TROPHIC FACIAL STIMULATOR USER MANUAL

NOTES CONTENTS

Contents

2

Facial Stimulator

3

Contraindications & Precautions

4

Care of your stimulator & accessories

5

Using the Stimulator

6

Facial Muscles

7

Electrode Placement

8

Facial Maps

9

Treatment for Facial Paralysis

10

Facial Exercises

11

The Programmes

12

Troubleshooting

13

Specifications

14

Notes

15

2

15

SPECIFICATIONS Signal Strength Indicators

Pulse Indicator

Battery Life Indicator

Dual Channel Neuromuscular Stimulator Pulse Geometry

Asymmetrical Biphasic net zero dc

Frequency

5 Hz to 20 Hz

Pulse Width

100 micro Seconds

On Cycle

2 Seconds

Off Cycle

2 Seconds

Supply Voltage(battery)

2 X “AA” 1.5 Volt Batteries

Power Output

0 to 60 milliAmps

A IIIIIIII B IIIIIIII

IIII X 20

The Display Signal Strength Buttons

On / Off Button

Countdown Timer

Electronic Amplitude Control Safe start 0 volts at switch on Operating Temp

0 to 40 degrees Celsius (32 to 104 F)

Humidity Range

10 to 90 R.H

Store within temperature range –23 C to 50 C (-9 F to 122 F) At 90% maximum relative humidity non condensing 500 hPA to 1060 hPA (0.5 Atm to 1.05 tm)

The Facial Trophic stimulator is an advanced micro-processor controlled 2 channel stimulator, designed specifically for the treatment of facial palsy. It features a liquid crystal display, making setup and use simple. The display shows output level, pulse output, battery level and remaining time left to end of treatment.

Suitable for continuous use

The unit features 5 treatment modes. Palsy is a sequential frequency for treatment of most palsies 5Hz, 10Hz & 20 Hz for muscle building for palsies of long standing Synkinesis1 & synkinesis2 for correct treatment of facial synkinesis.

14

3

Contra-indications and Precautions

1. It is inadvisable to use neuromuscular stimulation if a demand type pacemaker is fitted. 2. It is not advisable to drive a car or operate potentially dangerous machinery whilst receiving treatment. 3. The safety of neuromuscular stimulation during pregnancy has not been established. 4. Care must be used when treating the neck area to avoid the immediate vicinity of the richly innervated carotid sinus. 5. The patient should only use the unit as prescribed. 6. The unit should only be used on the person for whom it was prescribed. 7. Skin irritation from the treatment itself does not occur; however certain skin types do react to the tape and should use a hypoallergenic brand. Different electrodes are available for the rare occasions when a skin reaction in the shape of the pad is seen. 8. Do not immerse the unit in water. 9. Simultaneous connection of a stimulator and H.F surgical equipment may result in burns at the site of the stimulator electrodes and cause possible damage to the stimulator. 10. Operation in close proximity (e.g. 1 metre) to a shortwave or microtherapy equipment may produce instability in the stimulator equipment.

TROUBLE SHOOTING Unit Dead Replace battery Low output Check battery level on display, if less than 2 bars change battery Check condition of electrodes & cables Check electrodes placed correctly Output intermittent Check cables pushed into stimulator fully Check electrodes & cables Current output surges Check electrodes & cables Check cables pushed fully into stimulator No Output To increase output level, push and hold increase buttons. Pressing repeatedly will advance output in very small steps Check cables are pushed fully into stimulator Check condition of electrodes Unit wont switch off Press and hold ON/OFF button for 3 seconds until SWITCH OFF is displayed This prevents accidentally switching off the unit

11. Only use electrodes provided with the stimulator. Do not reduce the size of the electrodes.

4

13

The Programmes

Care of your Stimulator and Accessories All NuroMed stimulators are designed and built to comply with all British and European medical standards. This will ensure that our products are safe and will give you years of trouble free use. To ensure that the product remains in good condition and to prevent accidental damage please observe the instructions below.

All programmes are :2 seconds stimulation 2 seconds rest 100 micro seconds pulse width PALSY 5 Hz 10 minutes 10 Hz 10 minutes 15 Hz 10 minutes 10 Hz 10 minutes 5 Hz 10 minutes 10 Hz 10 minutes

treatment time 60 minutes

5 Hz

treatment time 60 minutes

10 Hz

treatment time 180 minutes

20 Hz

treatment time 30 minutes

SYNKINESIS 1 14 Hz 3 minutes 13 Hz 3 minutes 12 Hz 3 minutes 11 Hz 3 minutes 10 Hz 3 minutes 9 Hz 3 minutes 8 Hz 3 minutes 7 Hz 3 minutes 6 Hz 3 minutes 5 Hz 3 minutes

treatment time 30 minutes

SYNKINESIS 2 5 Hz 3 minutes 6 Hz 3 minutes 7 Hz 3 minutes 8 Hz 3 minutes 9 Hz 3 minutes 10 Hz 3 minutes 11 Hz 3 minutes 12 Hz 3 minutes 13 Hz 3 minutes 14 Hz 3 minutes

treatment time 30 minutes

Only use approved electrodes and cables for your treatment. Electrodes and gel should comply with current legislation and be certified to be bio-compatible. Electrodes and gel supplied by NuroMed are from approved sources. Do not cut electrodes down in size as this will impair the electrode and may result in too high a current density. After use wash electrodes (not self adhesive) in soapy water to remove gel and prevent bacterial build up. Wipe away excess liquid with a dry cloth and allow to dry, do not place on a radiator. Self adhesive electrodes should be wiped with a moist finger to stop them drying out after use. Replace on their backing and put away in their sealed bag. Only use alkaline batteries for optimum use of your stimulator, non-alkaline batteries will not last as long and may impair the output levels. Remove the battery if your stimulator is not to be used for more than a month. Remove flat batteries immediately as corrosion may damage your stimulator. If using a re-chargeable system follow the instructions supplied with your charger. Any charger system used should comply with appropriate LVD and EMC directives. Do not charge Alkaline or non re-chargeable batteries. Do not dispose of any battery on a fire or incinerator. The stimulator should only be connected to correct battery types. Examine the cables periodically and do not use if split or wires are exposed. Connectors that come into contact with the electrodes should be cleaned with a moist cloth to remove gel etc. Periodically examine the cabinet of your stimulator and ensure that the casing is in good condition. If cracked or physically damaged return it to NuroMed for inspection /repair. The cabinet should be cleaned with a cloth moistened in soapy water or proprietary cleaning solution. Do not spray liquids onto the cabinet as it is not waterproof and excess liquid will damage the unit. If the unit is subjected to excess liquid damage do not use, return to NuroMed for inspection/ repair. NuroMed stimulators should not be used in the presence of flammable mixtures. All NuroMed stimulators comply with EMC regulations, for your safety and correct operation do not use in close proximity to devices that emit radiation as part of their operation I.e. mobile phones, short wave therapy systems etc. Do not dismantle there are no user serviceable parts inside.

12

5

Using the Stimulator Switch the unit on by pressing the ON/OFF button unit will beep to indicate unit is on The stimulator will come on in PALSY mode this is suitable for treatment of most palsies Pressing the ON/OFF button again will change to 5Hz Pressing the ON/OFF button again will change to 10Hz Pressing the ON/OFF button again will change to 20Hz 10 Hz is to be used to build up the muscle if the palsy is of longstanding and the muscle needs to be rebuilt 20 Hz is to strengthen muscle again after a longstanding palsy 5 Hz is used for treatment of synkinesis Pressing the ON/OFF button again will change to SYNKINESIS 1 Used to promote muscle release and balance and to retrain eccentric muscle work in eyebrows Pressing the ON/OFF button again will change to SYNKINESIS 2 Used to promote facial movements, a more advanced program which may be used once the tightness starts to loosen off. When you have selected program to use it will start in a few seconds of releasing the button. The screen will display output level, battery level pulse output and battery level. To increase pulse strength press A+ or B+ this may be done at any time. Adjust output until you can feel the muscle just moving, large movements of the muscle do not give better results and will tire the muscle quickly. Press A– or B– if you want to reduce the output level.

FACIAL EXERCISES Exercise each side of the face separately Exercise 1 Lying down with small mirror in hand Raise the eyebrow with finger – look in the mirror. There shouldn’t be any activity under the eye , as only your finger is working. Relax the eye. Now slowly raise the eyebrow using the forehead muscles. Concentrate on the forehead muscles of the side you are exercising and remove the finger support. Try to gently retain eyebrow position. This exercise is to encourage forehead movement without mass movement of the cheek. It will become easier with electrical work.

Exercise 2 Raise corner of mouth into a smile position. Keep the cheek relaxed , Make the movement using a cotton bud, doing all the work with the cotton bud so that the muscles under the eye remain relaxed. Ignore the other side of your face. Think about the small muscles in your cheek, remove the bud and try to hold the smile. This will eventually give you a nice smile without eye movement, whilst you are lying down ! Keep repeating this, in time you will be able to smile sitting up.

Lying down without the mirror Place fingers gently onto the forehead. Raise your eyes to look behind you. Feel the wrinkles on your forehead, both sides working together. Soon you will feel more wrinkles.

On PALSY and SYNKINESIS programs the frequencies change throughout the program, this is normal. DO NOT ADJUST THE OUTPUT LEVEL if it feels weaker . Lower frequencies feel as though they have less energy.

After 2 months Try these procedures sitting in front of a mirror as opposed to lying down. Do not work too hard though, otherwise you will get unwanted activity under opposite eye.

The stimulator will switch off after the preset time of the program. If you wish to end treatment press the ON/OFF button until SWITCH OFF is displayed.

Repeat 5 times per exercise twice a day Hold each position up to 5 seconds

Some typical pad placements are shown on face map adjacent to this page. Your physiotherapist may recommend others more suitable for your condition.

It is the quality of the movement which is important. DO NOT RUSH.

6

11

TREATMENT FOR FACIAL PARALYSIS Acute The paralysis is in the first 6 weeks of onset. A realistic prognosis is not always possible as the degree of nerve damage has not been ascertained. Treatment may be initiated and cases with a neuropraxia will soon establish a full recovery. Use stimulator daily for 1 hour per day. Electrode placements may change on a daily basis to match the changing needs of the recovering face. Sub Acute Paralysis has persisted for 6-12 weeks without full recovery. It is most likely to be an axonotnemesis and nerve regeneration may be anticipated at a rate of 1mm per day Treatment may be initiated at this stage to minimise the complications which occur with nerve muscle mismatch. Use stimulator daily for 1 hour general order would be:Risorius/Zygomaticus Major - until mouth rests at midline Risorius/Levator Labii-until movement occurs in cheek Frontalis/Depressor Labi - prolonged treatment until face achieves balance Once recovery of forehead and lower lip are achieved further stimulation may take place to the cheek or lips as required. Chronic (3-12 months Post Onset) The principals of treatment for sub acute above will be used from 3-12 months if full recovery is not achieved. Chronic (1 year +) If after 12 months post onset, examination of the face still reveals a degree of denervation stimulation will show an improvement in movement which will become functionally appropriate with use of exercises. Long treatments for both the above are required, possibly 3 hours per day. Stimulation may be through the night whilst asleep. Exercise as soon as new movements are achieved Following Nerve or Muscle Grafting The use of stimulation will improve circulation and help with the production of spontaneous movement patterns. Treat for 1 hour per day with specific focus on reinnervating areas. NB. Following surgical damage to the nerve e.g. acoustic neuroma or parotid tumour removal the natural recovery process of axonotnemesis will take longer. Maximum recovery potential may be between year 2 and 3 in former.

10

7

ELECTRODE PLACEMENT Black = Cathode

Red = Anode

The cathode is placed on the motor point, these points do suffer slight individual differences. A feel will develop for most suitable electrode placement after treatment over a few weeks. The anode is placed close to the motor trunk in a position which is proximal in relation to the motor trunk. The electrodes should not touch, if this happens no treatment will occur. A Occipi Frontalis Where there is a flicker of movement present in the forehead. Where the lower position of the eyebrow is a major problem Where a tightness around the eye is a major concern B Levator Labii When the top lip does not lift during normal function Notes

C Zygomaticus Major When smiling is a problem D Risorius Where a flaccid paralysis of the cheek where resting position of the mouth shows a distortion to the unaffected side of the face. Risorius should be treated until symmetry at rest is achieved. E Depressor Labii To prevent catching the bottom of the lip during speech. This problem is only usually where a degree of recovery has taken place in the cheek and top lip.

The figures opposite are for your physiotherapist to show placements for you.

A good idea is to take a photo before you start treatment, and again periodically. You will then be able to see your progress.

Notes

8

9