divided into several sequences. A change of sequence causes the current intensity to be somewhat reduced so that subsequent adjustment may be necessary. This is designated with Intensity adaptation. The images attached to the program with indications and electrode placement represent treatment examples which, as and when necessary, can be varied or supplemented. Regarding Electrical Muscle Stimulation Electrical muscle stimulation (EMS) is an instrument for the selective activation of muscles and groups of muscles and has application in the sport and medical fields. Differentiation between endurance and strength training is effected depending on the selection of the parameters. In addition to muscular stimulation, the activation of the associated joints, ligaments and tendons is important for the contracture prophylaxis and tissue nutrition. Muscle stimulation with the AmpliMove medical is suitable for all patients who are subject to existing, or the prevention of, inactivity atrophy. This includes patients with painful, pain-related, post-traumatic and post-operative immobility as well as patients who may be subjected to low levels of physical exertion by suffering from cardiac, respiratory or other systemic illnesses and patients with central paresis. EMS has its place in stationary applications, ranging from the intensive care unit to the rehabilitation clinic. And just as important also where chronic illness is involved and continuing ambulatory and domestic use are necessary in order to maintain mobility and quality of life levels. A great virtue of electrical muscle stimulation lies in the primary stimulation of Type II fibres (strength fibres) which can be preferentially attained on account of reduced electrical resistance levels. The training of the strength fibres is frequently difficult because greater physical exertion is required here and to which patients often cannot be subjected. 15

16 schwa-medico Operating Manual - AmpliMove medical 6 Power Mode You can use the device directly from the 220 Volt mains or with the rechargeable battery in the device. The power mode is shown in the upper right side of the display. The device works on mains circuit. The device works on battery. Charging the Battery / Battery Operation If you wish to use your new AmpliMove medical on battery, you first need to charge it. Connect the mains adapter to the socket at the rear side of the device (no. 13). Turn the power switch (no. 12) to the position charging battery. Connect the mains adapter to your mains circuit socket. The left LED on the upper side of the case is lighting red while the device is charging. The LED is turning to green once the battery is fully charged. The device cannot be turned ON while charging and cannot be used for stimulation. Once the device is fully charged, disconnect the mains adapter from the mains circuit and from the device and store it in the transportation case. Turn the power switch (no. 12) back to the power mode. The battery level is indicated on the upper right side of the display with the symbol. The battery need to be recharged once the battery symbol turns to red. Please note: The device is automatically in battery operation if the mains adapter is not connected to the device. Important! Please handle the mains adapter with care and do not drop it. Operation on Mains Circuit Connect the mains adapter to the socket at the rear side of the device (no. 13). Turn the power switch (no. 12) to the position power mode. Connect the mains adapter to your mains circuit socket. The right LED on the upper side of the case is lighting green and the plug symbol indicates on the right side of the display that the device is operating on mains circuit. Please note: The battery is not recharged during mains circuit operation. Important! If you turn the switch to the battery mode position while the device is connected to the mains circuit, the device will automatically turn OFF and will not be available for stimulation purpose. The device automatically switches from battery operation to mains circuit operation if a mains adapter is connected to the device. 16

17 English 7 Operating the AmpliMove medical The AmpliMove medical device is operated via the keys. The colour display indicated on the upper left side the current menu. The indications on the lower side of the display are explaining the functions of the different keys. Those vary depending on the selected menu. Switching ON the device Press the key to switch ON the device. The device is ready after approximately 13 seconds. Start Menu / Choice of Menu/ Five different menus can be selected: Favourites (the last five programs in use) Basic programs (parameters of the predecessor unit AmpliMed) Expert programs (new programs with different sequences) User programs (for own parameters) Settings (time, date, language, software update) To select the desired menu: keys left... Select a menu key... Confirm your choice Menu Favourites Select the point Favourites with the keys in the start menu. Confirm your choice with the key. The favourites menu displays the last five programs in use. These programs can come from all 3 categories of programs (basic, expert and user). Start the selected program by pressing the intensity keys (left for channel 1 and right for channel 2). Press the i key to delete all user programs. Press the key to return to the start menu. 17

18 schwa-medico Operating Manual - AmpliMove medical keys left... Select a program key... Start the selected program i key... Delete all favourite programs key... Return to Start Menu Menu Settings Select the point Settings with the keys in the start menu. Confirm your choice with the key. keys left... Select a setting key... Confirm the selected setting key... Return to Start Menu Parameters In this menu the stimulation parameters can be adjusted directly without creating a user program. Select the point Parameters with the keys in the settings menu. Confirm your choice with the key. Press the left keys to jump from one parameter to the next one. Press the right keys to modify the parameter value. Confirm your modification with the key. The selected parameters are stored even after turning the device OFF. A user program cannot be created though. Please consult the chapter User programs for creating own programs. Press the key to return to the Settings menu. Therapy duration min Carrier frequency khz 18

19 English Low frequency current modulation: Modulation depth of low frequency current % Low frequency Hz Surge current modulation: Modulation depth of surge current % Rising ramp s Working phase s Falling ramp s Pause s keys left... Select a parameter keys right... Modify the parameter key... Save the selected parameters and start stimulation key... Return to menu Settings Setting Date and Time In this menu the date and time can be adjusted. Select the point Date / time with the keys in the settings menu. Confirm your choice with the key. Press the left keys to jump from one value to the next one. Press the right keys to modify the value. Confirm your modification with thekey. Press the key to return to the Settings menu. keys left... Select the date or time keys right... Modify the date or time key... Save the selected date and time key... Return to menu Settings 19

20 schwa-medico Operating Manual - AmpliMove medical Setting the Language In this menu the language can be changed. Select the point Language with the keys in the settings menu. Confirm your choice with the key. Press the left keys to select the desired language. Confirm your choice with the key. Press the key to return to the Settings menu without changing the language. keys left... Select a language key... Confirm the selected language key... Return to menu Settings Software Update Copy all files of the software update on an unpartitioned USB flash drive. Select the point Software update with the left keys in the settings menu. Confirm your choice with the key. Plug the USB flash drive with the copied files in the USB socket (no. 14) on the back side of the device. Wait until the device has detected the flash drive then press again the key to start the software update. The files are then copied and installed. The device automatically restarts. Pull out the flash drive after the successful software update. Important note! Do not connect any other device than a USB flash drive to the USB connector (no. 14) of the AmpliMove medical device. Do not try to charge an external appliance with the USB connector. The battery of the AmpliMove medical cannot be recharged via the USB connector. 20

21 English Basic Programs The origins of the Basic programs lay in the predecessor medium frequency stimulator AmpliMed. Most Basic programs consist of two sequences: the first one works a pain treatment, the second activates the muscle with a trapezoidal modulation. Select the point Basic Programs with the left keys in the Start menu menu. Confirm your choice with the key. A list of programs is proposed. Select a program by scrolling with the left keys. Confirm the selected program with the key. Increase the intensity with the of each channel (left key for channel 1 and right key for channel 2) to start the program. Press the i key to access information to the parameters of the selected program. Press the right or left keys to scroll between the parameter of the different sequences. Press again the i key to access information on examples of electrodes placements. Press the key to return to the Start Menu. keys left... Choose a program key... Confirm the selected program and start the program i key... Information key (parameters, electrode placement) key... Return to Start Menu 21

22 schwa-medico Operating Manual - AmpliMove medical Expert Programs The Expert Programs are new, innovative programs made of several short sequences. The chapter Program Description offers detailed information on each program. The intensity is automatically reduced between the sequences depending on the parameters in order to avoid unpleasant current feeling (so called intensity adaptation ). Select the point Expert Programs with the left keys in the Start menu menu. Confirm your choice with the key. Five different program categories are proposed: Dynamic, Tissue nutrition, Incontinence therapy, Muscle stimulation, Pain therapy. Select a category with the left keys and confirm your choice with the key. Press the key to return to the Start Menu. A list of programs then appears on the display. Select a program by scrolling with the left keys. Confirm the selected program with the key. Increase the intensity with the of each channel (left key for channel 1 and right key for channel 2) to start the program. Press the i key to access information to the parameters of the selected program. Press the right or left keys to scroll between the parameter of the different sequences. Press again the i key to access information on examples of electrodes placements. Press the key to return to the menu Expert programs. keys left... Choose a program key... Confirm the selected program and start the program i key... Information key (parameters, electrode placement) key... Return to the menu Expert program 22

23 English Information on the Programs Information on the programs can be accessed if pressing the i key after having selecting a program. The following information are displayed: Parameters of each sequence Program description Examples of electrode placement. Press the i key to display the parameters of the first sequence. Scroll through the sequences by pressing the right of left keys. Press the i key again to access information on examples of electrodes placements. Scroll through the different electrodes placements by pressing the right of left keys. Press the E key to access a program description. Press the key to return to the menu Expert programs. Name of the program Duration of the sequence Low frequency Modulation depth of surge current Sequence 1 of 3 Carrier frequency Modulation depth of low frequency current Rising ramp Working phase Falling ramp Pause 23

24 schwa-medico Operating Manual - AmpliMove medical Program Description Electrode Placement Description of the Electrodes Placement Connecting the Cables Connect the electrodes or sleeves with the cable(s) (always 2 electrodes per cable). Connect the cable(s) to the socket on the rear side of the AmpliMove medical (no. 15 and 16). Place the electrodes on the desired area (see examples on chapter Electrode placement). Always follow the recommendation of the therapist. 24

25 English Starting the Stimulation 1. Name of the program (upper left side) 2. Power mode (far upper right side) 3. Time (far upper right side) 4. Remaining therapy duration (clock symbol left) 5. Current sequence number / Total number of sequences (upper right side) 6. Remaining therapy duration of the sequence in use (clock symbol right) 7. Intensity channel 1 in Percent of the max. intensity (left) 8. Intensity channel 2 in Percent of the max. intensity (right) 9. Surge current modulation with ramp times (in the middle) 10. Low frequency and modulation depth in use (lower right side) 11. Carrier frequency in use (lower left side) Starting the Stimulation keys left... Start stimulation on channel 1 and increase intensity. Decrease intensity on channel 1 keys right... Start stimulation on channel 2.and increase intensity. Decrease intensity on channel 2 E key...open menu Therapy Options key...close menu and return to the program list 25

26 schwa-medico Operating Manual - AmpliMove medical Operation During the Stimulation keys left... Increase intensity on channel 1. Decrease intensity on channel 1 keys right... Increase intensity on channel 2. Decrease intensity on channel 2 E key...pause: To pause stimulation key...stop: To stop stimulation Operation During the Stimulation Pause keys right or left...start stimulation again key...stop stimulation 26 Options Press the E key once a program has been selected to enter the Options menu. Choice of Sequences In this menu you can select a specific therapy sequence. The sequences placed after the selected one are starting automatically.

27 English Contact Control If you are using poorly conductive electrodes or if the Therapy is interrupted through contact control information, you find the possibility to deactivate this option in this menu. This option will not be saved after turning the device off in order to guarantee the safety of the user. Safe Intensity control While raising the intensity, the running surge current modulation is interrupted and the work phase is activated over a rising ramp. This way, the selection of too high intensity settings during pause can be avoided. If you want to turn off this standard safety setting, please deactivate the safe intensity control. The running modulation is then not interrupted during the intensity setting. keys left... Select an option keys right... Select a sequence / Change the status key... Confirm your selection and close Options menu key... Close Options menu without changes Menu User programs : Creating Own Programs In this menu you can create own programs. Select the point User programs with the keys and confirm your choice with the key. A list of the already created user programs is displayed. keys left... Select a User program or a New user program key... Start a user program i key... Delete the selected user program E key... Edit the selected user program or create a new user program key... Close the menu User programs and return to Start Menu 27

28 schwa-medico Operating Manual - AmpliMove medical 28 Creating User Programs Select the point New user program with the keys in the menu User programs. Press the E key to edit the user program. The current name of the user program is displayed in the Enter program name window. Press the right key as often as necessary to delete the last character(s). Press the left keys to scroll through the alphabet. Press the E key to add the selected letter or figure to the program name. Press the i key to switch between capital and lower-case letters. The following characters are available: A to Z (capital and lower-case letters) 0 to 9 Space character. Press the key to save the program name. keys left...select a letter i key...switch between capital and lower-case letters key...confirm name of program and close the menu Enter program name E key...add the selected letter to the program name key...return to menu User programs key right...delete the last letter of the program name The point New sequence is already selected. Press the E key to add a sequence. Press the left keys to jump from one parameter to the next one. Press the right keys to modify the value of the selected parameter. Save the modification by pressing the key. You automatically get back to the overview of all sequences. The created sequence is displayed in the overview with its parameters. Repeat the procedure if you want to add further sequences. The order of the sequences is fixed and cannot be modified. Press the i key to delete a sequence. Confirm the

29 English delete procedure with the key. Press the E key to edit an already created sequence. Press the key to return to the User programs menu. You can modify the following parameters: Therapy duration min Carrier frequency khz Intensity adaptation % Low Frequency Modulation: Modulation depth of low frequency current % Low frequency Hz Surge Current Modulation: Modulation depth of surge current % Rising ramp s Working phase s Falling ramp s Pause s keys left... Select a parameter to be modified key... Save the sequence and return to menu Edit user program keys right... Modify the selected parameter key... Return to menu Edit user program without saving changes Note about the intensity adaptation: The intensity is reduced to the set percentage of the former intensity at the beginning of each new sequence. This way unpleasant stimulation can be avoided. The intensity adaptation can be set between 1 and 90% of the former intensity. 29

30 schwa-medico Operating Manual - AmpliMove medical The following figure is giving information on the name of the user program (no. 1), the duration of the program (no. 2) and in the chart below, an overview of the sequences and their parameters (no. 3). 30 keys left...select an existing or a new sequence key...save the user program and return to menu User programs i key...delete the selected sequence E key...edit the selected sequence or create a new sequence key...close menu Edit user program and return to menu User programs key right...edit the program name Modifying Existing User Programs Select an existing user program with the left keys in the menu User programs. Press the E key to edit the user program. The current name of the user program is displayed in the Enter program name window. Press the right key as often as necessary to delete the last character(s). Press the left keys to scroll through the alphabet. Press the E key to add the selected letter or figure to the program name. Press the i key to switch between capital and lower-case letters. The following characters are available: A to Z (capital and lower-case letters) 0 to 9 Space character. Press the key to save the program name. keys left...select a letter i key...switch between capital and lower-case letters key...confirm name of program and close the menu Enter program name

31 English E key...add selected letter to program name key...return to menu User programs key right...delete the last letter of the program name Select the sequence to be modified with the left keys. Press the E key to edit the sequence to be modified. Press the left keys to jump from one parameter to the next one. Press the right keys to modify the value of the selected parameter. Save the modification by pressing the key. You automatically get back to the overview of all sequences. The order of the sequences is fixed and cannot be modified. Press the i key to delete a sequence. Confirm the delete procedure with the key. Press the key to return to the User programs menu. You can modify the following parameters: Therapy duration min Carrier frequency khz Intensity adaptation % Low Frequency Modulation: Modulation depth of low frequency current % Low frequency Hz Surge Current Modulation: Modulation depth of surge current % Rising ramp s Working phase s Falling ramp s Pause s 31

32 schwa-medico Operating Manual - AmpliMove medical keys left... Select the parameter to be modified key... Save sequence and return to menu Edit user program keys right... Modify the selected parameter key... Return to menu Edit user program without saving.the modifications Note about the intensity adaptation: The intensity is reduced to the set percentage of the former intensity at the beginning of each new sequence. This way unpleasant stimulation can be avoided. The intensity adaptation can be set between 1 and 90% of the former intensity. The following figure is giving information on the name of the user program (no. 1), the duration of the program (no. 2) and in the chart below, an overview of the sequences and their parameters (no. 3). keys left... Select an existing or a new sequence key... Save the user program and return to menu User programs i key... Delete the selected sequence E key... Edit the selected sequence or create a new sequence key... Close menu Edit user program and return to menu. User programs keys right... Edit the program name 8 Description of the programs Basic Programs The Basic programs arise in the therapy cards of the analogue medium frequency stimulator called AmpliMed, which was the predecessor stimulator of the AmpliMove medical. These programs are mainly interesting for users who formally worked with the AmpliMed stimulator and want to use the settings of its therapy cards. The Basic programs may also represent an alternative to the Expert programs. 32

33 English Program 1 Arthrosis Program 2 Distortion Program 3 Tendonitis Program 4 Neck pain Program 5 Sciatica Program 6 Lumbago Program 7 Lymphatic drainage Program 8 Amyotrophy Program 9 Muscle contractures Program 10 Myalgia Program 11 Neuralgia Program 12 Frozen shoulder Program 13 Soft tissue lesions Program 14 Back pain Program 15 Muscle test according to Lange Expert Programs Muscle Stimulation Programs CAUTION: Where atrophic or untrained muscles are involved, the use of these programs can lead to muscular overload symptoms such as pain and strain. Of course, the muscle stimulation programs can be curtailed in such cases or used with reduced intensity levels until the musculature is better able to withstand the strain level. In principle, daily application is recommended to ensure continuous muscle training. If the training schedule permits, the muscle stimulation programs can be performed several times a day. Combining or changing programs can be useful. Adequate current intensity for the motoric stimulation and the triggering of visible contractions is required for all muscle stimulation programs. Program 1 Endurance Training (12 min) This program serves to stimulate low-fatigue Type I fibres which are responsible for the endurance of the muscle. It is suitable for the prophylaxis of condition loss associated with prolonged mobility limitation. Combination with the program Strength Training is recommended. Because the loss of condition proceeds more slowly than the loss of strength, the application of program Strength Training should be used twice as often as the program Endurance Training. Program 2 Strength Training (13 min) This program serves to stimulate Type II fibres which are responsible for the strength of the muscle. Prophylactically it is suitable for the loss of strength where limited mobility is involved and which can develop within a short time. For the maintenance of Type 33

34 schwa-medico Operating Manual - AmpliMove medical 34 II fibres, frequent, if possible daily, implementation of the program is recommended. Combined application with the program Endurance Training is recommended. Program 3 Endurance Training Muscular Atrophy (8 min) With a reduced total running time and longer pauses, this program is suitable for application where atrophy and limited muscle strain are involved. Combination with the program Strength Training Muscular Atrophy is recommended. Program 4 Strength Training Muscular Atrophy (9 min) With a reduced total running time and longer pauses, this program is suitable for application where atrophic and a limit on the strain on muscles is involved. For the development of Type II fibres, frequent, if possible daily, implementation of the program is recommended. Combined application with the program Endurance Training Muscular Atrophy is recommended. Program 5 Muscle Relaxation (4 min) By means of higher frequencies, this program leads to the relaxation of fasciated musculature. The short sequences are adapted to the high frequencies which lead rapidly to an activity reduction of the motor end-plate which is accompanied by consecutive muscle fibre relaxation. If required, this program can be repeated several times. Program 6 Endurance Training for Current Sensitive Patients (8 min) With this program the stimulation parameters and duration are carefully selected to ease sensitive patients into AmpliMove medical therapy. After a period of acclimatization one can change to the program Endurance Training. Combined application with the program Strength Training for Current Sensitive Patients is recommended. Please also take account of the description of the program Endurance Training. Program 7 Strength Training for Current Sensitive Patients (8 min) With this program the stimulation parameters and duration are carefully selected to ease sensitive patients into AmpliMove medical therapy. After a period of acclimatization one can change to the program Strength Training. Combined application with the program Endurance Training for Current Sensitive Patients is recommended. Please also take account of the description of the program Strength Training. Program 8 Detonisation of Spasticity (7 min) The placement of the electrodes is directly on the spastic muscle or the muscle group. The low frequencies of this program effect less strain activation and invigoration which leads to functional improvement and a reduction in the spasticity level.

35 English CAUTION: Especially in the start phase of acclimatization and the beginning of the therapy is an increase in the spasticity level possible. In such cases shortened application of the program is recommended. As an alternative and also as a supplement to this program, consideration should be given to the program Spasticity, Antagonistic Muscles in which the danger of an increase in the spastic level is reduced by the stimulation of the antagonists. Combining with the program Paresis can be advisable. Program 9 Paresis (12 min) This program can be used where central paresis is involved, primarily in order to maintain muscular strength and to effect movement in the associated joints, ligaments and tendons in the sense of a contracture prophylaxis. Where older paresis with atrophied muscles is involved, the use of the alternative program Endurance Training Muscular Atrophy or Strength Training Muscular Atrophy can be used. Program 10 Spasticity, Antagonistic Muscles (6 min) By stimulating their antagonists, spastic muscles can be distended and their tonus reduced. The activation of the antagonists is, compared with agonistic stimulation (program Detonisation of Spasticity ), is more agreeable and leads somewhat less frequently to an increase in the reactive spastic which can arise particularly during the acclimatization phase and at the beginning of the therapy. Under some circumstances, shortened application is advisable. As an alternative and also as a supplement to this program, consideration should be given to the program Detonisation of Spasticity. Combining with the program Paresis can be advisable. Pain Management Programs The programs for pain relief therapy can be applied for both acute and chronic pain. When necessary, they can be implemented several times a day. The selection of intensity levels is contingent on individual tolerance levels. Where sequences with a low frequency modulation up to15 Hz are involved, visible muscular twitching are to be provoked in order to attain maximum pain reduction. Sequences with frequencies in excess of 15 Hz require a clearly perceptible current intensity which is not painful and which does not trigger motoric reactions. However, motoric reactions can occur on account of the specific parameters of the AmpliMove medical even with less sensitive stimulation. This is unproblematic as long as this is tolerated in correlation with the illness causing the pain. Otherwise an alternative electrode placement outside the pain region is to be recommended, or the implementations of another stimulation program such as Pain, Current Sensitive Patients. 35

36 schwa-medico Operating Manual - AmpliMove medical Program 1 Myogenic Pain (16 min) This program is suitable for muscular pain and pain which is caused by or accompanied by muscular tension. The program changes the frequency range and the carrier frequencies. Stimulation in sequence1 should be above motoric threshold. Stimulation in sequences 2 and 3 should be above sensitive threshold. Program 2 Arthralgia (20 min) All those joints can be treated where periarticular muscular twitching for stimulation in sequence 1 and 2 can be triggered. For sequences 3 and 4 a sensitive threshold stimulation is sufficient. Where joints without attainable musculature are involved, the program Pain, Current Sensitive Patients can be used as an alternative. Program 3 Pain, Current Sensitive Patients (13 min) By using special parameters, stimulation with this program is particularly agreeable and is suitable for those patients who are sensitive to electrical current, especially during the initial phase of treatment with the AmpliMove medical. It is designed for a purely sensitive stimulation. The program can also be used as an alternative if muscular twitching cannot be triggered or cannot be tolerated. Program 4 Back Pain, Combination (15 min) This special program for the relief of back pain combines pain therapy with the treatment of myogenic tension and dysbalance. In all three sequences stimulation should be above the motoric threshold. With acute pain where the muscular contraction is intolerable and also with electrode placement in body regions where muscular twitching cannot be provoked, the alternative program Pain, Current Sensitive Patients can be used. Program 5 Neuropathic Pain (15 min) This program requires, in sequences 1 and 2, a sensitive, in sequence 3 a threshold motoric stimulation. If the electro-stimulation and/or the muscular twitching in the pain area are intolerable for the patient, an alternative electrode placement should be selected. In addition, the sensitive stimulating program Pain, Current Sensitive Patients can be used. Program 6 Ischialgia (15 min) Stimulation in sequences 1 and 2 should be above motoric threshold. The third sequence is optional. Where intolerance is involved, as an alternative the purely sensitive stimulation with program Pain, Current Sensitive Patients can be used. 36

37 English Incontinence Programs All programs with the exception of the Sacral Nerve Stimulation S2/3 are designed for stimulation above motoric threshold. On account of the greater fatigability of the pelvic floor musculature the stimulation times are somewhat curtailed. At the beginning of the therapy, treatment should be carried out at least once daily and, if necessary, several times each day. Program 1 Stress Incontinence (11 min) Both skin electrodes (self-adhesive electrodes or silicone electrodes) and also a vaginal probe (for men an anal probe) can be used whereby the probes are probably the more effective option. The stimulation should be above motoric threshold. This program is a muscle training. A regular, at the beginning daily application, is therefore recommended. Program 2 Stress Incontinence, Current Sensitive Patients (10 min) This program is more tolerable than the program Stress Incontinence, also as a result of the higher carrier frequency. Apart from that, the same notes as for the program Stress Incontinence apply. Program 3 Urge Incontinence (11 min) This program is suitable for the treatment of urge incontinence and over-active bladder. Stimulation should be above motoric threshold in all sequences. Both skin electrodes (self-adhesive electrodes or silicone electrodes) and also a vaginal probe (for men an anal probe) can be used whereby the probes are probably the more effective option. As a rule, treatment on a once daily basis is adequate. As an alternative to this program and the recommended electrode placement, program Posterior Tibial Nerve Stimulation or Sacral Nerve Stimulation S2/3 with its specific electrode placement is recommended. Program 4 Mixed Incontinence (12 min) This program contains components from the program for the treatment of stress and urge incontinence. If, after some time of therapy, the symptoms change into a purely urge or stress incontinence, a switch to the respective program can be executed. The stimulation should be above motoric threshold. Both skin electrodes (self-adhesive electrodes or silicone electrodes) and also a vaginal probe (for men an anal probe) can be used whereby the probes are probably the more effective option. This program is a muscle training. A regular, at the beginning daily application, is therefore recommended. Program 5 Fecal Incontinence (12 min) For treatment of fecal incontinence the anal probe is the method of choice: only if 37

38 schwa-medico Operating Manual - AmpliMove medical incompatibility or existing contra-indications regarding its use are involved, should skin electrodes be used. As an alternative, program Posterior Tibial Nerve Stimulation or Sacral Nerve Stimulation S2/3 with its specific electrode placement can be tried. Treatment should proceed once daily and threshold motoric. Program 6 Pelvic Floor Hypertension (8 min) Both skin electrodes (self-adhesive electrodes or silicone electrodes) and also a vaginal probe (for men an anal probe) can be used whereby the probes are probably the more effective option. The stimulation should be above the motoric threshold. As a rule, treatment on a once daily basis is adequate at the beginning but where discomfort is more serious, stimulation several times a day can be carried out. Program 7 Constipation (8 min) Both skin electrodes (self-adhesive electrodes or silicone electrodes) and also an anal probe can be used. Stimulation should be above the motoric threshold. As a rule, treatment on a once daily basis is adequate at the beginning but if complaints are more serious, stimulation several times a day can be carried out. Program 8 Posterior Tibial Nerve Stimulation (12 min) Stimulation of the N. tibialis post. can be described as non-segmental stimulation afferent fibres of the N. pudendus and is a therapy option for an overactive bladder and also for urge incontinence. And success has also been recorded in respect of fecal incontinence. An electrode is placed on the medial tibia edge, 4 fingers breadth over the tip of the inner malleolus (Acupuncture point MP 6), the other electrode beneath the inner ankle bone in the region of the heel. Correct placement and sufficient intensity will lead to muscular contractions and foot/toe movement. At the beginning, treatment once or twice a day is adequate. Program 9 Sacral Nerve Stimulation S2/3 (12 min) Sacral stimulation can be applied where an overactive bladder, urge and fecal incontinence is involved. The electrodes placement is simple and this program is therefore ideal, similarly as with Posterior Tibial Nerve Stimulation, for children and patients for whom a probe placement is out of the question. It has to do with a sensitive stimulation; slight muscular contractions which occur in sequence 1 are unproblematic. At the beginning, treatment once or twice a day is adequate. Tissue Nutrition Programs Electro-stimulation can have a positive effect on the nutrition of the tissue. The three tissues nutrition programs of the AmpliMove medical differ first and foremost through the modulation frequency. Electrode placement is local, with wound therapy above and below the wound in the healthy area. 38

39 English Program 1 Tissue Nutrition, Combination The combined stimulation with high and low frequency modulation frequencies is the program of first choice. Stimulation in sequence 1 should be above the motoric threshold. Stimulation in sequences 2 and 3 should be above the sensitive threshold. Program 2 Tissue Nutrition, Low Frequency If, in particular with wound therapy, the high frequency sequences of the program Tissue Nutrition, Combination are experienced as intolerable, this program represents an alternative. Blood circulation disorders can be improved as a result of the induced muscular contractions. Stimulation should be above the motoric threshold. Program 3 Tissue Nutrition, High Frequency This program is a sensitive stimulation which is applicable for those cases where the muscular contractions associated with the program Tissue Nutrition, Low Frequency are experienced as disagreeable. Dynamic Programs The dynamic programs operate with a continuous, alternating intensity on both channels and have an effect which is similar to massaging. To develop this effect, both channels are always connected to skin electrodes (self-adhesive or silicone electrodes) and aligned horizontally or vertically to each other in the therapy area. The stimulation can be carried out sensitively or above the motoric threshold. Program 1 Dynamic Stimulation, Slow (15 min) The change in intensity of the channels proceeds more slowly than in the program Dynamic Stimulation, Fast. Please Note: This program can also be used for an alternating, motoric stimulation of agonist and antagonist. This represents the ideal way to promote joint and joint structure mobility and venous reflux. The regular running time of 15 min should be reduced for agonist/antagonist stimulation by a few minutes otherwise the fatigue level can become too great. Program 2 Dynamic Stimulation, Fast (15 min) The change in intensity of the channels proceeds faster than in the program Dynamic Stimulation, Slow. 39

40 schwa-medico Operating Manual - AmpliMove medical 9 General Information Adjustments, Modifications and Repairs The manufacturer is only responsible for the safety and performance of the AmpliMove medical when readjustments, alterations and repairs are carried out by authorized persons and when the AmpliMove medical is used in accordance with the operating instructions. Classification The AmpliMove medical has been designed as a class IIa product in accordance with appendix IX of the Medical Device Directive 93/42/EEC. Reference sheet for battery retraction and disposal In connection with the sales of products which contain batteries or rechargeable batteries, we are obliged by law (battery law 18, section 1) to advise you of the following: The dustbin symbol ( ) marks batteries with hazardous substances as well as the circumstance that batteries must not be disposed of in the household waste but professionally. The chemical term of the hazardous substance is below the dustbin symbol. You are obliged by law to return used batteries. You may render used batteries at municipal collecting points or in local trade. We are also obliged to take back used batteries, whereat our obligation restricts to those which are or were part of our product range. Therefore, you may send back used batteries to us adequately stamped by mail or render these at our warehouse free of charge at the following address: schwa-medico GmbH, Wetzlarer Str , Ehringshausen, Germany Please refer to the following figures to see the respective symbols of batteries with hazardous substances: Battery contains more than % cadmium Battery contains more than % quicksilver Battery contains more than % plumb Warranty Legal right of warranty is applied according to German Civil Code. 40

41 English Guarantee The manufacturer issues a guarantee of 12 months from the date of purchase. The guarantee does not apply in the following cases: Damage due to improper handling Defects the customer is aware of on the date of purchase Damage caused by the customer For wearing parts and consumable supplies like, for instance, battery, cables and electrodes. Maintenance and Cleaning No special cleaning or care agents are required for the AmpliMove medical. Clean the stimulator, the cables and the mains adapter with a soft, lint-free cloth. Please ensure that no moisture permeates the stimulator. If moisture does permeate the stimulator, a technical check must be carried out before re-use. Technical Check We recommend a technical check on the AmpliMove medical every 24 months. This includes: 1. Confirming that user instructions have been included in the accompanying documentation. 2. Checking the equipment for completeness. 3. Visual check:» The type plate, the adhesive label and the inscriptions are complete and readable» For mechanical damage» For damage to all cables, mains adapter, plugs and sockets 4. Functional Safety» Checking the output signals with a load resistance of 500 Ω real current and voltage» Checking the frequency» Checking the modulation depth 5. Measurement after EN 62353:2008» Equipment leakage current» Applied part leakage current These technical checks may only be performed by suitably qualified persons. The results must be documented with the date and name of the person carrying out the check. 41

42 schwa-medico Operating Manual - AmpliMove medical Combination with Original Accessories The AmpliMove medical is a CE marked medical device and may therefore only be used together with the accessories listed in the chapter Accessories of this manual. The manufacturer and dealer cannot guarantee the security of the stimulator if not used with original accessories. 10 Delivery Content Item no. Description Quantity AmpliMove medical Mains Adapter SNT Electrode cable red, 1.5 m Electrode cable blue, 1.5 m Self-adhesive electrodes 5x5 cm (4 pieces) Self-adhesive electrodes 5x9 cm (2 pieces) STIMEX-TEX 1-35, 1 connector Instruction manual 1 Transportation case 1 11 Accessories The AmpliMove medical may only be used together with the accessories referred to in this chapter. The manufacturer cannot guarantee the safety of the AmpliMove medical if it is not used with original accessories. Mains Adapter and Cables Item no. Description Quantity Mains Adapter SNT Electrode cable red, 1.5 m Electrode cable blue, 1.5 m Electrode cable red, 2.5 m Electrode cable blue, 2.5 m 1 STIMEX Self-Adhesive Electrodes Technical Data: Compound: conductive and bonding material Manufacturer: Pierenkemper GmbH, Germany 42

43 English Application: Place self-adhesive electrodes directly on the appropriate skin treatment area, no special preparation of electrodes is necessary. See Electrode Maintenance below to ensure the electrode s effectiveness. Do not apply on broken skin! Electrode maintenance: For hygienic reasons, self-adhering electrodes are for single patient use only. After every treatment session return electrodes to their original foil and store them in their plastic bag. To increase longevity, store the STIMEX electrodes in a cool area (e.g. refrigerator). Item no. Description Quantity STIMEX, round 32 mm STIMEX, round 50 mm STIMEX, 32 x 32 mm STIMEX, 50 x 50 mm STIMEX, 50 x 90 mm STIMEX, 50 x 130 mm STIMEX, 80 x 130 mm STIMEX, 30 x 65 mm STIMEX, 90 x 150 mm 2 Silicone Electrodes (To be used with contact gel) Technical Data: Compound: silicone-carbon Manufacturer: Pierenkemper GmbH, Germany Application: Spread 2-3 drops of schwa-medico electrode gel over the flat side of the electrode. The electrode gel acts as a conductor for the electrode. Place the electrode on the relevant skin area and secure the electrode with a tape strip. Do not apply to open wounds! Because conductivity of the electrodes slowly decreases after approx. 6 months of use, replace electrodes after approx. 12 months of intensive use. Cleaning: Clean electrode surface with water and soap or an appropriate disinfectant (e. g. alcohol 90%) after every use. Item no. Description Quantity mm round x 45 mm x 48 mm x 68 mm x 65 mm 2 43

44 schwa-medico Operating Manual - AmpliMove medical STIMEX-TEX Stimulation Sleeves Instruction: Moisten the inner side of STIMEX-TEX before every utilisation. Connect the STIMEX-TEX with the cable of the AmpliMove medical. Slip the STIMEX-TEX over the arm, elbow, foot, leg or knee. Do not apply STIMEX-TEX on wounds. Maintenance and cleaning: Air-dry the STIMEX-TEX after every utilisation (not above a radiator). STIMEX-TEX may be washed by hand with cold water. Item no. Description Quantity STIMEX-TEX 1-20, 1 connector (approx cm circumference) STIMEX-TEX 1-30, 1 connector (approx cm circumference ) STIMEX-TEX 1-35, 1 connector (approx cm circumference ) STIMEX-TEX 2-20, Elbow 2 connectors (approx cm circumference) STIMEX-TEX 2-35, Knee 2 connector (approx cm circumference) 2 44