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1. Interferential Stimulation
Reducing inflammation and edema. Promoting healing through increased blood flow while reducing pain. Low Back Pain .................................................... Shoulder Pain ..................................................... Epicondylitis ....................................................... Carpal Tunnel ..................................................... Cervical Spasms/Pain ........................................... Knee Pain ......................................................... Plantar Fasciitis ................................................... Soft Tissue Injury ................................................. Tarsal Tunnel Surgery ............................................ 3 4 5 6 7 8 9 10 11
Electrode Placement
A-B Lead 1 C-D Lead 2
Combo Settings:
IF-High Treatment Time: 15 minutes
Ch2 Ch1 (+) (-) Ch2 Ch1 (+) (-)
Ch1 (+)
Ch2 (-)
Shoulder Pain
Chronic-Non Surgical
Channel 1: Place over supraspinatus trigger point & pec minor insertion Channel 2: Place over deltoid insertion and upper trapezius
Epicondylitis
Lateral Control Settings:
Switch: 8/8 Frequency: 250 Treatment Time: 10 minutes Amplitude: Maximum Sensory level ...Then Switch: 1/1 Frequency: 10 Treatment Time: 10 minutes Amplitude: Muscle Contraction
Control Settings:
Switch: 10/10 Frequency: 250 Amplitude: MS Contraction Treatment Time: 15 minutes
Combo Settings:
IF-High Treatment Time: 15 minutes Post-Op Shoulder Pain: Same placement, if able to avoid surgical incision. Adjust according to surgical site.
Medial
Same Settings
Combo Settings:
IF-High Treatment Time: 15 minutes ...If specific site of pain is known IF-FX10 Treatment Time: 15 minutes Sympathetic Nerve: 1-5 Hz Para Sympathetic: 10-150 Hz Motor Nerve: 10-50 Hz Sensory Nerve: 90-110 Hz Smooth Muscle; 0-10 Hz
Lateral Medial
Control Settings:
Switch: 10/10 Frequency: 10 treatment Time: 15 minutes Amplitude: Sensory level to tolerance
Combo Settings:
IF-Low Treatment Time: 15 minutes
Ch1 (+) Ch2 (-)
Carpal Tunnel
Electrode Placement
See diagram below
Cervical Spasms/Pain
Electrode Placement
Try to keep pads unilateral to spine in MS tissue areas Choose areas with trigger points in MS belly OK to cross spine
Control Settings:
Switch: 1/1 Frequency: 100 Treatment Time: 10 minutes Amplitude: Sensory level ...Then Switch: 8/8 Frequency: 10 Treatment Time: 10 minutes Amplitude: Maximum Sensory level
Control Settings:
Switch: 10/10 Frequency: 150 Treatment Time: 15-20 minutes Amplitude: Maximum Sensory to low level MS contraction
Combo Settings:
IF-Wide Treatment Time: 15 minutes Cervical Garment: Place electrodes as shown.
Combo Settings:
IF-Low Treatment Time: 15 minutes
Ch2 (+)
Ch1 (-)
Knee Pain
Control Settings:
Edema Reduction Switch: 1/1 frequency: 1-10 Treatment Time: 15-20 minutes Amplitude: Maximum Sensory level Chronic Pain Switch: 10/10 Frequency: 80-150 Treatment Time: 15-20 minutes Amplitude: Maximum Sensory level Acute Pain Switch: 10/10 Frequency: 1-150 Treatment Time: 15-20 minutes Amplitude: Maximum Sensory level
Plantar Fasciitis
Electrode Placement
Electrodes are placed on medial & lateral side of foot
Control Settings:
Switch: 8/8 frequency: 100 Treatment Time: 15 minutes Amplitude: Maximum Sensory level
Combo Settings:
IF-Wide Treatment Time: 10 minutes ...Then IF-Low Treatment time: 10
Combo Settings:
Edema Reduction IF-Low Treatment Time: 15-20 Chronic pain IF-High treatment Time: 15-20 Acute pain IF-Wide treatment Time: 15-20
Ch1 (+) Ch1 Ch2
Ch1
Ch2 (+)
Control Settings:
Switch: 8/8 Frequency: 100 Treatment Time: 15 minutes Amplitude: Maximum Sensory level
Control Settings:
Switch: 8/8 or 10/10 Frequency: 100 Treatment Time: 15 minutes Amplitude: Maximum Sensory level ...Then Switch: 1/1 frequency: 10 treatment Time: 15 minutes Amplitude: Maximum Sensory level
Combo Settings:
IF-Wide treatment Time: 10 minutes ...Then IF-Low Treatment Time: 10 minutes
Ch1 (+) Ch2 (-)
Combo Settings:
IF-Wide Treatment Time: 10 minutes ...Then IF-Low Treatment Time: 10 minutes
Ch2 (+) Ch1 (-) Ch1 (-) Medial View Ch1 (+) Ch2 (+) Lateral View Ch2 (-)
Sock Garment: Red lead goes into sock. Black lead placed in electrode proximal to the body.
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Cervical Sprain/Strain
Electrode Placement
Channel 1: Place electrodes bilaterally at suboccepital area Channel 2: Bilaterally at C7-T1 level
Control Settings:
Ch1 Ch1
Ch2
Ch2
Mode: N Frequency: 10 pps Pulse Width: 50-250 ms Amplitude: Sensory level to tolerance Treatment Time: 30 minutes to 1 hour intermittently throughout the day Cervical Garment: Place electrodes as shown
Control Settings:
Mode: N Frequency: 125 pps Pulse Width: 20-60 ms Amplitude: Sensory level to tolerance Treatment Time: 30 min to 1 hour intermittently throughout the day Low Back Garment: Place electrodes as shown
Option 2
Ch1C
h1
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Shoulder Sprain
Electrode Placement
Channel 1: Place one pad on trigger point of supraspinatus, other on deltoid insertion Channel 2: One pad on pec insertion other on teres major
Hip Strain/Pain
Electrode Placement
May use 2, or 4 electrodes. When using 2 pads, use 2 x 3.5. When using 4 pads, use 2 round. Option 1: Place 2 pads 3-4 inches apart, forming a square around the site of pain. Option 2: Place 2 x 3.5 above and below site of pain
Control Settings:
Mode: N Frequency: 100 pps Pulse Width: 150 ms Amplitude: Turn up MS contraction state if palpable trigger points Treatment Time: 15-20 minutes to decrease trigger points Shoulder Garment: Place electrodes as shown
Control Setting:
Mode: N Frequency: 80 pps Pulse Width: 250 ms Amplitude: Just below MS contraction
Ch1 Ch2
Ch1 Ch2
Ch1
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All-Stim
Control Settings: Chronic IF- HIGH Treatment Time: 20-30 min. Edema IF- LOW Treatment Time: 20-30 min.
Wrist Strengthening
Electrode Placement
Channel 1: Electrode over proximal third of forearm over wrist extensor bellies. Electrode ~ 2 superior to wrist crease in center of forearm. Channel 2: Electrode placed over proximal third of forearm over wrist flexor bellies Electrode placed centrally over flexor tendon ~ 3 superior to wrist crease Perform only one channel at a time or alternate setting when using OmniCare.
Ch1
Ch2
Ch2
Ch1
Control Settings:
Frequency: 30 Hz Pulse Width: 200+ ms Ramp: 3 seconds On Time: 8 seconds Off Time: 15 seconds Amplitude: MS contraction
Ch2
Ch2 Ch1
IF-4000
Control Settings: Chronic Switch: 10/10 Frequency: 80-150 Treatment Time: 20-30 minutes Amplitude: Maximum Sensory Level Edema: Switch: 1/1 Frequency: 1-10 Treatment Time: 20-30 minutes Amplitude: Maximum Sensory Level
Sock with TENS Red lead goes into sock Black lead placed in electrode proximal to the body
Combo Settings:
MSW300 MSCTR08 MSRLX02 Amplitude: MS contraction Treatment Time: 10 minutes
Ch1
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Intrinsic Strengthening
Electrode Placement
(-) Just proximal to pisiform (+) 23 superior and lateral to (-) electrode
Grip Strengthening
Recommend dual channel to stimulate intrinsics and wrist flexors.
Electrode Placement
Use 2 round electrodes and place 2-3 inches superior to volar crease. Place (+) leads from both channels here. Place channel 1 (-) electrode proximal to pisiform. Place channel 2 (-) electrode 1-2 inches distal to medial epicondyle over flexor MS bellies.
Control Settings:
Frequency: 30 Hz Pulse Width: 200+ ms Ramp: 3 seconds On Time: 10 seconds Off Time: 35 seconds Amplitude: MS Contraction Treatment Time: 15 minutes
Control Settings:
Frequency: 30 Hz Pulse Width 200+ ms Ramp: 3 seconds On Time: 10 seconds Off Time: 35 seconds Amplitude: MS Contraction Treatment Time: 15-20 minutes
Ch1 Ch2
Combo Settings:
MSW300 MSCTR10 MSRLX30 MSRMP03 Treatment Time: 15 minutes
Ch1 Ch2
Ch1 Ch2
Combo Settings:
MSW350 MSCTR10 seconds MSRLX35 seconds MSRMP02 Treatment Time: 15-20 minutes
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Quadriceps Strengthening
Recommend dual channel placement
Electrode Placement
Channel 1: Electrode over VMO Electrode superior portion of vastus lateralis Channel 2: Electrode superior to lateral border of patella Electrode central MS belly of rectus femoris
Control Settings:
Frequency: 100 Hz Pulse Width: 200+ ms Ramp: 3 seconds On Time: 15 seconds Off Time: 2 seconds Treatment Time: 15-20 minutes
Control Settings:
Frequency: 100 Hz Pulse Width: 200+ ms Ramp: 5 seconds On Time: 15 seconds Off Time: 30 seconds Amplitude: MS Contraction Treatment Time: 15 minutes
Combo Settings:
Ch2
Ch2
MSW350 MSCTR15 seconds MSRLX3 seconds MSRMP03 Treatment Time: 15-20 minutes
Ch1 Ch1
Ch1 Ch1
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Shoulder Weakness
Electrode Placement
Channel 1: Along medial periscopular border on rhomboid MS bellies Channel 2: Infraspinatus with option of also teres major
Control Settings:
Frequency: 50-70 pulses per second Pulse Width: 200+ ms Ramp: 2 seconds On Time: 5 seconds Off Time: 15 seconds Intensity: To muscle contraction state Treatment Time: 15 minutes
Ch1
Ch2
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Strengthening of VMO
Electrode Placement
Channel 1: (+) electrode over VMO (-) electrode superior portion of vastus lateralis
Control Setting:
frequency: 30 Hz Pulse Width: 200+ ms Ramp: 2 seconds On Time: 10 seconds Off Time: 20 seconds Treatment Time: 15 minutes
Control Settings:
Frequency: 50+ Hz Pulse Width: 200+ ms Ramp: 2 seconds On Time: 15 seconds Off Time: 10 seconds Treatment Time: 20-30 minutes
Combo Settings:
MSW350 MSCTR10 seconds MSRLX20 seconds MSRMP02 Treatment Time: 15-20 minutes
Ch1 Ch1
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ACL Reconstruction
Goal: Lower edema, facilitate quad set
Fibromyalgia
Electrode Placement
Find trigger points along paraspinals
Electrode Placement
A: Channel A (IFC) - Quadripolar placement around knee for IFC B: Channel B (NMS) - One pad on VMO, one pad on rectus femoris
Control Settings:
Rate: 70 Hz Ramp: 3 seconds On Time: 5-10 seconds Off Time: 10 seconds Treatment Time: 20 minutes
Control Settings:
IF-Low CB-IF-15 minutes MS-W-400 CB-MS-15 minutes Treatment Time: 30 minutes
Ch1 B
Combo Settings:
MS-W-250 MS-CTR-10 seconds MS-RLX-20 seconds MS-RMP-02 IF-Wide Treatment Time: 20 minutes Thoracic Garment: Place electrodes as shown
Ch1 (+)
Ch2 (-)
Ch1
Ch2 (+)
Ch1 (-)
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These suggested treatment protocols are offered as an example, only to treat decubiti and other types of open wounds with the PGS-123
I. Information
1. Gauge the wound. 2. Gauge the depth of the wound. 3. Try to establish the type of microorganism(s) present in the wound, if any. 4. Describe any aspects of the wound. 5. Photograph the wound, i.e.: pre-stimulation, weekly and monthly.
II. Basis
1. Polarity is the main dimension to consider. a. Negative Polarityto retard microorganism growth. b. Positive Polarityfacilitate cellular migration. c. Switching of polarity is used to re-activate the healing process after reaching healing plateaus.
1. Clean the wound. 2. Pack the wound with sterile gauze that has been soaked in sterile water or normal saline to enhance electrical activity. 3. Place one active electrode distal to the wound 4. Place the second active electrode (if possible) just distal to the first electrode. For multiple wounds you can place an active electrode over each wound. For multiple wounds see Treatment in Water. 5. Attach the dispersive electrode proximal to the active electrode(s), so that the current will take the most direct route through the wound and not around it.
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Current: Alternating Pulse Rate: 20-25 pps first 30 min.; 5 pps last 15 min. Polarity: Negative Intensity: Treat to Patient Tolerance Treatment Time: 45 minutes; three times per day or PRN If patient cannot tolerate low pulse rates, increase pulse rate to a more tolerable level.
Patient may feel worse on second day of treatment due to use of muscles which were in a state of disuse. Third day, patient should begin to feel improvement and increase in range of motion.
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Sciatica
Electrode Placement
2 electrodes: Place one over gluteal fold inferior to L5 & other below gluteal crease over sciatic path. 1 Dispersive: Place over belly of hamstring on contralateral side.
Edematous Hands
Electrode Placement
Active: Use glove on affected side. Dispersive: Place on opposite extremity
Control Setting:
Mode: Alternating Polarity: Negative Rate: 40 pps for MS pumping 10 pps for maximum MS pumping Amplitude: Maximum MS contraction level to tolerance Treatment Time: 1 hour, three times daily Glove: Red lead goes into glove Black lead placed into dispersive
Control Settings:
Mode: Continuous Polarity: Negative Rate: 100 pps Amplitude: Maximum Sensory Level Treatment Time: 1 hour, three times a day
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DeQuavairs
Electrode Placement
Dispersive: Place on lower back.
Control Settings:
Acute Pain Mode: Alternating Polarity: Negative Rate: 80-150 pps Amplitude: Maximum Sensory Level Treatment Time: 20 minutes Edema Reduction Mode: Alternating Polarity: Negative Rate: 30-50 pps Amplitude: Maximum Sensory Level Treatment Time: 30-40 minutes
Control Settings:
Acute Edema Mode: Alternating Polarity: Negative Rate: 80-150 pps Amplitude: Maximum Sensory Level Treatment Time: 20 minutes Chronic Edema mode: Alternating Polarity: Negative Rate: 30-50 pps Amplitude: Maximum Sensory Level Treatment Time: 20 minutes Sleeve: Red lead goes into sleeve Black lead placed into dispersive
Lateral
Medial
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Shoulder
Degenerative Joint Disease ................................................. 715.11 Pain in Shoulder .............................................................. 719.41 Rotator Cuff Tendonitis ...................................................... 726.1 Tendonitis ..................................................................... 726.11 Shoulder Impingement ...................................................... 726.19 Sprain/Strain .................................................................. 840.9
Arm
Upper Arm .................................................................... 719.42 Forearm ....................................................................... 719.43 Hand ........................................................................... 719.44 Pain in Arm/Hand/Limb ..................................................... 729.5
Thoracic
Thoracic Region .............................................................. 724.0 Pain in Thoracic Spine ....................................................... 724.1 Sprains/Strains of Other & Unspecified Parts of Back .................. 847 Dorsal or Thorasic Sprain & Strain ......................................... 847.1
Lumbar
Lumbar Radiculopathy ...................................................... 721.42 Herniated Disc ................................................................ 722.8 Degenerative Disc Disease ................................................. 722.52 Lumbar Region ............................................................... 724.02 Pain Low Back ............................................................... 724.2 Lumbosacral Radiculitis ..................................................... 724.4 Muscle Spasm ............................................................... 728.85 Lumbar Spondylolysis ....................................................... 738.4 Lumbar Vertebrae ............................................................ 839.20 Sprain/Strain Lumbosacral ................................................. 846 Sprains/Strains of Other & Unspecified Parts of Back .................. 847
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