Date post: | 03-Jun-2015 |
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Welcome!
Pain ManagementWithout the effect of DRUGS
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of DRUGS
NexWave
Presentation Overview
Basics of Electrotherapy
Different Types of Modalities
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Theories of Pain Control
Electrotherapy – Indications for use
Zynex NexWave Product Training
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Electrical impulses are sent through electrodes placed on the skin
Electrodes are placed over nerve centers near or over the area of pain
The impulses block pain by stimulating the nerve fibers and/or activating the release of endorphins
Types of Electrotherapy Modalities
Transcutaneous Electrical Nerve Stimulation (TENS)Typically delivered between 1 Hz and 250 HzIndicated for chronic and acute pain relief
Interferential Current (IFC)
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Interferential Current (IFC)Typically delivered between 4,000 Hz and 5,000 HzIndicated for chronic and acute pain relief, edema reduction, increase circulation
Neuromuscular Electrical Nerve Stimulation (NMES)
Typically delivered between 25 Hz and 80 HzIndicated for muscle disuse atrophy, muscle re-education, muscle spasm reduction, increase ROM
TENS Current
TENS current is typically delivered between 1 Hz and 250
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delivered between 1 Hz and 250 Hz.
With TENS and NMES Stimulation, sensation is felt directly under the electrodes
Interferential Current
IFC uses a fixed carrier frequency of 4,000 Hz per second and also a second adjustable frequency of 4,001-4,250 Hz per second.
4000 Hz 4010 Hz
4,010 Hz minus 4000 Hz = 10 Hz
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When the fixed and adjustable frequencies combine (heterodyne), they produce the desired signal frequency (Interference frequency or beat frequency).
IFC is concentrated at the point of intersection between the electrodes. This concentration occurs deep in the tissues as well as at the surface of the skin
4000 Hz 4010 Hz
4,000 Hz 4,010 Hz
10 Hz
Neuromuscular Electrical Stimulation (NMES)
NMES is usually delivered between 25Hz and 80Hz
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Stimulation is delivered at a much higher intensity (mA) than IFC or TENS
Electrodes are placed over muscle motor points to facilitate a muscle contraction instead of at a sensor or muscle twitch like IFC or TENS
TENS Versus Interferential Current (IFC)
TENS Versus IFC
IFC is believed to penetrate to deeper tissues than TENS because
the current is concentrated at the point of intersection between the
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the current is concentrated at the point of intersection between the
electrodes.
This concentration occurs deep in the tissues as well as at the
surface of the skin, reaching to greater depths and over a larger volume of tissue than TENS
Capacitive skin resistance decreases as pulse frequency increases.
For example, at a frequency of 4,000 Hz capacitive skin resistance is eighty times lower than with a frequency of 50 Hz (in TENS range)
How Electrotherapy
Controls Pain
Gate Control – Mild continuous high
There are two theories of pain control:
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Gate Control – Mild continuous high
frequency electrical stimulation (>20PPS) blocks the pain signal traveling to the brain
Endorphin Release – Strong but
comfortable low frequency electrical stimulation at a muscle twitch (<=10PPS) causes the body to release its own pain relieving substances called endorphins
The Gate Control Theory
• Pain stimuli travels along the small diameter, slow conducting nerve fibers to the spinal cord where they are transmitted to the brain (A-delta, C fibers)
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the brain (A-delta, C fibers)
• The pain stimuli carried by the small diameter fibers can be inhibited by stimulating the large diameter, fast conducting, sensory nerve fibers (A-beta fibers).
• The application of TENS to the A-beta fibers “closes a gate” in the spinal column which prevents the pain stimuli from reaching the brain
On-set of pain relief is immediate, but pain returns shortly after treatment
The Endorphin Release Theory
The Endorphin Release theory is based on the presence of natural
opiates in the body.
These opiates, which act as the body’s natural pain suppressor, are
produced in the pituitary gland as beta endorphins and in the spinal
cord as enkephalins.
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cord as enkephalins.
Stimulation of the sensory nerves promotes the release of these
opiates.
These endorphins then bind to specific receptor sites in the central
and peripheral nervous system where they block the perception of
pain.
Electrical stimulation applied at or below 10 Hz at a muscle
twitch has shown to produce endorphins. On-set of pain relief
is slower (20 minutes), but pain relief can last for hours after
treatment
Product Training Overview
NexWave
-Interferential Mode
-NMES Mode
-Marketing Materials
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-Marketing Materials
-Clinical documentation
Specific Treatments
NexWave – Product training
Features & Benefits
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Indications for Use
Product Operation & Programming
NexWave – Patient Locations
Rehabilitation Clinics
Physiotherapists & Doctors
Pain Management
Post Surgery or Injury
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Post Surgery or Injury
Sports Medicine
Sports Clinics & Sports Teams
Work Job Site Doctors
Worker pain relief while on the job
NexWave – Indications for Use
Transcutaneous Electrical Nerve Stimulation (TENS)Management and symptomatic relief of chronic intractable pain, post-traumatic and post-surgical pain
Interferential Current (IFC)Management and symptomatic relief of chronic intractable
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Management and symptomatic relief of chronic intractable pain, post-traumatic and post-surgical pain
Neuromuscular Electrical Stimulation (NMES)Relaxation of muscle spasms
Prevention and retardation of disuse atrophy
Increase of local blood circulation
Muscle rehabilitation and re-education
Maintaining and increasing range of motion
NexWave – Clinical Benefits
Product Features & Benefits
3 Modalities in 1 Device
TENS, IFC, and NMES
Microprocessor controlled
Integrity of waveform is maintained under extreme conditions
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Allows for a small design for portability
Digital Display
Displays Modality
mA output treatment
Timer information
Program for desired waveform
NexWave – Safety & Compliance
Built in Compliance MeterRecords number of treatments and treatment time
Documents patient usage to help with coverage and substantiate compliance
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and substantiate compliance
Unlock/Lock ButtonAfter 20sec the units locks to prevent accidental changes in stimulation & settings
Dual Power: 9V and A/C AdapterWorks on 220/110 and saves battery life
Battery can be installed either direction
NexWave Programing
On/Off and Modality Selection
1. Press on/off Button Once
to Turn Device On
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2. Press labeled Button to
Enter Modality: IFC TENS
NMES
NexWave Programming
Selecting the Mode
5. To select the desired mode,
continue to pressing Mode button
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6. Must unlock before any changes
can be made
NexWave Programing
Intensity & Treatment Time Setting
7. + (up) to Increase Intensity
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8. Press the Timer button and select a
Treatment Time (10 – 90 min.) or
“Continuous” for No Timer
NexWave Programing
Compliance Meter
9. Screen Demonstrates All
information
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10. Device is Now Programmed and
Ready to Start Treatment
NexWave Operation
Electrode Set-up
1. Connect Leadwires to Electrodes
While Electrodes are Still on Plastic
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Tip: It is easier to connect leadwires to the
electrodes before placing the electrodes over
the treatment site
NexWave Operation
Electrode Placement
2. Place the Electrodes Over the Treatment Site.
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Important: When Using IFC, Electrodes Must be Crisscrossed.
IFC
Placement
TENS
Placement
TENS or NMES
Placement
NexWave - Operation
Connect The Leads
3. Connect Lead wires to Device
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Important: Make Sure Lead wires are
Inserted Completely
NexWave - Operation
Start Treatment
4. Press Up Button to Set Desired
Stimulation Level
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Stimulation Level
Important: Stimulation Should be Set to
a Strong, but Comfortable Sensation
NexWave - IFC Modes
Low High Mode:Channel 2 Freq. Sweeps between 4001 Hz and 4128 Hz every 15 sec. Channel 1 remains set at 4000 Hz
Lumbar – Lower Back Pain
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IFC
Placement
Current should cross where most of the stimulation is delivered in the area of the pain. Placement must allowfor surgical site, density of tissue and nerve position.
NexWave - IFC Modes
Low:Channel 2 Freq. Sweeps between 4001 Hz and 4010 Hz every 15 sec. Channel 1 remains set at 4000 Hz
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IFC
Placement
Current should cross where most of the stimulation is delivered in the area of the pain. Placement must allowfor surgical site, density of tissue and nerve position.
NexWave - IFC Modes
Combo:
Combo consists of three 2 minute cycles which repeat over the duration of the treatment:
1st cycle – Low Mode
2nd cycle – High mode where channel 2 sweeps between4064 Hz 4000 Hz. Both channels are cycled on and off
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4064 Hz 4000 Hz. Both channels are cycled on and off At 6 sec. intervals.
3rd Cycle- Muscle Mode: Frequency of channel 2 is fixed at 4064 Hz, and channel 1 is fixed at 4000. Both channels areCycled on and off at 6 sec. intervals.
IFC
Placement
NexWave - TENS Programs
SweepTENS frequency decreases from 125 Hz to 11Hz over 4 seconds. During this period the Pulse Width adjusts 120 to µs to 300 µs. Then frequency is increased from 1 to 10 Hz over 2 sec, the pulse width remains at 300 µs. The increased from 11 Hz to 125
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remains at 300 µs. The increased from 11 Hz to 125 Hz over a 4 sec. span. During this same time the Pulse Width is decreased from 300 µs to 120 µs.
Benefits:Sweep allows for gate block (quick onset of relief) and Endorphins Release (long Carry-over) in one program
NexWave - TENS Programs
LMD – Low ModulatedThe Frequency sweeps from 66.7 to 100 Hz 100 µs and back again over 12 sec. Pulse
Benefits:
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Benefits:
Quick on set of relief
No modulation may result in accommodation
NexWave – TENS Programs
Modulate
The frequency shifts between 66 and 100 Hz at an interval of 6 seconds. The Pulse Width will also shift during the 6 seconds interval. The default Pulse Width is 225µsec. and when the frequency is at it’s minimum, the Pulse Width is at it’s maximum and visa
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minimum, the Pulse Width is at it’s maximum and visa versa.
Benefits:
Quick onset of relief
Modulation helps prevent accommodation
Comfortable massaging sensation
NexWave – NMES Programs
Preset 10 sec. ON -10 sec. OFF
Preset 20 sec. ON -10 sec. OFF
Preset 30 sec. ON -10 sec. OFF
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Preset 30 sec. ON -10 sec. OFF
Benefits
Both channels are On and Off at the same time
Muscles Strengthening
Increase ROM
Muscle re-education
Low Back Neurostimulation System
Conductive Garment Description
Allows Patient to Place Electrodes on Lower Back Without Assistance
Electrodes Stay on Garment When Removed from Body for Easy Reapplication
Product Positioning
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Product Positioning
Pain Management
Physical Therapy
Compatible Devices:
TruWave TENS
NexWave
IF8100 IFC
Distribution Materials
Communication Materials
International Web page
Device Specs
“Getting Started” Pages
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“Getting Started” Pages
Electrotherapy Studies
Power Point Presentations
Physician & Physiotherapist
Supporting Research on Electrotherapy for
Pain Management
Defines TENS mechanism of pain control
Establishes benefits of electrotherapy as an adjunctive
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electrotherapy as an adjunctive pain control option
Gives Support to electrotherapy by referencing research with copy of abstracts on back
Target market is Interventional Pain Management Specialist
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Thank You
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