Amrex. SynchroSonic U/HVG50 * User's Guide. electrotherapy equipment a division of Amrex-Zetron, Inc.

Transcription

1 SynchroSonic U/HVG50 * User's Guide Amrex electrotherapy equipment a division of Amrex-Zetron, Inc. *Federal law (USA) restricts this device to sale by or on the order of a licensed practitioner licensed by the law of the state in which he practices to use or order the use of this device.

2 SynchroSonic U/HVG50 User's Guide Revised January 1999 Copyright Amrex-Zetron, Inc All rights reserved. Printed in the United States of America The following are registered or trademarked by Amrex: Amrex SynchroSonic QuickConnect Flextrode AMREX electrotherapy equipment a division of Amrex-Zetron, Inc. 641 East Walnut Street Carson, California (310) Toll Free Customer Service (800) Fax (310) amrex@amrex-zetron.com Web Site:

3 Thank you... for selecting the Amrex SynchroSonic U/HVG50. We believe that you will find this instrument to be versatile, dependable and user friendly. The SynchroSonic U/HVG50 provides three widely used therapeutic modalities: Low Voltage Galvanic, High Voltage Pulsed D.C. Stimulation and Ultrasound. Each modality may be applied separately or the Ultrasound may be combined with either Low Voltage Galvanic or High Voltage Pulsed D.C. Stimulation simultaneously through the ultrasound transducer. Your SynchroSonic U/HVG50 has been manufactured by a group of dedicated, highly trained employees who exemplify the sixty year Amrex tradition of manufacturing therapeutic equipment of the highest quality while supporting you with prompt, courteous customer service. Upon receipt of your SynchroSonic U/HVG50, verify your accessories against the enclosed check list. Promptly return the postage paid Registration Card to Amrex. Save the original shipping carton and all packing materials. Please carefully review this User s Guide prior to operating the SynchroSonic U/HVG50. Should you have questions regarding your new purchase, or need assistance, telephone Amrex Technical Services at (800) i

4 Limited Warranty Amrex-Zetron, Inc. (Manufacturer) warrants each instrument it manufactures to be free from defects in material and workmanship under normal use and service for a period of two (2) years from the date of purchase. This two year warranty extends only to the original purchaser and shall not apply to batteries, fuses, accessories or any instrument which has been subjected to misuse, neglect, accident or abnormal conditions of operation. There is a one (1) year warranty on the ultrasound transducer and cable. The Manufacturer's obligation under this warranty is limited to repairing or replacing, at the Manufacturer's option, any instrument returned to the factory within two (2) years from the date of purchase. If the Manufacturer determines that the product fails to conform to this warranty due to misuse, alteration or abnormal condition of operation, including evidence that nonauthorized personnel have attempted to repair the device, the instrument will be repaired at customers expense. This warranty is exclusive and in lieu of all other warranties, expressed or implied, including but not limited to any other warranty of merchantability or fitness for any particular purpose. Manufacturer shall not be liable for any special, incidental or consequential damages, whether in contract, tort or otherwise. Service and Shipping Information Amrex Technical Services has a representative to assist you should your equipment require service or repair. It is necessary to obtain a Return Merchandise Authorization (RMA) number before returning equipment to the factory for warranty repair. Call our representative toll free (800) Damage, resulting from repairs made outside the factory, is not covered under the warranty. To maintain compliance with FDA, 21 CFR Performance Standards, your Amrex ultrasound must be calibrated and safety tested on an annual basis. Amrex strongly recommends that servicing be referred to the factory. Call toll free (800) Save the original shipping carton and all packing materials to safely return Amrex equipment to the factory for service; repair; annual calibration, electrical and mechanical safety check. All accessories, including the ac line cord, must be included with the returned instrument. The customer is responsible for all freight charges. The Manufacturer shall assume NO responsibility for damage in transit. ii

5 Contraindications Warnings Precautions THIS INSTRUMENT OPERATES ON 120 VOLTS AC, 60 Hz. (unless otherwise indicated on the unit) AND MUST BE PROPERLY GROUNDED FOR SAFETY. The three wire power cord with "hospital grade" plug should be connected to a GROUNDED AC wall receptacle. It is the personal responsibility and obligation of the user to insure that this instrument is properly connected to the AC POWER source before use. Warning Risk of burns and fire. DO NOT use near conductive material such as metal bed parts or innerspring mattresses. Renew electrode cables upon evidence of deterioration. Use of controls, adjustment, or performance of procedures, other than those specified herein, may result in hazardous exposure to ultrasonic and/or electrical energy. Important Intensity Reset Circuit: The Low Voltage Galvanic and the High Voltage Pulsed D.C. modalities incorporate a safety reset function as part of the intensity control. This is to prevent any sudden or inadvertent stimulation output to the patient in the event that: The modality intensity control(s) are not set to the 0/Reset position at power on. The ac power is interrupted. The patient Treatment Stop switch is activated. The treatment period has ended. The modality intensity control(s) must be returned to the 0/Reset position before stimulation output can be activated. Note: When the Low Voltage Galvanic Intensity control is returned to the Reset/0 position it will enable an audible "click". Patient "Treatment Stop" Switch: When the patient "Treatment Stop" switch is activated, Low Voltage Galvanic output and/or High Voltage Pulsed D.C. Stimulator output will be discontinued immediately. The LVG Reset Intensity indicator light and/or HVS Reset Intensity indicator light will illuminate. Low Voltage Galvanic and/or High Voltage Pulsed D.C. Stimulator output cannot be resumed until the Low Voltage Galvanic Intensity control and/or High Voltage Pulsed D.C. Stimulator Intensity control are returned to the 0/Reset position which will turn off the LVG Reset Intensity indicator light and/or HVS Reset Intensity indicator light. NOW the Low Voltage Galvanic output and/or High Voltage Pulsed D.C. Stimulator output can be activated. Note: When the Low Voltage Galvanic Intensity control is returned to the 0/Reset position it will enable an audible "click". iii

6 Ultrasound Contraindications Ultrasound should not be used in the following areas: transcerebrally; near the heart or reproductive organs; over viscera, eyes, ears, the spinal column, malignancies, the joint capsule in arthritic conditions either acute or subacute, or over total joint replacements. Ultrasound should not be used in cases of: cardiac pacemakers, pregnancy, implants, malignant or benign tumors, multiple sclerosis, arteriosclerosis or weakened blood vessels, hemophilia, thrombosis and thrombophlebitis either acute or subacute. Neither should ultrasound be used over bone in growing children, where the skin suffers from any sensory impairment, nor in the area of the carotid sinus nerves, visceral plexus or large autonomous ganglion. Ultrasound Precautions Excessive doses of ultrasound can cause damage to tissue. Periosteal pain is an indication of excess intensity. Should this occur, reduce the power and/or move the transducer more quickly over the area being treated. Any bleeding tendency is increased by heating because of the increase in blood flow and vascularity of the heated tissues. Care should be used in treating patients who have bleeding disorders. iv

7 Electrical Muscle Stimulation Contraindications Contraindicated for patients with cardiac demand pacemakers. Should not be used on cancer patients. Electrical Muscle Stimulation Warnings Long term effects of chronic electrical stimulation are unknown. Safety has not been established for the use of electrical muscle stimulation during pregnancy. Adequate precautions should be taken in the case of persons with suspected heart problems. Adequate precautions should be taken in the case of persons with suspected or diagnosed epilepsy. Do not stimulate over the carotid sinus nerves, especially in patients with a known sensitivity to the carotid sinus reflex. Severe spasm of the laryngeal and pharyngeal muscles may occur when the electrodes are positioned over the neck or mouth. The contractions may be strong enough to close the airway or cause difficulty in breathing. Electrical muscle stimulators should not be applied transcerebrally. Electrical muscle stimulators should not be used over swollen, infected or inflamed areas or skin eruptions. Caution should be used in the transthoracic application of electrical muscle stimulators in that the introduction of electrical current into the heart may cause arrhythmias. Electrical muscle stimulators should be kept out of the reach of children. Electrical Muscle Stimulation Precautions Precautions should be observed: When there is a tendency to hemorrhage following acute trauma or fracture. Following recent surgical procedures when muscle contraction may disrupt the healing process. Over the menstruating uterus. Where sensory nerve damage is present by a loss of normal skin sensation. Some patients may experience skin irritation or hypersensitivity due to the electrical stimulation or the conductive medium. The irritation can usually be reduced by use of an alternate conductive medium or alternate electrode placement. Skin irritation and burns beneath the electrodes have been reported with the use of electrical muscle stimulators. v

8 vi

9 Table of Contents Part 1 Overview... 1 Part 2 Power Section... 5 Part 3 Low Voltage Galvanic Modality... 9 Part 4 High Voltage Pulsed D.C. Stimulator Modality Part 5 Ultrasound Modality Part 6 U/HVG50 General Operation and Application Procedures General Operation Ultrasound Modality Application of Ultrasound Adverse Effects - Shortwave Diathermy Interference Ultrasound Indications Ultrasound Contraindications Ultrasound Precautions The Ultrasound Transducer Transducer Cable Fault Alarm System QuickConnect Transducer Cable System (Optional Feature) Dual Transducers (Optional Feature) vii

10 General Operation Low Voltage Galvanic Modality Accessories Low Voltage Galvanic Modality Patient Lead and Pad Electrode Verification Patient Treatment Stop Switch Operation Patient Accessory Identification and Connection Application of Low Voltage Galvanic Current Adverse Effects - Shortwave Diathermy Interference Low Voltage Galvanic Indications Low Voltage Galvanic Contraindications Low Voltage Galvanic Warnings General Operation High Voltage Pulsed D.C. Stimulator Modality Accessories High Voltage Pulsed D.C. Stimulator Modality Patient Lead and Pad Electrode Verification Patient Treatment Stop Switch Operation Patient Accessory Identification and Connection 1 Channel, 1 Pad Patient Accessory Identification and Connection 1 Channel, 2 Pad Patient Accessory Identification and Connection 1 Channel, 1Pad and 1 Channel, 2 Pad Patient Accessory Identification and Connection 1 Channel, 2Pad and 1 Channel, 2 Pad Patient Accessory Identification and Connection 2 Channel, 2 Pad Patient Accessory Identification and Connection 2 Channel, 2 Pad and 2 Channel, 2 Pad Patient Accessory Identification and Connection 1 Probe Electrode Application of Electrical Muscle Stimulation Adverse Effects - Shortwave Diathermy Interference High Voltage Stimulation Indications Electrical Muscle Stimulation Contraindications Electrical Muscle Stimulation Warnings Electrical Muscle Stimulation Precautions U/HVG50 Combination Mode Ultrasound Modality Combined With Low Voltage Galvanic Modality Control Settings and General Operation Patient Accessory Identification and Connection Combination Mode Ultrasound Modality Combined With High Voltage Pulsed D.C. Stimulator Modality Control Settings and General Operation Patient Accessory Identification and Connection Combination Mode viii

11 Appendix A Specifications Input Power Requirements Ultrasonic Generator Applicator (Transducer) Label Abbreviations Instrument Cleaning Instructions Sound Pressure Level Spatial Pattern Electrical Stimulator-High Voltage Electrical Stimulator-Low Voltage Service and Shipping Information Appendix B References Appendix C Notes ix

12 x

13 Overview Part 1 AMREX The layout of the U/HVG50 panel is logically arranged into four major sections. These sections are, from left to right: Power, Low Voltage Galvanic, High Voltage Pulsed D.C. Stimulator and Ultrasound. With the exception of the Power section, each section relates to a specific therapeutic modality. The modalities may be used separately or in certain combinations. U/HVG50 User's Guide 1

14 Part 1 In the illustration below, dashed lines surround each of the U/HVG50's sections. A brief description of each section follows the illustration, and Parts 2 through 5 of this User's Guide contain detailed descriptions. 2 U/HVG50 User's Guide

15 Power Section Overview Use the Power Section to select the treatment modality, activate the main ac power and set the treatment duration. When the treatment is complete the power will shut off and a bell will sound. A patient "Treatment Stop" option is provided. When the patient "Treatment Stop" switch is pressed, the Low Voltage Galvanic modality output and/or High Voltage Pulsed D.C. Stimulator modality output will be discontinued immediately. Low Voltage Galvanic Modality Section Set the intensity and monitor the output of Low Voltage Galvanic current with the controls, instruments and connectors in this section of the panel. Select the Cont mode for continuous D.C. output, Surge mode for surged galvanic output or Alt Polarity Surge mode for alternating polarity surged galvanic output. Use the Low Voltage Galvanic Surge Duration control to regulate the surge or the alternating polarity rate. Check the D.C. output before applying the output current using the Test Load switch. Manually reverse the polarity with the Low Voltage Galvanic Polarity switch. High Voltage Pulsed D.C. Stimulator Modality Section Set the intensity and monitor the output of High Voltage Pulsed D.C. stimulation with the controls, instruments and connectors in this section of the panel. Compensate for intensity differences in treatment sites between Active Pads A and B output jacks using the High Voltage Pulsed D.C. Stimulator Balance control. Regulate the frequency of pulses with the HighVoltage Pulsed D.C. Stimulator Frequency control and select the duration of the surge or reciprocal output with the High Voltage Surge Pulsed D.C. Stimulator Surge Duration control. Apply alternate interrupted output to both Active Pads A and B output jacks or the interrupted output simultaneously with the High Voltage Pulsed D.C. Stimulator Reciprocal/Surge switch. Reverse the polarity between the Active Pads A and B output jacks and the dispersive pad output jack with the High Voltage Pulsed D.C. Stimulator Polarity switch. Activate either the Pad or Probe with the High Voltage Pulsed D.C. Stimulator Pad/Probe switch. Ultrasound Modality Section Set the intensity and monitor the output of Ultrasonic energy with the controls, instruments and connectors in this section of the panel. Select either non-interrupted output or a specific interrupted rate using the Ultrasound Interrupted Output Slide control. Combine Ultrasound energy with Low Voltage Galvanic current using the Combination Mode LV Galvanic Ultrasound switch or High Voltage Pulsed D.C. stimulation using the Combination Mode HV Stimulator Ultrasound switch. U/HVG50 User's Guide 3

16 Part 1 4 U/HVG50 User's Guide

17 Power Section Part 2 AMREX In the illustration below, dashed lines surround the U/HVG50's power section. U/HVG50 User's Guide 5

18 Part 2 The power section of the U/HVG50 panel is depicted below. Items referenced with circled numbers (1 3) are explained on the following page. 6 U/HVG50 User's Guide

19 Power Section 1. POWER/TIMER: Controls the main ac power as well as the timer for treatment. Turn the Power/Timer knob clockwise past the 10 minute mark and then set it to the desired treatment time. The ac power will shut off and a bell will sound when treatment is completed. To initiate early shut off, turn the Power/Timer knob counterclockwise to the Off position. The ac power will shut off and a bell will sound. 2. INTERNAL POWER: (Modality Selections): Controls the secondary ac power for each of the three modality sections: LV Galvanic HV Stimulator Ultrasound The LVG On, HVS On, and Ultrasound On indicator lights (located above the upper left corner of each meter) will independently illuminate when each modality is activated. 3. "TREATMENT STOP" JACK: Provides for connection to patient "Treatment Stop" switch. Note: When the patient "Treatment Stop" switch is activated, Low Voltage Galvanic output and/or High Voltage Pulsed D.C. Stimulator output will be discontinued immediately. The LVG Reset Intensity indicator light and/or HVS Reset Intensity indicator light will illuminate. Low Voltage Galvanic and/or High Voltage Pulsed D.C. Stimulator output cannot be resumed until the Low Voltage Galvanic Intensity control and/or High Voltage Pulsed D.C. Stimulator Intensity control are returned to the 0/Reset position which will turn off the LVG Reset Intensity indicator light and/or HVS Reset Intensity indicator light. NOW the Low Voltage Galvanic output and/or High Voltage Pulsed D.C. Stimulator output can be activated. Note: When the Low Voltage Galvanic Intensity control is returned to the 0/Reset position it will enable an audible "click". U/HVG50 User's Guide 7

20 Part 2 8 U/HVG50 User's Guide

21 Low Voltage Galvanic Modality Part 3 AMREX In the illustration below, dashed lines surround the U/HVG50's low voltage galvanic section. U/HVG50 User's Guide 9

22 Part 3 The low voltage galvanic section of the U/HVG50 panel is depicted below. Items referenced with circled numbers (4 8 ) are explained on the following page. 10 U/HVG50 User's Guide

23 Low Voltage Galvanic Modality 4. LOW VOLTAGE GALVANIC METER: Output current for the Low Voltage Galvanic modality is displayed on the meter dial in dc milliamperes from 0 to 10. The meter is the guide to dc dosage. The generally accepted safe guideline is 1 milliampere per square inch of electrode surface. 5. LVG ON INDICATOR LIGHT: When illuminated indicates the Low Voltage Galvanic modality is enabled, provided the Power/Timer switch is activated and the Internal Power LV Galvanic switch is depressed. 6. LVG RESET INTENS ITY INDICATOR LIGHT: When illuminated indicates LVG Reset Intensity circuit is activated. 7. LOW VOLTAGE GALVANIC INTENSITY CONTROL: Regulates output current from 0 to 10 dc milliamperes as displayed on the meter dial. The Low Voltage Galvanic Intensity control has a reset circuit feature. Once the power has been interrupted or turned off, or the patient "Treatment Stop" switch activated, or the treatment period has been completed and the bell has sounded, the LVG Reset Intensity indicator light (located above the upper right corner of the Low Voltage Galvanic meter) will illuminate when power is restored. The Low Voltage Galvanic Intensity control must be returned to the 0/Reset position enabling the audible "click" which will turn off the LVG Reset Intensity indicator light. NOW the dc output current can be activated. Note: When the patient "Treatment Stop" switch is activated, Low Voltage Galvanic output and/or High Voltage Pulsed D.C. Stimulator output will be discontinued immediately. The LVG Reset Intensity indicator light and/or HVS Reset Intensity indicator light will illuminate. Low Voltage Galvanic and/or High Voltage Pulsed D.C. Stimulator output cannot be resumed until the Low Voltage Galvanic Intensity control and/or High Voltage Pulsed D.C.Stimulator Intensity control are returned to the 0/Reset position which will turn off the LVG Reset Intensity indicator light and/or HVS Reset Intensity indicator light. NOW the Low Voltage Galvanic output and/or High Voltage Pulsed D.C. Stimulator output can be activated. Note: When the Low Voltage Galvanic Intensity control is returned to the 0/Reset position it will enable an audible "click". WARNING The Low Voltage Galvanic Intensity control should always be increased gradually to avoid burns or trauma to tissue. 8. LOW VOLTAGE GALVANIC SURGE DURATION CONTROL: Regulates the surge duration or alternating polarity surge duration from Min (3.33 seconds on, 3.33 seconds off) to Max (0.50 seconds on, 0.50 seconds off). The surge duration or alternating polarity surge duration is reflected on the Low Voltage Galvanic meter dial. The Low Voltage Galvanic Surge Duration control is disabled during treatment in the Cont Mode. U/HVG50 User's Guide 11

24 Part 3 The low voltage galvanic section of the U/HVG50 panel is depicted below. Item referenced with circled number (9) is explained on the following page. 12 U/HVG50 User's Guide

25 Low Voltage Galvanic Modality 9. LOW VOLTAGE GALVANIC OUTPUT MODE CONTROL: Rotate the control to the desired selection: Cont Continuous dc output is reflected on the Low Voltage Galvanic meter dial. Normal or Reverse polarity may be selected by depressing the Low Voltage Galvanic Polarity switch. Surge When the Low Voltage Galvanic Surge Mode is selected, the Low Voltage Galvanic output surges from the Galvanic Output jacks and the Low Voltage Galvanic meter dial will reflect the output cycle. The output cycle may be set by the Low Voltage Galvanic Surge Duration control. Normal or Reverse polarity may be selected by depressing the Low Voltage Galvanic Polarity switch. Alt Polarity Surge When the Low Voltage Galvanic Alt Polarity Surge Mode is selected, the Low Voltage Galvanic output surges from the Galvanic Output jacks and reverves polarity with each cycle. The Low Voltage Galvanic meter dial will reflect the output cycle. The output cycle may be set by the Low Voltage Galvanic Surge Duration control. The Low Voltage Galvanic Polarity switch is disabled during treatment in the Alt Polarity Surge Mode. U/HVG50 User's Guide 13

26 Part 3 The low voltage galvanic section of the U/HVG50 panel is depicted below. Items referenced with circled numbers (10 14) are explained on the following page. 14 U/HVG50 User's Guide

27 Low Voltage Galvanic Modality 10. REVERSE POLARITY INDICATOR LIGHT: When illuminated, indicates positive polarity. Low Voltage Galvanic Mode: The Black Galvanic Output jack is positive when Reverse polarity indicator light is illuminated. Combination Mode LV Galvanic / Ultrasound: The Ultrasound transducer faceplate is positive when Reverse polarity indicator light is illuminated. The black Galvanic Output jack is disabled. 11. GALVANIC OUTPUT JACKS: Red on the left; black on the right. 12. NORMAL POLARITY INDICATOR LIGHT: When illuminated, indicates positive polarity for the red Galvanic Output jack. 13. LOW VOLTAGE GALVANIC POLARITY SWITCH: (Momentary) Selects a Normal or Reverse polarity at the Galvanic Output jacks. Polarity is indicated by the Normal or Reverse polarity indicator light located above the Galvanic Output jacks. The Low Voltage Galvanic Polarity switch is disabled during treatment in the Alt Polarity Surge Mode. Note: Electron flow is from negative electrode to positive electrode. 14. TEST LOAD SWITCH: (Momentary) Allows the operator to verify the Low Voltage Galvanic Intensity control setting by displaying the dc output on the Low Voltage Galvanic meter dial. Verification of Patient Leads and Pad Electrodes: Depress the Test Load switch and adjust the Low Voltage Galvanic Intensity control until dc output indicates five milliamperes on the Low Voltage Galvanic meter dial. Release the Test Load switch and make no further adjustments to the Low Voltage Galvanic Intensity control. Place the patient pad electrodes active faces in full contact with each other and observe the output current displayed on the Low Voltage Galvanic meter dial. If the output current from the patient leads and pad electrodes is less than five milliamperes, replacement is indicated. Note: A very generous amount of Flextrode Conductive Spray or Amrex Conductance and Coupling Gel is needed to insure good conductivity. For iontophoresis, thoroughly moisten the pads only with FDA approved iontophoretic substances. U/HVG50 User's Guide 15

28 Part 3 16 U/HVG50 User's Guide

29 Part 4 AMREX High Voltage Pulsed D.C. Stimulator Modality In the illustration below, dashed lines surround the U/HVG50's high voltage pulsed d.c. stimulator section. U/HVG50 User's Guide 17

30 Part 4 The high voltage pulsed d.c. stimulator section of the U/HVG50 panel is depicted below. Items referenced with circled numbers (15 19) are explained on the following page. 18 U/HVG50 User's Guide

31 High Voltage Pulsed D.C. Stimulator Modality 15. HIGH VOLTAGE PULSED D.C. STIMULATOR METER: Output voltage for the High Voltage Pulsed D.C. Stimulator modality is displayed on the meter dial in peak volts from 0 to 500. The meter may be used for reference settings. 16. HVS ON INDICATOR LIGHT: When illuminated indicates the High Voltage Pulsed D.C. Stimulator modality is enabled, provided the Power/Timer switch is activated and the Internal Power HV Stimulator switch is depressed. 17. HVS RESET INTENSITY INDICATOR LIGHT: When illuminated indicates HVS Reset Intensity circuit is activated. 18. HIGH VOLTAGE PULSED D.C. STIMULATOR INTENSITY CONTROL: Regulates the output from 0 to 500 peak volts as displayed on the meter dial. The High Voltage Pulsed D.C. Stimulator Intensity control has a reset circuit feature. Once the power has been interrupted or turned off, or the patient "Treatment Stop" switch activated, or the treatment period has been completed and the bell has sounded, the HVS Reset Intensity indicator light (located above the upper right corner of the High Voltage Pulsed D.C. Stimulator meter) will illuminate when power is restored. The High Voltage Pulsed D.C. Stimulator Intensity control must be returned to the 0/Reset position which will turn off the HVS Reset Intensity indicator light. NOW the High Voltage Pulsed D.C. Stimulator output can be activated. Note: When the patient "Treatment Stop" switch is activated, Low Voltage Galvanic output and/or High Voltage Pulsed D.C. Stimulator output will be discontinued immediately. The LVG Reset Intensity indicator light and/or HVS Reset Intensity indicator light will illuminate. Low Voltage Galvanic and/or High Voltage Pulsed D.C. Stimulator output cannot be resumed until the Low Voltage Galvanic Intensity control and/or High Voltage Pulsed D.C. Stimulator Intensity control are returned to the 0/Reset position which will turn off the LVG Reset Intensity indicator light and/or HVS Reset Intensity indicator light. NOW the Low Voltage Galvanic output and/or High Voltage Pulsed D.C. Stimulator output can be activated. Note: When the Low Voltage Galvanic Intensity control is returned to the 0/Reset position it will enable an audible "click". 19. HIGH VOLTAGE PULSED D.C. STIMULATOR BALANCE CONTROL: Allows the operator to compensate for intensity differences between the Active Pads A output jacks and Active Pads B output jacks. When set at the Normal position, the intensity is equal on Active Pads A output jacks and Active Pads B output jacks. As the Balance control is rotated from Normal position towards A Min the intensity will be decreased for the Active Pads A output jacks or as the Balance control is rotated from Normal position towards B Min the intensity will be decreased for the Active Pads B output jacks. U/HVG50 User's Guide 19

32 Part 4 The high voltage pulsed d.c. stimulator section of the U/HVG50 panel is depicted below. Items referenced with circled numbers (20 27) are explained on the following page. 20 U/HVG50 User's Guide

33 High Voltage Pulsed D.C. Stimulator Modality 20. HIGH VOLTAGE PULSED D.C. STIMULATOR SURGE DURATION CONTROL: Provides a selection of Cont (continuous) or 2.5, 5 and 10 Sec (second) on/off intervals of high voltage pulsed d.c. stimulation output. Rotate the control to the desired selection. When High Voltage Pulsed D.C. Stimulator Surge Duration control is set at Cont (continuous), the Recip / Surge Output Mode switch is disabled. 21. FREQUENCY CONTROL: Provides a frequency selection range from 1 to 160 pulses per second. Rotate the control to the desired selection. 22. PROBE ON INDICATOR LIGHT: When illuminated, reflects the High Voltage Pulsed D.C. Stimulator output frequency and the surge rate for High Voltage Pulsed D.C. Stimulator Probe Mode or Combination Mode HV Stimulator / Ultrasound. High Voltage Pulsed D.C. Stimulator Probe Mode: When the Pad / Probe Output Mode switch is set to the Probe (down) position, the illuminated Probe On Indicator Light reflects the High Voltage Pulsed D.C. Stimulator output frequency and the surge rate for the Probe output jack. Combination Mode HV Stimulator / Ultrasound: When the Combination Mode HV Stimulator / Ultrasound switch is set to the down (on) position, the illuminated Probe On Indicator Light reflects the High Voltage Pulsed D.C. Stimulator output frequency and the surge rate for the transducer faceplate. The Probe output jack is disabled. 23. PROBE OUTPUT JACK: Probe output jack is black. Probe Application: Requires a probe to the Probe output jack and one pad electrode to the Dispersive Pad jack. 24. OUTPUT RATE B INDICATOR LIGHT: Reflects the output frequency and the surge or reciprocal rate of the Active Pads B output jacks. 25. ACTIVE PADS B OUTPUT JACKS: Active Pads B output jacks are black. 26. ACTIVE PADS A OUTPUT JACKS: Active Pads A output jacks are black. 27. OUTPUT RATE A INDICATOR LIGHT: Reflects the output frequency and the surge or reciprocal rate of the Active Pads A output jacks. U/HVG50 User's Guide 21

34 Part 4 The high voltage pulsed d.c. stimulator section of the U/HVG50 panel is depicted below. Items referenced with circled numbers (28 29) are explained on the following page. 22 U/HVG50 User's Guide

35 High Voltage Pulsed D.C. Stimulator Modality 28. DISPERSIVE PAD OUTPUT JACK: Dispersive Pad output jack is white. The Dispersive Pad output jack is active with ground when the Combination Mode HV Stimulator / Ultrasound switch is activated. The total surface area of the dispersive sponge pad electrode must be at least twice the combined total surface area of the pad electrodes connected to the Active Pads A and/or B output jacks. Important: A dispersive sponge pad electrode must be used with all active pad applications. One Active Pad Application: Single Channel requires one pad electrode to any one of the Active Pads A or B output jacks. Two Active Pad Application: Single Channel requires a pair of pad electrodes to the Active Pads A output jacks (A+A) or a pair of pad electrodes to the Active Pads B output jacks (B+B). Dual Channel requires a pair of pad electrodes to either Active Pads A output jack and to either Active Pads B output jack (A+B). Three Active Pad Application: Dual Channel requires one pad electrode to either Active Pads A output jack and a pair of pad electrodes to the Active Pads B output jacks (B+B). Four Active Pad Application: Single Channel Dual Pad requires a pair of pad electrodes to the Active Pads A output jacks (A+A) and another pair of pad electrodes to the Active Pads B output jacks (B+B). Dual Channel Dual Pad requires a pair of pad electrodes to an Active Pads A output jack and Active Pads B output jack (A+B) and another pair of pad electrodes to an Active Pads A output jack and Active Pads B output jack (A+B). Note: A dispersive sponge pad electrode must be used in addition to the active pads, probe, or transducer faceplate for all U/HVG50 High Voltage Pulsed D.C. Stimulator applications including Combination Mode HV Stimulator/ Ultrasound. 29. PAD / PROBE OUTPUT MODE SWITCH: Provides a selection of either Pad or Probe output mode. When the Pad/Probe Output Mode switch is set to the Pad (up) position, the Active Pads output jacks are enabled and the output rate A and B indicator lights will illuminate. When the Pad/Probe Output Mode switch is set to the Probe (down) position, the Probe output jack is enabled for continuous or surge output regardless of the Recip / Surge Output Mode switch setting and the Probe On indicator light will illuminate. Note: The Pad/Probe Output Mode switch is disabled when the Combination Mode HV Stimulator / Ultrasound switch is depressed to the down (on) position. U/HVG50 User's Guide 23

36 Part 4 The high voltage pulsed d.c. stimulator section of the U/HVG50 panel is depicted below. Item referenced with circled number (30) is explained on the following page. 24 U/HVG50 User's Guide

37 High Voltage Pulsed D.C. Stimulator Modality 30. HIGH VOLTAGE PULSED D.C. STIMULATOR POLARITY MODE SWITCH: Provides for the polarity between the Active Pads output jacks or the Probe output jack and the Dispersive Pad output jack to be reversed. When the High Voltage Pulsed D.C. Stimulator Polarity Mode switch is set to the + (up) position, the Dispersive Pad output jack is positive. When the High Voltage Pulsed D.C. Stimulator Polarity Mode switch is set to the - (down) position the Dispersive Pad output jack is negative. U/HVG50 User's Guide 25

38 Part 4 The high voltage pulsed d.c. stimulator section of the U/HVG50 panel is depicted below. Item referenced with circled number (31) is explained on the following pages. 26 U/HVG50 User's Guide

39 High Voltage Pulsed D.C. Stimulator Modality 31. RECIP / SURGE OUTPUT MODE SWITCH: Provides a selection of either Recip (reciprocal) or Surge output mode. The Recip (reciprocal) or Surge output modes may be changed during treatment. Recip (reciprocal) Output Mode: Pad Output Mode: When the Recip / Surge Output Mode switch is set to the Recip (up) position, the High Voltage Pulsed D.C. Stimulator output cycle alternates from the Active Pads A output jacks to the Active Pads B output jacks and the output rate A and B indicator lights will reflect the output cycle. The reciprocal cycle may be set by the High Voltage Pulsed D.C. Stimulator Surge Duration control. Probe Output Mode: When the Recip / Surge Output Mode switch is set to the Recip (up) position, or the Surge (down) position, the High Voltage Pulsed D.C. Stimulator output cycle surges from the Probe output jack and the Probe On indicator will reflect the output cycle. The surge cycle may be set by the High Voltage Pulsed D.C. Stimulator Surge Duration control. Note: The Recip / Surge Output Mode switch is disabled when the High Voltage Pulsed D.C. Stimulator Surge Duration control is set at the Cont (continuous) position. U/HVG50 User's Guide 27

40 Part 4 The high voltage pulsed d.c. stimulator section of the U/HVG50 panel is depicted below. Item referenced with circled number (31) is explained on the previous and following page. 28 U/HVG50 User's Guide

41 High Voltage Pulsed D.C. Stimulator Modality 31. CONTINUED --- RECIP / SURGE OUTPUT MODE SWITCH: Provides a selection of either Recip (reciprocal) or Surge output mode. The Recip (reciprocal) or Surge output modes may be changed during treatment. Surge Output Mode: Pad Output Mode: When the Recip / Surge Output Mode switch is set to the Surge (down) position, the High Voltage Pulsed D.C. Stimulator output cycle surges simultaneously from all of the Active Pads output jacks and the output rate A and B indicator lights will reflect the output cycle. The surge cycle may be set by the High Voltage Pulsed D.C. Stimulator Surge Duration control. Probe Output Mode: When the Recip / Surge Output Mode switch is set to the Recip (up) position, or the Surge (down) position, the High Voltage Pulsed D.C. Stimulator output cycle surges from the Probe output jack and the Probe On indicator will reflect the output cycle. The surge cycle may be set by the High Voltage Pulsed D.C. Stimulator Surge Duration control. Note: The Recip / Surge Output Mode switch is disabled when the High Voltage Pulsed D.C. Stimulator Surge Duration control is set at the Cont (continuous) position. U/HVG50 User's Guide 29

42 Part 4 30 U/HVG50 User's Guide

43 Part 5 AMREX Ultrasound Modality In the illustration below, dashed lines surround the U/HVG50's ultrasound section. U/HVG50 User's Guide 31

44 Part 5 The ultrasound section of the U/HVG50 panel is depicted below. Items referenced with circled numbers (32 38) are explained on the following page. 32 U/HVG50 User's Guide

45 Ultrasound Modality 32. ULTRASOUND METER: Consists of four scales: Average Power Watts Average Intensity Watts/CM² Peak Power Watts Peak Intensity Watts/CM² Refers to the total watts applied to the patient. Has a range of 0 to 20 watts. Refers to the power density or watts per square centimeter. Has a range of 0 to 5 watts/cm². Refers to output at 120 Hz amplitude modulated. Refers to the power density or watts per square centimeter at 120 Hz amplitude modulated. 33. ULTRASOUND ON INDICATOR LIGHT: When illuminated indicates the Ultrasound modality is enabled, provided the Power/Timer switch is activated and the Internal Power Ultrasound switch is depressed. 34. COMBINATION MODE INDICATOR LIGHT: When illuminated indicates the Combination Mode LV Galvanic / Ultrasound or HV Stimulator / Ultrasound modality is enabled, provided the Power/Timer switch is activated, Internal Power Ultrasound switch is depressed and the Internal Power LV Galvanic switch or Internal Power HV Stimulator switch is depressed. 35. INTERRUPT ON INDICATOR LIGHT: When illuminated indicates either the Interrupted Output mode is enabled or the Transducer Cable Fault Alarm System is activated. 36. ULTRASOUND TRANSDUCER: Connects to the Ultrasound Output transducer connector. Amrex recommends that the transducer and generator be calibrated on an annual basis. Note: Always return the Ultrasound Intensity control to "0" when the transducer is not in contact with the patient to avoid serious damage to the transducer crystal and the ultrasound generator. Note: Only Use The Transducer(s) Assigned To This Generator. Transducer serial number is located on the Transducer and on the Generator Label. 37. ULTRASOUND TRANSDUCER CRADLE: Provides storage for the transducer. A velcro strap is included to secure the transducer to the cradle. 38. TRANSDUCER PROTECTION SWITCH: When the transducer is placed in the cradle, the ultrasonic energy will automatically shut off AND when the transducer is removed from the cradle, the ultrasonic energy will resume IF: the Ultrasound Intensity control is not set at the "0" position, the treatment period has not been completed and the bell has not sounded. U/HVG50 User's Guide 33

46 Part 5 The ultrasound section of the U/HVG50 panel is depicted below. Items referenced with circled numbers (39 41) are explained on the following page. 34 U/HVG50 User's Guide

47 Ultrasound Modality 39. ULTRASOUND INTENSITY CONTROL: Regulates output from 0 to Max as displayed on the Ultrasound Meter dial. Note: Always return the Ultrasound Intensity control to "0" when the transducer is not in contact with the patient to avoid serious damage to the transducer crystal and the ultrasound generator. 40. ULTRASOUND INTERRUPTED OUTPUT SLIDE CONTROL: Provides a variable selection of interrupted output. When the slide switch is in the Off position, the output will be non-interrupted. As the control is moved to the right, the Interrupt On indicator light (located above the upper right corner of the ultrasound meter) will illuminate and the interrupted rate will increase. The approximate duration is 3½ to 1½ second intervals, 50% duty cycle. When the control is returned to the Off position, the Interrupt On indicator light will turn off and the interrupted rate will stop. ULTRASOUND WAVEFORM AMPLITUDE MODULATED AT 120 Hz. NON-INTERRUPTED ULTRASOUND OUTPUT INTERRUPTED ULTRASOUND OUTPUT ( 50 PERCENT DUTY CYCLE ) ON 0 T TIME ON OFF 0 T TIME 41. ULTRASOUND OUTPUT TRANSDUCER CONNECTOR: Provides for connection to an Amrex Ultrasound Transducer. The Tranducer Cable Fault Alarm System detects improper transducer cable connection and/or transducer cable damage. If a transducer cable is improperly connected or damaged, an audible signal will be emitted from the generator, the "Interrupt On" light will illuminate and the ultrasound meter will display "0" output. Ultrasound output will cease until the transducer cable is properly connected to the generator or, if damaged, replaced. U/HVG50 User's Guide 35

48 Part 5 The ultrasound section of the U/HVG50 panel is depicted below. Items referenced with circled numbers (42 44) are explained on the following page. 36 U/HVG50 User's Guide

49 Ultrasound Modality 42. COMBINATION MODE HV STIMULATOR / ULTRASOUND SWITCH: Provides for high voltage pulsed dc stimulation and ultrasound to be applied simultaneously through the ultrasound transducer. When the Combination Mode HV Stimulator / Ultrasound switch is activated: The Dispersive Pad jack is active with ground. The Probe On indicator light reflects the High Voltage Pulsed D.C. Stimulator output frequency and surge rate for the transducer faceplate. The Pad / Probe Output Mode switch is disabled. The Probe output jack is disabled. The Recip / Surge Output Mode switch is set to the Recip (up) position, or the Surge (down) position, the High Voltage Pulsed D.C. Stimulator output cycle surges from the transducer faceplate. The Recip / Surge Output Mode switch is disabled when the High Voltage Pulsed D.C. Stimulator Surge Duration control is set at the Cont (continuous) position. The total surface area of the dispersive pad must be at least twice the total surface area of the transducer faceplate. 43. COMBINATION MODE LV GALVANIC / ULTRASOUND SWITCH: Provides for low voltage galvanic current and ultrasound to be applied simultaneously through the ultrasound transducer faceplate. When Combination Mode LV Galvanic Ultrasound switch is activated. The red Galvanic Output jack is active with ground. The Ultrasound transducer faceplate is positive when Reverse polarity indicator light is illuminated. The black Galvanic Output jack is disabled. The Low Voltage Galvanic Surge Duration control is disabled when the Low Voltage Galvanic Output Mode control is set at Cont Mode. 44. COMBINATION MODE OFF SWITCH: In the Off position, only ultrasonic energy is obtained through the transducer even though the Low Voltage Galvanic modality section and/or the High Voltage Pulsed D.C. Stimulator modality section may still be active. U/HVG50 User's Guide 37

50 Part 5 38 U/HVG50 User's Guide

51 U/HVG50 General Operation and Application Procedures Part 6 AMREX General Operation Ultrasound Modality 1. Connect the U/HVG50's ac power cord to the U/HVG50's ac receptacle and plug the "Hospital Grade" connector to a properly grounded 120 Vac, 60 Hz receptacle. 2. Set all three Internal Power switches (LV Galvanic, HV Stimulator and Ultrasound) to the up (off) position. 3. Connect the assigned ultrasound transducer to the generator's Ultrasound Output transducer connector and place the handle in the transducer cradle. 4. Reduce the Ultrasound Intensity control to "0". 5. Set the Ultrasound Interrupted Output slide control to the Off position. 6. Set the Combination Mode Off switch to the down (off) position. 7. Prepare a contact medium at and around the treatment site with a liberal coating of Amrex Conductance and Coupling Gel. 8. Turn the Power/Timer knob and set it to the desired treatment time. Note: When the treatment time is less than ten (10) minutes, turn the Power/ Timer knob clockwise past the ten (10) minute mark and then set it back to the desired time. Allow one (1) minute for the ultrasound modality to warm-up. 9. Depress the Internal Power Ultrasound switch to the on (down) position. The Ultrasound On indicator light (located above the upper left corner of the ultrasound meter) will illuminate. 10. Verify that the Ultrasound Intensity control is set at the "0" position before removing the transducer from the cradle and placing the transducer faceplate on the prepared treatment site. U/HVG50 User's Guide 39

52 Part Slowly increase the Ultrasound Intensity control to the desired output level as indicated on the ultrasound meter dial. If desired, adjust the Ultrasound Interrupted Output slide control now. When the Ultrasound Interrupted Output slide control is adjusted, the Interrupt On indicator light (located above the upper right corner of the ultrasound meter) will illuminate and the Ultrasound Meter indicator will rise and fall indicating interrupted cycles provided the transducer is not in the ultrasound cradle. 12. When treatment is completed, the ac power will shut off and a bell will sound. To initiate early shut off, turn the Power/Timer knob counterclockwise to the Off position. The ac power will shut off and a bell will sound. Reduce the Ultrasound Intensity control to "0" position and thoroughly clean the transducer faceplate before placing the transducer in the transducer cradle. 40 U/HVG50 User's Guide

53 Application of Ultrasound U/HVG50 General Operation and Application Procedures Therapeutic ultrasound provides for increased cell permeability as well as micro-massage. Analgesic and thermal effects occur when ultrasound is applied to the nerve root and primary treatment site. Ultrasonic energy is transmitted by means of an applicator, or transducer, applied directly to the skin. Since ultrasonic energy will not be efficiently transmitted through air, a conducting medium (water or gel) must be used between the transducer and skin tissue. Amrex Conductance and Coupling Gel is recommended. This gel is excellent for ultrasonic energy transmission as well as conductance for application of electrical muscle stimulation.the Amrex transducer utilizes a polished aluminum faceplate. Coupling agents other than Amrex Conductance and Coupling Gel may cause a discoloration or "pitting" of the aluminum. Apply a generous amount of gel to the area being treated. Place the transducer in contact with the skin surface BEFORE increasing the output intensity. Move the transducer in a slow, rotary or stroking motion. If the area to be treated is an irregular surface that does not allow proper soundhead contact, the AMREX transducer may be utilized for underwater therapy. Immerse the area to be treated and the transducer maintaining approximately one inch distance between the area being treated and the faceplate. To insure proper transmission of ultrasonic energy, brush away air bubbles if they appear on the soundhead's faceplate. At the conclusion of the treatment, thoroughly clean the transducer faceplate before placing the transducer in the Cradle. Always return the Ultrasound Intensity control to "0" when the transducer is not in contact with the patient to avoid serious damage to the transducer crystal and generator. Caution Excessive doses of ultrasound can cause damage to tissue. Periosteal pain is an indication of excess intensity. If this occurs, the power should be reduced and/or move the transducer more quickly over the area being treated. The Interrupted Output mode may also be utilized to reduce heat build up in tissue and for the mechanical effect of ultrasound on tissue. U/HVG50 User's Guide 41

54 Part 6 Adverse Effects - Shortwave Diathermy Interference It is extremely important for the physiotherapist to have a clear understanding of the potential danger involved in the use of an ultrasound device in close proximity to an active shortwave diathermy unit. A medical shortwave diathermy unit is a very powerful transmitter of radio energy, the larger ones having an output of 500 watts. Any ultrasound device with external leads, in close proximity to a shortwave unit, is likely to be affected by interference. This interference may be in the form of sparking between electrodes or between the leads and the device casing. The leads connecting the ultrasound device to the patient can act as an aerial and collect the radio frequency energy from the shortwave unit. This could interfere with the operation of the ultrasound unit or affect internal functions of the device. Or, it could result in the patient experiencing some unusual "surges" of current. There is no significant electrical radiation from an ultrasound device. The increasing electronic sophistication of physiotherapeutic equipment is likely to mean that this problem is going to become more obvious. The minimum safe operating distance is difficult to determine since local factors must be considered. At least two or three meters is needed between the nearest parts of either instrument, including the cables and electrodes. The ultrasound device does not need to be plugged into a power supply to be affected by interference from a shortwave unit. Some very old types of shortwave generators seem to produce more interference than others which compounds the problem even further. With some shortwave units, the distance between devices of at least three meters may still be inadequate. In practice, shortwave diathermy units and ultrasound units should be placed and operated as far away from each other as possible. It may be necessary to screen off all shortwave units from other equipment or to have fully screened rooms in which shortwave diathermy equipment can be operated without risk of interfering with other sensitive equipment. This is often difficult in a small practice where space is at a premium. In such cases, the units may have to be operated at different times, not simultaneously. In all cases, it would be very dangerous to give shortwave diathermy and ultrasound treatment to a patient simultaneously. Any patient who reports a sudden, unexplainable "surge" in output may be experiencing the effects of shortwave interference. 42 U/HVG50 User's Guide

55 Ultrasound Indications U/HVG50 General Operation and Application Procedures Ultrasound delivered to the body using an efficient coupling provides deep heating effects to body tissues. When therapeutic ultrasound is delivered to the body at intensities capable of generating a deep tissue temperature increase, some or all of the following effects may occur: Pain relief Reduction of muscle spasm Increase in collagen elasticity or extensibility Increase in blood flow Increase in soft tissue elasticity Increase in enzyme activity Mild inflammatory response which can help resolve chronic inflammatory processes Some of the general conditions for which ultrasound has been used as an adjunctive therapy are: Increase range of motion of contracted joints using heat and stretch techniques Treatment of chronic bursitis, epicondylitis and tenosynovitis Reflex Sympathetic Dystrophy as in shoulder-hand syndrome or Sudeck's atrophy Treatment of plantar warts Chronic arthritis Back pain from lumbago, coccygodynia, radiculitis, sciatica, spondylitis deformans and others Reduction of postoperative pain, phantom pains and pain from intercostal neuralgia U/HVG50 User's Guide 43

56 Part 6 Ultrasound Contraindications Ultrasound should not be used in the following areas: transcerebrally; near the heart or reproductive organs; over viscera, eyes, ears, the spinal column, malignancies, the joint capsule in arthritic conditions either acute or subacute, or over total joint replacements. Ultrasound should not be used in cases of: cardiac pacemakers, pregnancy, implants, malignant or benign tumors, multiple sclerosis, arteriosclerosis or weakened blood vessels, hemophilia, thrombosis and thrombophlebitis either acute or subacute. Neither should ultrasound be used over bone in growing children, where the skin suffers from any sensory impairment, nor in the area of the carotid sinus nerves, visceral plexus of large autonomous ganglion. Ultrasound Precautions Excessive doses of ultrasound can cause damage to tissue. Periosteal pain is an indication of excess intensity. Should this occur, reduce the power and/or move the transducer more quickly over the area being treated. Any bleeding tendency is increased by heating because of the increase in blood flow and vascularity of the heated tissues. Care should be used in treating patients who have bleeding disorders. 44 U/HVG50 User's Guide

57 The Ultrasound Transducer U/HVG50 General Operation and Application Procedures It is important to maintain the transducer. Care should be taken to avoid sharply bending or twisting the cable. Cable life depends on frequency of use as well as on proper handling. If it becomes necessary to replace the standard cable, the transducer and the generator must be returned to the factory. Damage to the crystal may result from overheating. When not in use, always return the transducer to the cradle and reduce the Ultrasound Intensity control to "0". The transducer incorporates a machined aluminum faceplate and conductance mediums other than Amrex Conductance and Coupling Gel may cause a discoloration or "pitting" of the aluminum. Use standard alcohol when cleaning the faceplate. Note: Only Use The Transducer(s) Assigned To This Generator. Transducer serial number is located on the Transducer and on the Generator label. Transducer Cable Fault Alarm System Detects improper transducer cable connection and/or transducer cable damage. If a transducer cable is improperly connected or damaged, an audible signal will be emitted from the generator, the "Interrupt On" light will illuminate and the ultrasound meter will display "0" output. Ultrasound output will cease until the transducer cable is properly connected to the generator or, if damaged, replaced. For Amrex models equipped with a standard transducer: The generator and transducer must be returned to the factory for repair and calibration, electrical and mechanical safety check. For Amrex models equipped with the Amrex "QuickConnect System" and less than one (1) year since the last ultrasound calibration: The transducer cable may be replaced on site. For Amrex models equipped with the Amrex "QuickConnect System" and more than one (1) year since the last ultrasound calibration: Amrex strongly recommends that the generator and transducer be returned to the factory for repair and calibration, electrical and mechanical safety check. U/HVG50 User's Guide 45

58 Part 6 QuickConnect Transducer Cable System (Optional Feature) The QuickConnect System enables the practitioner to quickly and easily replace the transducer cable in the office or clinic. Only transducer cables equipped with the Amrex QuickConnect System may be replaced in this manner. To REMOVE the Cable from the Transducer Handle: 1. Verify that the Power/Timer knob is turned counterclockwise to the Off position. Reduce the Ultrasound Intensity control to "0" position and thoroughly clean the transducer faceplate before placing the transducer in the transducer cradle. 2. Set all three Internal Power switches (LV Galvanic, HV Stimulator, and Ultrasound) to the up (off) position. 3. Disconnect the assigned ultrasound transducer from the generator's Ultrasound Output Transducer Connector and remove the handle from the transducer cradle. 4. Firmly squeeze the rubber boot and pull away from the transducer handle. To INSTALL the Cable: 5. Slide the rubber boot down the replacement cord to expose the connector. 6. Grip the metal ring lined area of the connector and firmly push it into the transducer handle. A snap sound will indicate proper installation. 7. Slide the rubber boot up the cord, over the connector and into the transducer handle. Note: The QuickConnect cable must be properly connected to the transducer handle before immersion in water. 8. Connect the assigned ultrasound transducer to the generator's Ultrasound Output Transducer Connector and place the handle in the transducer cradle. To order a QuickConnect System" cable replacement, telephone Amrex Technical Services at (800) and refer to Amrex Part Number P27-DCA. To upgrade your unit to include the QuickConnect System, send the transducer and the generator with your request for Amrex Part Number P2-RETRO, to Amrex, 641 East Walnut Street, Carson, California U/HVG50 User's Guide

59 U/HVG50 General Operation and Application Procedures Dual Transducers (Optional Feature) Dual transducers enable the practitioner to select an alternate transducer to provide a wider range of flexibility for therapeutic applications. The standard size transducer provides maximum coverage for stimulation therapy while the smaller size transducer is ideal for treating outer extremities. Only Amrex generators equipped with dual transducers may be exchanged in this manner. To Change from One Assigned Amrex Transducer to Another: 1. Verify that the Power/Timer knob is turned counterclockwise to the Off position. Reduce the Ultrasound Intensity control to "0" position and thoroughly clean the transducer faceplate before placing the transducer in the transducer cradle. 2. Verify that all three Internal Power switches (LV Galvanic, HV Stimulator, and Ultrasound) are in the up (off) position. 3. Disconnect the assigned ultrasound transducer from the generator's Ultrasound Output Transducer Connector and remove the handle from the transducer cradle. 4. Firmly squeeze the rubber boot and pull away from the transducer handle. 5. Slide the rubber boot down the cord to expose the connector. 6. Grip the metal ring lined area of the connector and firmly push it into the alternate transducer handle. A snap sound will indicate proper installation. 7. Slide the rubber boot up the cord, over the connector and into the alternate transducer handle. Note: The QuickConnect cable must be properly connected to the transducer handle before immersion in water. 8. Connect the assigned alternate ultrasound transducer to the generator's Ultrasound Output Transducer Connector and place the handle in the transducer cradle. U/HVG50 User's Guide 47

60 Part 6 General Operation Low Voltage Galvanic Modality 1. Connect the U/HVG50's ac power cord to the U/HVG50's ac receptacle and plug the "Hospital Grade" connector to a properly grounded 120 Vac, 60 Hz receptacle. 2. Connect the patient "Treatment Stop" switch to the Treatment Stop Jack. 3. Set all three Internal Power switches (LV Galvanic, HV Stimulator and Ultrasound) to the up (off) position. 4. Reduce the Low Voltage Galvanic Intensity control to the 0/Reset position enabling the audible "click". 5. Set the Ultrasound Interrupted Output slide control to the Off position. 6. Set the Combination Mode Off switch to the down (off) position. 7. Set the Low Voltage Galvanic Output Mode control to Cont. 8. Set the Low Voltage Galvanic Surge Duration control to the Min position. 9. Prepare the sponge pad electrodes and apply them to the patient. The sponge pad electrodes may be held in place by means of retention straps or weight bags. Hand the patient "Treatment Stop" switch to the patient and explain its function. WARNING Patient Leads should be securely connected to the pad electrodes and to the galvanic output jacks. 10. Turn the Power/Timer knob and set it to the desired treatment time. Note: When the treatment time is less than ten (10) minutes, turn the Power/ Timer knob clockwise past the ten (10) minute mark and then set it back to the desired time. 11. Depress the Internal Power LV Galvanic switch to the on (down) position. The LVG On indicator light (located above the upper left corner of the Low Voltage Galvanic meter) and the Normal polarity indicator light will illuminate. 12. Verify that the Low Voltage Galvanic Intensity control is set at the 0/Reset position. 13. Depress the Low Voltage Galvanic Polarity switch to select normal or reverse polarity. The Normal or Reverse polarity indicator light will reflect the selection. Note: Normal or Reverse polarity may be selected during treatment except when treating in the Alt Polarity Surge Mode. 48 U/HVG50 User's Guide

61 U/HVG50 General Operation and Application Procedures 14. Slowly increase the Low Voltage Galvanic Intensity control to the desired galvanic output level. WARNING The Low Voltage Galvanic Intensity control should always be increased gradually to avoid burns or trauma to tissue. Note: If the LVG Reset Intensity indicator light is illuminated, no output will be obtained until the Low Voltage Galvanic Intensity control is returned to the 0/Reset position enabling the audible "click". 15. If desired, select an alternate Low Voltage Galvanic Output Mode: Surge or Alt Polarity Surge. Adjust the Low Voltage Galvanic Surge Duration control to regulate the surge duration or alternating polarity surge duration. The output rate selected is indicated on the Low Voltage Galvanic meter dial. 16. When treatment is completed, the ac power will shut off and a bell will sound. To initiate early shut off, turn the Power/Timer knob counterclockwise to the Off position. The ac power will shut off and a bell will sound. Reduce the Low Voltage Galvanic Intensity control to the 0/Reset position enabling the audible "click". Thoroughly clean the sponge pad electrodes with warm water. To continue or extend a patient's treatment time after the treatment is completed and the bell has sounded: Return the Low Voltage Galvanic Intensity control to the 0/Reset position enabling the audible "click". Set the Low Voltage Galvanic Output Mode control to Cont. Turn the Power/Timer knob and set it to the desired treatment time. Note: When the treatment time is less than ten (10) minutes, turn the Power/ Timer knob clockwise past the ten (10) minute mark and then set it back to the desired time. Slowly increase the Low Voltage Galvanic Intensity control to the desired output level. If required, set the Low Voltage Galvanic Output Mode control to Surge or Alt Polarity Surge. U/HVG50 User's Guide 49

62 Part 6 Accessories Low Voltage Galvanic Modality Patient Lead and Pad Electrode Verification 1. Depress the Test Load switch and adjust the Low Voltage Galvanic Intensity control until dc output indicates five milliamperes on the Low Voltage Galvanic Meter dial. 2. Release the Test Load switch and make no further adjustments to the Low Voltage Galvanic Intensity control. 3. Place the patient pad electrodes active faces in full contact with each other. Observe the output current displayed on the Low Voltage Galvanic Meter dial. If the output current from the patient leads and pad electrodes is less than five milliamperes, replacement is indicated. Note: A very generous amount of Flextrode Conductive Spray or Amrex Conductance and Coupling Gel is needed to insure good conductivity. Important: It is the personal responsibility and obligation of the user to verify that patient leads and pad electrodes show no evidence of deterioration prior to patient application. When such evidence exists, replace the patient leads or pad electrodes. Never sharply bend or twist the patient leads. Loose connections or broken patient leads can cause poor conductance and possible discomfort to the patient. Should the patient complain of low stimulation output, no output or sudden irregular increases in output, immediately discontinue treatment. Check for the following: Secure patient lead connections. Proper pad electrode contact with the patient. LV Stimulator pad electrode wear or lack of cleanliness. Replace patient leads and pad electrodes that show any evidence of deterioration. WARNING The Low Voltage Galvanic Intensity control should always be increased gradually to avoid burns or trauma to tissue. Patient Treatment Stop Switch Operation When the patient "Treatment Stop" switch is activated during Low Voltage Galvanic treatment, the Low Voltage Galvanic output will be discontinued immediately. The LVG Reset Intensity indicator light will illuminate. Low Voltage Galvanic output cannot be resumed until the Low Voltage Galvanic Intensity control is returned to the 0/Reset position which will turn off the LVG Reset Intensity indicator light. NOW the Low Voltage Galvanic output can be activated. Note: When the Low Voltage Galvanic Intensity control is returned to the 0/Reset position it will enable an audible "click". 50 U/HVG50 User's Guide

63 U/HVG50 General Operation and Application Procedures Patient Accessory Identification and Connection WARNING Patient Leads should be securely connected to the pad electrodes and to the galvanic output jacks. Application of Low Voltage Galvanic Current Galvanic (dc) current must be applied through sponge type pad electrodes. To obtain maximum conductivity, completely and thoroughly moisten the sponge pad electrode by immersing it in water and applying a generous amount of Flextrode Conductive Spray or Amrex Conductance and Coupling Gel. When using Low Voltage Galvanic current for iontophoresis, thoroughly moisten the pad electrodes only with FDA approved iontophoretic substances. Check the dc output before applying the output current using the Test Load switch. Note: Electron flow is from negative electrode to positive electrode. U/HVG50 User's Guide 51

64 Part 6 Adverse Effects - Shortwave Diathermy Interference It is extremely important for the physiotherapist to have a clear understanding of the potential danger involved in the use of an ultrasound device in close proximity to an active shortwave diathermy unit. A medical shortwave diathermy unit is a very powerful transmitter of radio energy, the larger ones having an output of 500 watts. Any ultrasound device with external leads, in close proximity to a shortwave unit, is likely to be affected by interference. This interference may be in the form of sparking between electrodes or between the leads and the device casing. The leads connecting the ultrasound device to the patient can act as an aerial and collect the radio frequency energy from the shortwave unit. This could interfere with the operation of the ultrasound unit or affect internal functions of the device. Or, it could result in the patient experiencing some unusual "surges" of current. There is no significant electrical radiation from an ultrasound device. The increasing electronic sophistication of physiotherapeutic equipment is likely to mean that this problem is going to become more obvious. The minimum safe operating distance is difficult to determine since local factors must be considered. At least two or three meters is needed between the nearest parts of either instrument, including the cables and electrodes. The ultrasound device does not need to be plugged into a power supply to be affected by interference from a shortwave unit. Some very old types of shortwave generators seem to produce more interference than others which compounds the problem even further. With some shortwave units, the distance between devices of at least three meters may still be inadequate. In practice, shortwave diathermy units and ultrasound units should be placed and operated as far away from each other as possible. It may be necessary to screen off all shortwave units from other equipment or to have fully screened rooms in which shortwave diathermy equipment can be operated without risk of interfering with other sensitive equipment. This is often difficult in a small practice where space is at a premium. In such cases, the units may have to be operated at different times, not simultaneously. In all cases, it would be very dangerous to give shortwave diathermy and ultrasound treatment to a patient simultaneously. Any patient who reports a sudden, unexplainable "surge" in output may be experiencing the effects of shortwave interference. 52 U/HVG50 User's Guide

65 Low Voltage Galvanic Indications U/HVG50 General Operation and Application Procedures Iontophoresis using FDA approved substances Stimulation of denervated muscles Electrical Muscle Stimulators should only be used under medical supervision for adjunctive therapy for the treatment of medical diseases and conditions. Low Voltage Galvanic Contraindications Contraindicated for patients with cardiac demand pacemakers. Should not be used on cancer patients. Safety has not been established for use during pregnancy. Should not be applied transcerebrally. Low Voltage Galvanic Warnings Adequate precautions should be taken in the case of persons with suspected heart problems. Do not stimulate over the carotid sinus nerves, especially in patients with a known sensitivity to the carotid sinus reflex. Caution should be used in the transthoracic application in that the introduction of electrical current into the heart may cause arrhythmias. Caution should be used when there is a tendency to hemorrhage following acute trauma or fracture. U/HVG50 User's Guide 53

66 Part 6 General Operation High Voltage Pulsed D.C. Stimulator Modality 1. Connect the U/HVG50's ac power cord to the U/HVG50's ac receptacle and plug the "Hospital Grade" connector to a properly grounded 120 Vac, 60 Hz receptacle. 2. Connect the patient "Treatment Stop" switch to the Treatment Stop Jack. 3. Set all three Internal Power switches (LV Galvanic, HV Stimulator and Ultrasound) to the up (off) position. 4. Reduce the High Voltage Pulsed D.C. Stimulator Intensity control to the 0/Reset position. 5. Set the Ultrasound Interrupted Output slide control to the Off position. 6. Set the Combination Mode Off switch in the down (off) position. 7. Set the Balance control to Normal. 8. Set the High Voltage Pulsed D.C. Stimulator Surge Duration control to Cont. 9. Set the Frequency control to the desired frequency. 10. Set the High Voltage Pulsed D.C. Stimulator Mode switches to the desired output modes: The Recip/Surge switch to reciprocal or surge mode. The High Voltage Pulsed D.C. Stimulator Polarity switch to + (positive) or - (negative) polarity for the Dispersive Pad output jack. The polarity setting may be changed anytime during treatment. The Pad/Probe switch to pad or probe mode. 11. Prepare the pad electrode(s) and apply them to the patient. The pad electrode(s) may be held in place by means of retention straps or weight bags. Hand the patient "Treatment Stop" switch to the patient and explain its function. WARNING Patient leads should be securely connected to the pad electrodes and to the stimulator output jacks. 12. Turn the Power/Timer knob and set it to the desired treatment time. Note: When the treatment time is less than ten (10) minutes, turn the Power/ Timer knob clockwise past the ten (10) minute mark and then set it back to the desired time. 54 U/HVG50 User's Guide

67 U/HVG50 General Operation and Application Procedures 13. Depress the Internal Power HV Stimulator switch to the on (down) position. The HVS On indicator light (located above the upper left corner of the High Voltage Pulsed D.C. Stimulator meter) will illuminate. The output rate A and B indicator lights or the Probe On indicator light will illuminate. 14. Verify that the High Voltage Pulsed D.C. Stimulator Intensity control is set at the 0/Reset position. 15. Slowly increase the High Voltage Pulsed D.C. Stimulator Intensity control to the desired output level. Note: If the HVS Reset Intensity indicator light is illuminated, no output will be obtained until the High Voltage Pulsed D.C. Stimulator Intensity control is returned to the 0/Reset position. 16. If the High Voltage Pulsed D.C. Stimulator Pad/Probe switch is set at Pad mode, the High Voltage Pulsed D.C. Stimulator Balance control may be adjusted to the desired intensity levels for Active Pads A and B output jacks. 17. If desired, select an alternate High Voltage Pulsed D.C. Stimulator Surge Duration: 2.5, 5 or 10 seconds. The output rate A and B indicator lights or the Probe On indicator light will reflect the output rate selected. 18. When treatment is completed, the ac power will shut off and a bell will sound. To initiate early shut off, turn the Power/Timer knob counterclockwise to the Off position. The ac power will shut off and a bell will sound. Reduce the High Voltage Pulsed D.C. Stimulator Intensity control to the 0/Reset position. Thoroughly clean the pad electrode(s) with warm water and dispose of the used cloth cover(s). To continue or extend a patient's treatment time after the treatment is completed and the bell has sounded: Return the High Voltage Pulsed D.C. Stimulator Intensity control to the 0/Reset position. Set the High Voltage Pulsed D.C. Stimulator Surge Duration control to Cont. Turn the Power/Timer knob and set it to the desired treatment time. Note: When the treatment time is less than ten (10) minutes, turn the Power/ Timer knob clockwise past the ten (10) minute mark and then set it back to the desired time. Slowly increase the High Voltage Pulsed D.C. Stimulator Intensity control to the desired output level. If required, set the High Voltage Pulsed D.C. Stimulator Surge Duration control to 2.5, 5 or 10 seconds. U/HVG50 User's Guide 55

68 Part 6 Accessories High Voltage Pulsed D.C. Stimulator Modality Patient Lead and Pad Electrode Verification 1. Depress the Test Load switch and adjust the Low Voltage Galvanic Intensity control until dc output indicates five milliamperes on the Low Voltage Galvanic Meter dial. 2. Release the Test Load switch and make no further adjustments to the Low Voltage Galvanic Intensity control. 3. Place the patient pad electrodes active faces in full contact with each other. Observe the output current displayed on the Low Voltage Galvanic Meter dial. If the output current from the patient leads and pad electrodes is less than five milliamperes, replacement is indicated. Note: A very generous amount of Flextrode Conductive Spray or Amrex Conductance and Coupling Gel is needed to insure good conductivity. Important: It is the personal responsibility and obligation of the user to verify that patient leads and pad electrodes show no evidence of deterioration prior to patient application. When such evidence exists, replace the patient leads or pad electrodes. Never sharply bend or twist the patient leads. Loose connections or broken patient leads can cause poor conductance and possible discomfort to the patient. Should the patient complain of low stimulation output, no output or sudden irregular increases in output, immediately discontinue treatment. Check for the following: Secure patient lead connections. Proper pad electrode contact with the patient. HV Stimulator pad electrode wear or lack of cleanliness. Replace patient leads and pad electrodes that show any evidence of deterioration. Patient Treatment Stop Switch Operation When the patient "Treatment Stop" switch is activated during High Voltage Pulsed D.C. Stimulator treatment, the High Voltage Pulsed D.C. Stimulator output will be discontinued immediately. The HVS Reset Intensity indicator light will illuminate. High Voltage Pulsed D.C. Stimulator output cannot be resumed until the High Voltage Pulsed D.C. Stimulator Intensity control is returned to the 0/Reset position which will turn off the HVS Reset Intensity indicator light. NOW the High Voltage Pulsed D.C. Stimulator output can be activated. 56 U/HVG50 User's Guide

69 U/HVG50 General Operation and Application Procedures Patient Accessory Identification and Connection 1 Channel, 1 Pad Important The total surface area of the Dispersive Pad must be at least twice the total surface area of the active pad electrode at any one of the A or B jacks. WARNING Patient leads should be securely connected to the pad electrodes and to the stimulator output jacks. U/HVG50 User's Guide 57

70 Part 6 Patient Accessory Identification and Connection 1 Channel, 2 Pad Important The total surface area of the Dispersive Pad must be at least twice the total surface area of the active pad electrodes at the A+A or B+B jacks. WARNING Patient leads should be securely connected to the pad electrodes and to the stimulator output jacks. 58 U/HVG50 User's Guide

71 U/HVG50 General Operation and Application Procedures Patient Accessory Identification and Connection 1 Channel, 1 Pad and 1 Channel, 2 Pad Important The total surface area of the Dispersive Pad must be at least twice the total surface area of the active pad electrodes at the A and B+B jacks. WARNING Patient leads should be securely connected to the pad electrodes and to the stimulator output jacks. U/HVG50 User's Guide 59

72 Part 6 Patient Accessory Identification and Connection 1 Channel, 2 Pad and 1 Channel, 2 Pad Important The total surface area of the Dispersive Pad must be at least twice the total surface area of the active pad electrodes at the A+A and B+B jacks. WARNING Patient leads should be securely connected to the pad electrodes and to the stimulator output jacks. 60 U/HVG50 User's Guide

73 U/HVG50 General Operation and Application Procedures Patient Accessory Identification and Connection 2 Channel, 2 Pad Important The total surface area of the Dispersive Pad must be at least twice the total surface area of the active pad electrodes at the A+B jacks. WARNING Patient leads should be securely connected to the pad electrodes and to the stimulator output jacks.. U/HVG50 User's Guide 61

74 Part 6 Patient Accessory Identification and Connection 2 Channel, 2 Pad and 2 Channel, 2 Pad Important The total surface area of the Dispersive Pad must be at least twice the total surface area of the active pad electrodes at the A+B and A+B jacks. WARNING Patient leads should be securely connected to the pad electrodes and to the stimulator output jacks. 62 U/HVG50 User's Guide

75 U/HVG50 General Operation and Application Procedures Patient Accessory Identification and Connection 1 Probe Electrode (Optional Accessory) Important The total surface area of the Dispersive Pad must be at least twice the total surface area of the Probe Electrode WARNING Patient leads should be securely connected to the pad electrode, probe electrode and to the stimulator output jacks. U/HVG50 User's Guide 63

76 Part 6 Application of Electrical Muscle Stimulation Electrical muscle stimulation, high voltage or low voltage ac, is usually applied through carbon type pad electrodes with disposable cloth covers, or sponge type pad electrodes.the Flextrode System has been designed for the application of electrical stimulation with the use of carbon type electrodes. The Flextrode pad electrode must be used with the Flextrode disposable cloth cover. The cloth cover provides added hygienic protection and increased conductance to the patient. To obtain maximum conductivity, it is important to properly prepare the Flextrode pad electrode and cloth cover before application of electrical muscle stimulation. The Flextrode pad electrode and cloth cover assembly must be completely and thoroughly moistened by immersing it in water. Apply a generous amount of Flextrode Conductive Spray to the moistened cloth cover. If the Flextrode Conductive Spray is not desired, apply a generous amount of Amrex Conductance and Coupling Gel to the thoroughly moistened Flextrode cloth cover. A generous amount of Flextrode Conductive Spray or Amrex Conductance and Coupling Gel is required to insure good conductivity. Thoroughly clean pad(s) with warm water after each treatment and dispose of the used cloth cover(s). Important It is the personal responsibility and obligation of the user to verify that patient cords and electrode pads show no evidence of deterioration prior to patient application. When such evidence exists, replace the cords or electrodes. Never sharply bend or twist the cords. Loose connections or broken cords can cause poor conductance and possible discomfort to the patient. Should the patient complain of low stimulation output, no output or sudden irregular increases in output, immediately discontinue treatment. Check for the following: secure cord connections; proper electrode contact with the patient; electrode wear or lack of cleanliness. Replace patient cords and/or pad electrodes that show any evidence of deterioration. 64 U/HVG50 User's Guide

77 U/HVG50 General Operation and Application Procedures Adverse Effects - Shortwave Diathermy Interference It is extremely important for the physiotherapist to have a clear understanding of the potential danger involved in the use of an ultrasound device in close proximity to an active shortwave diathermy unit. A medical shortwave diathermy unit is a very powerful transmitter of radio energy, the larger ones having an output of 500 watts. Any ultrasound device with external leads, in close proximity to a shortwave unit, is likely to be affected by interference. This interference may be in the form of sparking between electrodes or between the leads and the device casing. The leads connecting the ultrasound device to the patient can act as an aerial and collect the radio frequency energy from the shortwave unit. This could interfere with the operation of the ultrasound unit or affect internal functions of the device. Or, it could result in the patient experiencing some unusual "surges" of current. There is no significant electrical radiation from an ultrasound device. The increasing electronic sophistication of physiotherapeutic equipment is likely to mean that this problem is going to become more obvious. The minimum safe operating distance is difficult to determine since local factors must be considered. At least two or three meters is needed between the nearest parts of either instrument, including the cables and electrodes. The ultrasound device does not need to be plugged into a power supply to be affected by interference from a shortwave unit. Some very old types of shortwave generators seem to produce more interference than others which compounds the problem even further. With some shortwave units, the distance between devices of at least three meters may still be inadequate. In practice, shortwave diathermy units and ultrasound units should be placed and operated as far away from each other as possible. It may be necessary to screen off all shortwave units from other equipment or to have fully screened rooms in which shortwave diathermy equipment can be operated without risk of interfering with other sensitive equipment. This is often difficult in a small practice where space is at a premium. In such cases, the units may have to be operated at different times, not simultaneously. In all cases, it would be very dangerous to give shortwave diathermy and ultrasound treatment to a patient simultaneously. Any patient who reports a sudden, unexplainable "surge" in output may be experiencing the effects of shortwave interference. U/HVG50 User's Guide 65

78 Part 6 High Voltage Stimulation Indications Relaxation of muscle spasms Prevention or retardation of disuse atrophy Increased local blood circulation Muscle reeducation Maintenance of or increase in range of motion Immediate postsurgical stimulation of calf muscles to prevent venous thrombosis Electrical Muscle Stimulators should only be used under medical supervision for adjunctive therapy for the treatment of medical diseases and conditions. Electrical Muscle Stimulation Contraindications Contraindicated for patients with cardiac demand pacemakers. Should not be used on cancer patients. Electrical Muscle Stimulation Warnings Long term effects of chronic electrical stimulation are unknown. Safety has not been established for the use of electrical muscle stimulation during pregnancy. Adequate precautions should be taken in the case of persons with suspected heart problems. Adequate precautions should be taken in the case of persons with suspected or diagnosed epilepsy. Do not stimulate over the carotid sinus nerves, especially in patients with a known sensitivity to the carotid sinus reflex. Severe spasm of the laryngeal and pharyngeal muscles may occur when the electrodes are positioned over the neck or mouth. The contractions may be strong enough to close the airway or cause difficulty in breathing. Electrical muscle stimulators should not be applied transcerebrally. Electrical muscle stimulators should not be used over swollen, infected or inflamed areas or skin eruptions. Caution should be used in the transthoracic application of electrical muscle stimulators in that the introduction of electrical current into the heart may cause arrhythmias. Electrical muscle stimulators should be kept out of the reach of children. 66 U/HVG50 User's Guide

79 Electrical Muscle Stimulation Precautions Precautions should be observed: U/HVG50 General Operation and Application Procedures When there is a tendency to hemorrhage following acute trauma or fracture. Following recent surgical procedures when muscle contraction may disrupt the healing process. Over the menstruating uterus. Where sensory nerve damage is present by a loss of normal skin sensation. Some patients may experience skin irritation or hypersensitivity due to the electrical stimulation or the conductive medium. The irritation can usually be reduced by use of an alternate conductive medium or alternate electrode placement. Skin irritation and burns beneath the electrodes have been reported with the use of electrical muscle stimulators. U/HVG50 User's Guide 67

80 Part 6 U/HVG50 Combination Mode The Ultrasound modality may be combined with either Low Voltage Galvanic or High Voltage Pulsed D.C. Stimulator modalities for simultaneous application through the ultrasound transducer. This technique involves using a large electrode pad and the ultrasound transducer. The transducer soundhead will become the active electrode which will transmit both ultrasound and the selected modality. Combination modes require specific control settings and pad arrangements. Ultrasound Modality Combined With Low Voltage Galvanic Modality Control Settings and General Operation 1. Connect the U/HVG50's ac power cord to the U/HVG50's ac receptacle and plug the "Hospital Grade" connector to a properly grounded 120 Vac, 60 Hz receptacle. 2. Connect the patient "Treatment Stop" Switch to the Treatment Stop Jack. 3. Set all three Internal Power switches (LV Galvanic, HV Stimulator and Ultrasound) to the up (off) position. 68 U/HVG50 User's Guide

81 U/HVG50 General Operation and Application Procedures 4. Connect the assigned ultrasound transducer to the generator's Ultrasound Output transducer connector and place the handle in the transducer cradle. 5. Connect the dispersive sponge pad electrode to the red Galvanic Output jack. 6. Reduce the Low Voltage Galvanic Intensity control to the 0/Reset position enabling the audible "click". 7. Reduce the Ultrasound Intensity control to "0". 8. Set the Ultrasound Interrupted Output slide control to the Off position. 9. Set the Combination Mode Off switch to the down (off) position. 10. Set the Low Voltage Galvanic Output Mode control to Cont. 11. Set the Low Voltage Galvanic Surge Duration control to the Min position. 12. Prepare a contact medium at and around the treatment sites with a liberal coating of Amrex Conductance and Coupling Gel. Properly secure the thoroughly moistened dispersive sponge pad electrode insuring that the entire conductive area of the pad makes full contact. The conductive area of the dispersive sponge pad electrode must be at least twice the area of the transducer faceplate. Hand the patient "Treatment Stop" switch to the patient and explain its function. WARNING Patient lead should be securely connected to the pad electrode and to the galvanic output jack. 13. Turn the Power/Timer knob and set it to the desired treatment time. Note: When the treatment time is less than ten (10) minutes, turn the Power/ Timer knob clockwise past the ten (10) minute mark and then set it back to the desired time. Allow one (1) minute for the ultrasound modality to warm-up. 14. Depress the Internal Power Ultrasound switch to the on (down) position. The Ultrasound On indicator light (located above the upper left corner of the ultrasound meter) will illuminate. 15. Depress the Internal Power LV Galvanic switch to the on (down) position. The LVG On indicator light (located above the upper left corner of the Low Voltage Galvanic meter) and the Normal polarity indicator light will illuminate. 16. Depress the Combination Mode LV Galvanic / Ultrasound switch to the on (down) position. The Combination Mode indicator light (located above the middle of the ultrasound meter) will illuminate. 17. Verify that the Low Voltage Galvanic Intensity control is set at the 0/Reset position enabling the audible "click". U/HVG50 User's Guide 69

82 Part Depress the Low Voltage Galvanic Polarity switch to slecet a normal or reverse polarity. The Normal or Reverse polarity indicator light will reflect the selection. Note: Normal or Reverse polarity may be selected during treatment except when treating in the Alt Polarity Surge Mode. 19. Verify that the Ultrasound Intensity control is set at the "0" position before removing the transducer from the cradle and placing the transducer faceplate on the prepared treatment site. 20. Slowly increase the Ultrasound Intensity control to the desired output level as indicated on the Ultrasound meter dial. If desired, adjust the Ultrasound Interrupted Output slide control now. When the Ultrasound Interrupted Output slide control is adjusted, the Interrupt On indicator light (located above the upper right corner of the ultrasound meter) will illuminate and the Ultrasound meter indicator will rise and fall indicating interrupted cycles provided the transducer is not in the ultrasound cradle. Low Voltage Galvanic output is unaffected by the Ultrasound Interrupted Output slide control setting. 21. Slowly increase the Low Voltage Galvanic Intensity control to the desired galvanic output level. WARNING The Low Voltage Galvanic Intensity control should always be increased gradually to avoid burns or trauma to tissue. Note: If the LVG Reset Intensity indicator light is illuminated, no output will be obtained until the Low Voltage Galvanic Intensity control is returned to the 0/Reset position enabling the audible "click". 22. If desired, select an alternate Low Voltage Galvanic Output Mode: Surge or Alt Polarity Surge. Adjust the Low Voltage Galvanic Surge Duration control to regulate the surge duration or alternating polarity surge duration. The output rate selected is indicated on the Low Voltage Galvanic meter dial. 23. When treatment is completed, the ac power will shut off and a bell will sound. To initiate early shut off, turn the Power/Timer knob counterclockwise to the Off position. The ac power will shut off and a bell will sound. Reduce the Low Voltage Galvanic Intensity control to the 0/Reset position enabling the audible "click". Reduce the Ultrasound Intensity control to "0" position and thoroughly clean the transducer faceplate before placing the transducer in the transducer cradle. Thoroughly clean the dispersive sponge pad electrode with warm water. To continue or extend a patient's treatment time, return the Low Voltage Galvanic Intensity control to the 0/Reset position enabling the audible "click", reset the Power/Timer knob and slowly increase the Low Voltage Galvanic Intensity control to the desired output level. 70 U/HVG50 User's Guide

83 U/HVG50 General Operation and Application Procedures Patient Accessory Identification and Connection Combination Mode Important The total surface area of the Dispersive Pad must be at least twice the total surface area of the Transducer faceplate. WARNING Patient lead should be securely connected to the pad electrode and to the galvanic output jack. U/HVG50 User's Guide 71

84 Part 6 Ultrasound Modality Combined With High Voltage Pulsed D.C. Stimulator Modality Control Settings and General Operation 1. Connect the U/HVG50's ac power cord to the U/HVG50's ac receptacle and plug the "Hospital Grade" connector to a properly grounded 120 Vac, 60 Hz receptacle. 3. Connect the patient "Treatment Stop" switch to the Treatment Stop Jack. 3. Set all three Internal Power switches (LV Galvanic, HV Stimulator and Ultrasound) to the up (off) position. 4. Connect the assigned ultrasound transducer to the generator's Ultrasound Output transducer connector and place the handle in the transducer cradle. 5. Connect the dispersive sponge pad electrode to the white Dispersive Pad jack. 6. Reduce the High Voltage Pulsed D.C. Stimulator Intensity control to the 0/Reset position. 72 U/HVG50 User's Guide