PHYACTION PERFORMA Instructions for Use Feb 2004

Contents

INTRODUCTION CHAPTER 1 1.1 1.2 1.3 1.4 1.5

Electrical safety... Explosion safety... Safety in use... Use of the appliance... Medical device directive...

CHAPTER 2 2.1 2.2 2.3 2.4 2.5 2.6

4.1 4.2 4.3 4.4

3 3 3 3 3 6

EXPLANATION OF THE OPERATING MECHANISMS

Mains switch... Selector key channel A... Selector key channel B... Selector key for pulse length... Channel A pulse length display... Channel B pulse length display... Pulse repeat frequency selector key... Pulse repeat frequency display... Peak output selector key... Average output selector key... Channel A output display... Channel B output display... Treatment time selector key... Treatment time display... Adjustment regulator... Start/stop key... Start/stop indicator lamp... Emitter A connection... Emitter B connection... Fixing points for electrode arms... Electrode arm... Circuplode... Mains entry port with mains fuses... Connection for potential equalizing cable... Model specification plate... Undercarriage with swivel castors... Ventilation openings...

CHAPTER 4

2 2 2 2 2

INSTALLATION

Check on delivery... Power voltage... Functional test... Placing and transportation... Fastening electrode arms and electrodes... Use of the high-frequency induction field indicator...

CHAPTER 3 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 3.10 3.11 3.12 3.13 3.14 3.15 3.16 3.17 3.18 3.19 3.20 3.21 3.22 3.23 3.24 3.25 3.26 3.27

SAFETY ASPECTS

7 7 7 7 7 7 7 7 7 7 8 8 8 8 8 8 8 8 8 8 9 9 9 9 9 9 9

TREATMENT ASPECTS AND SETTING SEQUENCE

Introduction... Measures to be taken BEFORE treatment... Measures DURING treatment... Measures AFTER treatment...

Contents - Instructions for use Phyaction Performa

10 10 11 12

CHAPTER 5 5.1 5.2 5.3 5.4 5.5 5.6

Introduction... Dosage... Treatment frequency... Number of treatments... Contact control... Treatment guidelines...

CHAPTER 6 6.1 6.2 6.3 6.4 6.5 6.6

8.1 8.2 8.3

INDICATIONS AND CONTRA-INDICATIONS

EXAMPLES OF TREATMENT

CHAPTER 10

FAULTS, GUARANTEE AND MAINTENANCE

Faults... Replacing the mains fuses... Guarantee and service... Cleaning... Maintenance... Disinfection and sterilization... Technical maintenance...

CHAPTER 11 11.1 11.2

TECHNICAL SPECIFICATIONS

ACCESSORIES

Standard accessories... 30 Optional accessories... 30

CHAPTER 13 13.1 13.2

27 27 27 28 28 28 28

Specifications... 29 Technical data... 29

CHAPTER 12 12.1 12.2

20 20 20 20 21 22

Indications... 23 Absolute contra-indications... 23 Relative contra-indications... 23

CHAPTER 9

10.1 10.2 10.3 10.4 10.5 10.6 10.7

17 17 17 18 19 19

EFFECTS OF SHORT-WAVE THERAPY

Introduction... Reactions to heat... Thermal effects... Athermal effects... Influence of electromagnetic energy on wound healing... Specific effect on soft-tissue lesions...

CHAPTER 8

13 13 15 15 15 15

BASIC DATA ON SHORT-WAVE THERAPY

Introduction... Generation of the electromagnetic field... The Circuplode conductivity method... Penetration depth... Dissipation... Specific absorption rate (SAR)...

CHAPTER 7 7.1 7.2 7.3 7.4 7.5 7.6

PARAMETERS OF SHORT-WAVE THERAPY AND TREATMENT GUIDELINES

EXPLANATION OF THE SYMBOLS

Symbols on the front of the appliance... 31 Symbols on the model plate... 31

BIBLIOGRAPHY Contents - Instructions for use Phyaction Performa

Contents - Instructions for use Phyaction Performa

INTRODUCTION

You have selected the Phyaction Performa, Uniphy’s short-wave therapy appliance. Many congratulations on your purchase. We are convinced that the Performa will serve you for many years in the treatment of a great many symptoms. The Phyaction Performa is an appliance used in pulsating short-wave therapy, whereby the various parameters can be set in a simple and orderly manner. This manual should not only been seen as an instruction manual for the appliance, but also as a work of reference covering various aspects of short-wave therapy. The first four chapters provide information on the various safety aspects, installation, operating mechanisms and methods for adjustment. Chapters 5 to 9 will be of interest to those interested in the theory of short-wave therapy; basic data, effects, explanation of the various parameters, indications and contra-indications. In chapter 10, practical applications for short-wave therapy are shown for a number of indications. If you have any questions or comments, we would be glad to hear from you. Our physiotherapists are always ready to help you. We wish you every success with the therapy!

Uniphy BV February 2004

INTRODUCTION

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CHAPTER 1

SAFETY ASPECTS

1.1 Electrical safety The appliance may only be used in areas containing facilities which comply with current legal requirements. Pay particular attention to the use of the earth connection, as otherwise the patient’s leakage current will exceed the permitted limit for BF-type appliance. 1.2 Explosion safety The appliance is not suitable for use in areas where inflammable gases or fumes are present. Therefore, remove the plug from the socket before disinfecting the area in which the appliance is located, as some disinfectants evaporate to form an explosive mixture. 1.3 Safety in use - Metal parts can cause concentrations of intensity in the high-frequency field. This applies both to implanted metal objects and objects which the patient is carrying and which are located close to the applicator. The standard minimum distance is 1 metre from the applicator. See paragraph 4.2. - Patients with a pacemaker may not be treated. Patients implanted with other electronic equipment may receive short-wave therapy, as long as sufficient care is taken. If there is any doubt, consult a doctor. See paragraph 4.2.3. - The appliance is not suitable for use in wet areas. - The appliance must not be disinfected or sterilised. - Each time the appliance is switched on (with the main switch) an automatic test is carried out. - The Circuplode(s), including the cable and plug, must be checked regularly for damage. - Using this appliance in the proximity of another high-frequency electrotherapy appliance can affect the correct operation of the appliance. - The proper and safe operation of the device can only be guaranteed if it is used with the standard and/or optional accessories as mentioned in these operating instructions (see chapter 12, ACCESSORIES). - In order to safeguard the long-term safety of the device, we advise you to have a technical safety check of the device and the accessories performed at least once every year. 1.4 Use of the appliance The appliance and accessories must be used solely by qualified persons (trained in the application of shortwave therapy) in accordance with all the requirements included in this manual. The Phyaction Performa must be used solely for providing short-wave therapy. The temperature range for the use of the Phyaction Performa ranges from +10°C to +40°C. The temperature range for storage and transport of the device ranges from -20°C to +70°C. 1.5 Medical device directive This device complies with the essential requirements of the Medical Device Directive of the European Committee (93/42/EEC). For information on manufacturer’s liability, see chapter 10, FAULTS, GUARANTEE, MAINTENANCE.

1. SAFETY ASPECTS

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CHAPTER 2

INSTALLATION

2.1 Check on delivery Check that the appliance, the electrode arm(s) and the conductivity electrode(s) were not damaged during transport, and that the accessories are intact and complete (see chapter 12 ACCESSORIES). In the event of damage and/or missing parts, contact your supplier. 2.2 Power voltage Your appliance is suitable for a nominal power voltage of 110-120 or 220-240 Volt AC, 50-60 Hz. The model plate on the reverse of the appliance indicates the power voltage for which your appliance is wired. You cannot change this yourself. Check this data carefully before putting the plug in the socket. The mains entry port is located on the back of the appliance. 2.3 Functional test The appliance is tested during production for electrical safety. Each time the appliance is switched on, the processor carries out a two-second safety test to assess whether the appliance is functioning correctly. You must check whether all the displays and lamps light up. After the test has been completed, you will hear a buzzing sound, and the appliance can be operated. If a fault is detected during treatment, this is indicated on the display by lines (--). The appliance will no longer operate. See paragraph 10.1. 2.4 Placing and transportation Read chapter 1 on Safety Aspects before you use the Phyaction Performa for the first time. Ensure that the appliance is horizontal and stable. Do not place the appliance close to heat sources such as radiators or hotair grids and avoid leaving the appliance for long periods of time in direct sunlight. Ensure that the ventilation grilles on the back of the appliance are not covered, so that air can circulate freely. Do not place any objects on the appliance, and ensure that no liquids are spilled into the appliance. If any liquids or foreign objects do enter the housing, switch off the appliance immediately, remove the plug from the socket and contact your supplier to have the appliance inspected before using it again. We would like to emphasise the fact that the Circuplodes must be handled very carefully. We also recommend that you avoid using the Phyaction Performa immediately after extreme temperature changes. 2.5 Fastening electrode arms and electrodes On the last page of this instruction manual you will find a drawing showing the appliance and accessories. The numbers in the text correspond to the numbers in this drawing. Thanks to their special construction, the Phyaction Performa’s conductivity electrodes are known as Circuplodes. 2.5.1 Assembly The electrode arm(s)23 must be mounted in the correct manner on the back of the cabinet. See figure 1. If necessary, use the crosshead screwdriver supplied to mount the arms.

2. INSTALLATION

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Figure 1. Fastening the electrode arm(s) 2.5.2 Adjusting the electrode arms Figures 2 to 6 show how the various joints of the arms can be adjusted, if necessary. The fixing points of the arms must be adjusted in such a way that the arms can be properly fixed in placed by hand-tightening the black fixing-knob24. For adjustment, use the heaviest electrode only with the arms set at the position shown in figure 2. Use the box spanners supplied.

Figure 2.

2. INSTALLATION

Figure 3.

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Figure 4.

Figure 5.

Figure 6. 2.5.3 Composition of fixing system Figure 7 shows the composition of the fixing system. The black fixing-knob24 is mounted as standard on the front of the arm. If required, it can also be mounted on the back.

Figure 7.

2. INSTALLATION

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2.5.4 Electrode fastening The electrodes26 are inserted into the opening at the end of the electrode arms, and fixed in place using the black knob27. See figure 8.

Figure 8. 2.5.5 Connecting the electrode cable(s) On one side, the electrode cable is connected to the Circuplode by means of two identical bayonet connectors, and on the other side connected to the connection18,21 on the back of the appliance. Then fix the cable in the channel of the cable guide28, which is fixed halfway along the electrode arm. This prevents the cable touching a patient or another cable, which could concentrate the electromagnetic output. 2.6 Use of the high-frequency induction field indicator Included as standard with the Phyaction Performa is an indicator which can make the high-frequency induction field visible to both you and your patient. To do this, hold the indicator against the active Circuplode, making sure, in connection with the contact check, that at least 50% of the electrode surface is covered by your hand,. As soon as the dosage is increased and output flows from the appliance, the yellow LED on the indicator lights up. The LED glows brighter as the output increases. At low frequencies, the LED will blink.

2. INSTALLATION

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CHAPTER 3

EXPLANATION OF THE OPERATING MECHANISMS

On the last page of this instruction manual you will find a drawing showing the appliance and accessories. The numbers in the text correspond with the numbers in this drawing. 3.1 Mains switch The mains switch1 on the top of the front side of the appliance is used to switch the Phyaction Performa on and off. Switching on: press the key to the right (I). Switching off: press the key to the left (0). 3.2

Selector key channel A After pressing the selector key2 for channel A, the green lamp in the key lights up. You can now set the parameters for channel A.

3.3

Selector key channel B After pressing the selector key3 for channel B, the green lamp in the key lights up. You can now set the parameters for channel B.

3.4

Selector key for pulse length After pressing the selector key for pulse length4 the green lamp in the key lights up. Pressing this key links the adjustment regulator15 to the pulse length parameter for channel A or channel B. The pulse length can now be set between 65 and 400 µs and is shown on the display5 for A or the display6 for B.

3.5 Channel A pulse length display This display5 shows the pulse length for channel A in microseconds. The pulse length can be set by selecting channel A and pressing key4. 3.6 Channel B pulse length display This display6 shows the pulse length for channel B in microseconds. The pulse length can be set by selecting channel B and pressing key4. The display will not light up if channel B is not connected. 3.7

Pulse repeat frequency selector key After pressing the pulse repeat frequency selector key7 the green lamp in the key lights up. Pressing this key links the adjustment regulator to the pulse repeat frequency parameter of both channel A and channel B. The frequency can now be set between 26 and 400 Hz, in ten steps, and can be read on the display8.

3.8 Pulse repeat frequency display The pulse repeat frequency display8 shows the pulse repeat frequency for both channels. When this is set for channel A, for example, it is also adopted by channel B. 3.9

Peak output selector key After the peak output selector key9 is pressed, the green lamp in the key lights up. Pressing this key causes the peak output to be shown on displays11 and 12. The peak output of the large Circuplode (diameter 14 cm) can be set between 0 and 200 Watt, and of the small Circuplode (diameter 9 cm) between 0 and 100 Watt. If the lamp flashes on and off, this indicates that the peak output is being shown on the display while the key9 is not pressed in. 3.10 Average output selector key After this key10 is pressed, the green lamp in the key lights up. Pressing this key causes the average output to be shown on display11 and display12. This also links the adjustment regulator to the output parameter. The

3. EXPLANATION OF THE OPERATING MECHANISMS

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average output for the large Circuplode can be set between 0 - 32 Watt and the small Circuplode between 0 - 16 Watt. If the lamp flashes on and off, this indicates that the peak output is being shown on the display while the key10 is not pressed in. 3.11 Channel A output display The display11 shows the peak or average output, depending on the choice of keys 9 or 10. During automatic adjustment, the display will flash on and off. After switching on with key16 the display shows the actual output. This can vary slightly from the values set in advance. 3.12 Channel B output display This display will light up only if an electrode is connected to channel B. See 3.11 for further details. 3.13 Treatment time selector key After the treatment time selector key13 is pressed, a green lamp in the key lights up. This links the adjustment regulator to the treatment time parameter. Treatment time can now be set in minutes, and can be read on display14. Treatment can only start once the treatment time has been set. 3.14 Treatment time display The treatment time display14 shows the set treatment time or the remaining treatment time. Treatment time is the same for both channels. Between 0 and 10 minutes, the time is displayed in half minutes, between 10 and 30 minutes it is displayed in whole minutes. When the timer is operational, this is shown by a flashing dot on the display. In the event of insufficient contact, treatment is interrupted and the treatment timer stops. At the end of the treatment time, a buzzer will sound for 4 seconds, and the output is returned to 0 Watt. 3.15 Adjustment regulator All parameters are set with the adjustment regulator15: the regulator is linked to the parameter for which the green lamp is lit. To reduce the value, turn the regulator to the left. To increase the value, turn the regulator to the right. The regulator has no start or finish settings. The parameter value can be read off the appropriate display. The adjustment range is determined by the parameter selected. 3.16 Start/stop key When treatment is commenced, the lamp in the key goes green. It can only be started if a treatment time has been set. Treatment can be stopped before the end of the treatment time by pressing the start/stop key16 again. The output is then reduced to zero. The lamp in the key then lights up red. 3.17 Start/stop indicator lamp During the automatic test when the appliance is switched on, the start/stop lamp17 lights up yellow. If treatment has stopped or has not yet started, the lamp is red. When treatment is started, the lamp lights up green. 3.18 Emitter A connection The electrode cable20 is connected to this connection18 via the bayonet connection19. The length and impedance of the cable are critical. For this reason, never use other commercially available cables. Connecting any cable other than one supplied can jeopardise the patient’s safety and damage the correct operation of the appliance, and is therefore prohibited.

3.19 Emitter B connection For the connection of emitter B19 see 3.18. 3.20 Fixing points for electrode arms The electrode arms are fixed to the fixing points22. For assembly details see paragraph 2.5.

3. EXPLANATION OF THE OPERATING MECHANISMS

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3.21 Electrode arm The electrode arm23 is connected to the fixing points22 Using the large black knob24, one of the joints of the fixing system can be locked. At the end of the arm there is an opening25 in which the Circuplode26 can be inserted. The Circuplode is locked in place by means of the small black knob27. The cable can be fitted into the cable guide28 attached to the arm. 3.22 Circuplode On the back of the Circuplode26 there is a connection29 to which the bayonet connection30 of the electrode cable31 can be connected. You will also see a lamp32 which lights up green as soon as there is any electromagnetic output. During adjustment and in the event of insufficient contact, the lamp will flash on and off. 3.23 Mains entry port with mains fuses The mains power cord34 (supplied) is connected to the mains entry port33. Here there are also two 6.3 A F mains fuses (type G, 250 V). See paragraph 10.2 for instructions on replacing faulty fuses. 3.24 Connection for potential equalizing cable A special earth cable can be supplied for use in areas for which a potential equalizing cable is required in accordance with national installation standards, and connected to this connection35. 3.25 Model specification plate The model specification plate36 shows appliance data such as the model and serial number (for service and guarantee, etc.), as well as connection data such as mains voltage and measured power. 3.26 Undercarriage with swivel castors The two wheels on the front of the undercarriage37 are fitted with foot-operated brakes; to block them, press down the handle38, to release them, pull the handle up. 3.27 Ventilation openings The ventilation openings39 in the housing allow the heat produced by the electronics to be expelled. It is important that these openings are not covered.

3. EXPLANATION OF THE OPERATING MECHANISMS

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CHAPTER 4

TREATMENT ASPECTS AND SETTING SEQUENCE

4.1 Introduction This chapter deals with various measures which must be taken before, during and after treatment. For further information on the theory of pulsating short-wave therapy and the parameters, we refer you to chapters 5 through 8. Before using this appliance for the first time, please read chapter 1, Safety Aspects, and chapter 2, Installation. 4.2 Measures to be taken BEFORE treatment Chapter 8, Indications and Contra-indications, contains information essential for safe and effective treatment. Before commencing treatment, ensure that there are no contra-indications. 4.2.1 Metal objects and furniture Metal articles can cause concentrations of intensity in the high-frequency field. This applies both to metal objects worn or carried by the patient and to objects in the close vicinity of the applicator. As a rule of thumb, a minimum distance of 1 metre must be observed. Therefore, use only wooden, glued furniture. During treatment, the patient must also not come into contact with any metal objects, such as radiators or window frames. 4.2.2 Clothing and intervening substance For all short-wave treatments, it is recommended that the patients remove their clothing, and that a towel be placed between the skin and the electrode. The towel keeps both skin and applicator dry. It also prevents loss of heat, promotes hygiene and ensures the patient’s privacy. Treating patients who are naked offers various advantages: firstly, it is the easiest way to ensure that no metal objects are located in the high-frequency field (metal in clothing, such as buttons, zips, or hidden jewellery, keys, etc.) Secondly, it also prevents undesired concentrations of energy resulting from nylon, leather, damp sweaty clothing, ointment dressings, wet dressings, etc.) 4.2.3 Implanted electronic devices Patients with implanted electronic devices may be treated with short-wave therapy, as long as sufficient care is taken (for example, patients with an implanted pacemaker must not be treated!) If in doubt, consult a doctor. Electronic hearing aids must be removed, as these may be damaged by the electromagnetic radiation, or could cause a fault to occur. 4.2.4 Implanted metals Metal objects in the body, such as plates, pins, screws, a coil, pacemakers, etc., form a contra-indication. The electrode must be placed at a distance of at least 1 metre from the implanted metal. In order to prevent undesired concentrations around the metal and the dangers related to this (internal burns), short-wave therapy resulting in a perceivable thermal effect should not be given. 4.2.5 Other points of attention - The patients must receive clear instructions on what he or she may and/or must feel. Any unpleasant sensations must be avoided. - From the point of view of safety, use only the original. undamaged electrode cables and electrodes. - Patients who have a reduced thermal sensitivity in the area to be treated must be treated with care. In these cases, use only a low dosage and short treatment times. - It may be necessary to carry out a check on the patient’s subjective experiences and for a doctor to carry out an objective skin reaction check. - Application on a treatment area which has been locally anaesthetized is strongly advised against. 4.2.6 Simultaneous use of other electronic equipment The Phyaction Performa generates a high-frequency field at the legally permitted frequency of 27.12 MHz. This field can affect the electronic circuits of equipment in the vicinity.

4. TREATMENT ASPECTS AND SETTING SEQUENCE

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The sensitivity of equipment to high-frequency fields can vary greatly. This is because some manufacturers do not adequately shield their equipment against high-frequency fields. If this occurs, we recommend that you contact the manufacturer or supplier in question. We recommend that you pay attention to the following points in order to reduce the chance high-frequency interference to a minimum: - Avoid simultaneous use of other electro-medical equipment in the direct vicinity of the appliance. - Under the influence of electromagnetic output, electronic equipment can become damaged or break down. This not only applies to electro-medical equipment, but also to audio-video appliances, watches, diskettes and cashpoint cards, etc. This can only be completely prevented by installing a Faraday cage. - The greater the distance between the short-wave appliance and other equipment, the lesser the chance of high-frequency interference. Place the short-wave appliance and the patient at a distance of at least 1 metre from surrounding equipment and/or long metal objects. - It is advisable that the short-wave appliance be connected to a separate power group. - Ensure that the power cord of the short-wave appliance is kept out of the way of the patient and/or other electrode cables or mains leads of other (electro-medical) equipment. - Use a treatment chair or couch that is completely metal-free. 4.2.7 Measures regarding the appliance - Ensure that all operating switches are set to zero. - Electrode cables also emit an electromagnetic field. Ensure that the electrode cables do not come in contact with the ground, with the patient or with each other. If contact is made, or nearly made, this results in a high concentration of electromagnetic output, causing a great deal of heat. If a certain arrangement does cause the cables to touch the patient or each other, a layer of felt at least 4 cm thick must be placed on the point of contact as an intervening substance. - Movement of the electrodes can be prevented by fixing them in place with Velcro. 4.3 Measures DURING treatment An automatic test is always carried out every time the Phyaction Performa is switched on. See paragraph 2.3. 4.3.1 Setting sequence For an explanation of the operating mechanisms, we refer you to chapter 3, EXPLANATION OF THE OPERATING MECHANISMS. The following parameters are set in sequence: 1.

It is possible to set the pulse length separately for channel A and channel B. Therefore it is necessary to indicate which channel is to be set. Select Circuplode A or B with the appropriate selector key. A green lamp lights up on the selector key pressed. If no electrode is connected to channel A or B, the parameters in question cannot be set. Before you can set the parameters, the Circuplode must be connected to the appliance. On the back of the Phyaction Performa, near the connections for the electrode cables, there is a sticker showing which connection is for channel A and which for channel B. If you are facing the operating pad of the Phyaction Performa, the left connection is for channel A and the right for channel B.

2.

Press the pulse length selector key to adjust the pulse length for the Circuplode selected. Set the pulse length by turning the knob.

3.

Press the pulse frequency selector key to adjust the pulse frequency, then turn the knob to set the required frequency.

4.

Pressing the peak output or average output key allows you to set the peak output or average output for the selected Circuplode. The output can be then set by turning the knob.

4. TREATMENT ASPECTS AND SETTING SEQUENCE

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5.

If you wish to execute an application using only one Circuplode, move straight on to point 6. When applying two Circuplodes simultaneously, select the second electrode by pressing the appropriate selector key after having carried out steps 1 to 4. Then set the pulse length and output for the second Circuplode in the manner described above.

6.

Once all the parameters for one or both Circuplodes have been set, treatment time can be set by pressing the treatment time selector key and setting the desired treatment time in minutes by turning the knob. Treatment can only commence once the treatment time has been set.

7.

Treatment can now be started by pressing the start/stop key, which causes the green lamp on the key to light up. During the automatic tuning, the value on the output display flashes on and off. In order to ensure treatment quality, the contact control is switched on automatically if there is insufficient contact. As soon as contact is restored, treatment is resumed.

8.

During treatment, the settings can be adjusted by the same method. We recommend that you do not increase the intensity during treatment.

9.

After treatment is finished, you will hear a short bleeping sound and the output is reduced to zero. The red light on the start/stop key lights up. The pulse length and frequency remain in view on the displays. Treatment can also be terminated at any time by pressing the start/stop key.

4.3.2 Regarding the patient During treatment, the therapist must regularly check the patient’s subjective heat sensation. Increased blood flow can cause tissue temperature to increase. If there is insufficient blood circulation, this heat cannot be adequately dispersed, which can result in thermal lesions. If pain or muscle tension increase during treatment, the dosage should be reduced, for example by reducing the pulse frequency. 4.4 Measures AFTER treatment After treatment has finished, the electrode(s) should be removed and, if appropriate, the appliance switched off.

4. TREATMENT ASPECTS AND SETTING SEQUENCE

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CHAPTER 5

PARAMETERS OF SHORT-WAVE THERAPY AND TREATMENT GUIDELINES

5.1 Introduction In chapter 6, we discuss how the output of the electromagnetic field which penetrates the tissue is transformed into heat by the currents generated. In practice, it is impossible to measure these heat increases, especially when they are only very small. The patient can sense temperature changes in the skin. Deeper tissues do not contain thermosensors. This means that we always have to rely on the patients’ subjective perceptions. This is determinative for the dosage of the therapy, along with the nature and condition of the complaint, of course. Athermal effects also cannot be measured in practice. The therapist must rely on clinical effects in the course of time (such as changes in mobility, pain, swelling and temperature), which can be measured before, during and after treatment. For more extensive information on the theory of short-wave therapy, please turn to chapters 6, 7 and 8. 5.2 Dosage A number of factors play a significant role in determining the dosage in short-wave therapy, and the therapist has to make a choice for a specific setting. The following must be considered: 1. Circuplode format 2. Application with one or two Circuplodes simultaneously 3. Electrode placement 4. Pulse length 5. Pulse repeat frequency 6. Peak output or average output 7. Treatment time 8. Dose These parameters are covered in sequence in the following paragraphs. 5.2.1 Circuplode format The conductivity electrodes of the Phyaction Performa are known as ’Circuplodes’, thanks to their special construction (see paragraph 6.3). Two sizes of Circuplode can be used on the Phyaction Performa. A Circuplode with a 14 cm diameter is supplied as standard. A smaller Circuplode with a 9 cm diameter is supplied as optional. The smaller Circuplode can be used to treat small areas of the body. The electrode should be approximately the same size as the part of the body to be treated. In addition to the difference in treatment surface area between the two electrode formats, there is also a difference in peak output; the large Circuplode has a peak output of 200 Watt, the smaller one has a peak output of 100 Watt. The Phyaction Performa automatically recognises which format Circuplode is connected to which channel, and adapts the maximum output immediately. 5.2.2 Application with two Circuplodes simultaneously The Phyaction Performa offers the possibility of working with two Circuplodes simultaneously, whether or not of the same format. Simultaneous use offers the following advantages: - covering a large treatment area in one session; - complaints on two sides can be treated simultaneously; - one part of the body can be approached from two sides at once; - a local and a segmental treatment can be given simultaneously. If two Circuplodes are to be used simultaneously, the pulse length and output can be set for each Circuplode individually. The pulse repeat frequency and treatment time selected are equal for both Circuplodes. During simultaneous use, the two Circuplodes cannot weaken or strengthen the other, as the pulse of one Circuplode is transmitted in the pulse pause of the other.

5. PARAMETERS AND TREATMENT GUIDELINES

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5.2.3 Electrode placement The Circuplode must be placed with the permeable screen aimed at the area of the body to be treated. In order to ensure an optimum alignment, it is important that the electrode is not placed further than 1 cm away from the part of the body to be treated. Direct contact with the area of the body, with a towel as an intervening substance, is to be preferred. Above all, the part of the body to be treated must be large enough in relation to the Circuplode to ensure a sufficient transfer of power. As explained in paragraph 6.3, the effects of the Circuplode only take place around the edges, in other words where the coils of the spool are located. Theoretically, there is no electromagnetic field in the middle of the Circuplode, and virtually no heat will be generated there. The middle of the coil is therefore the least effective. The Circuplodes must therefore be placed in such a way that the outside part of the coil affects that part of the body where power dissipation is desired and can be expected. 5.2.4 Pulse length The average output is the product of the peak output, pulse length and pulse repeat frequency. The pulse length on the Phyaction Performa is adjustable in 7 steps from 65 - 400 µsec. 5.2.5 Pulse repeat frequency The pulse repeat frequency on the Phyaction Performa is adjustable in 10 steps, ranging from 26 - 400 Hz. For a given intensity and a variable pulse length, the pulse repeat frequency determines whether a cumulative thermal effect can take place, causing the tissue temperature actually to increase. This process is dependent partly on local blood circulation, and the extent to which it cools down the area. Figure 10 shows that if the thermal effect can be equalized in the pulse pause, the temperature will not increase and no heat will be felt. If a new impulse is given after the thermal effect has disappeared, a new thermal effect will occur, just as large as the previous one, while the athermal effect is added to the athermal effects already present. Therefore, we can see that summation is taking place.

Figure 9. Heat development during pulsing short-wave therapy A: no measurable temperature increase B: measurable temperature increase 5.2.6 Peak output or average output The Phyaction Performa offers the therapist the choice of displaying the peak output or the average output. Peak output Pp (Watt) refers to the size of the pulse in figure 10, in other words the intensity. The maximum peak output of the large Circuplode (diameter 14 cm) is 200 Watt and of the smaller Circuplode (diameter 9 cm) is 100 Watt. The average output P (Watt) is the product of the set peak output, the pulse length and the pulse frequency. If you are interested in viewing the average output resulting from the settings, the output display can be set to show the average output instead of the peak output. The maximum average output of the large Circuplode is 32 Watt and the small Circuplode, 16 Watt.

5. PARAMETERS AND TREATMENT GUIDELINES

Instructions for use Phyaction Performa - Page 14

Figure 10. Pulse output (Pp) and average output (P) 5.2.7 Treatment times In general, treatment times between 10 and 30 minutes are recommended. With normal blood circulation, maximum vasodilation will have been achieved within this period of time. 5.2.8 Dose For the application of pulsed electromagnetism, the dose of treatment is determined by the product of the peak output, pulse length, pulse repeat frequency and treatment length. The setting is implemented according to subjective criteria. If the patient can and may feel heat for a certain indication, a subjective heat sensation by the patient is assumed when determining the dosage. When using the Circuplode, most heat is generated in places where there are no thermosensors (in the muscles) and heat sensation in the skin is relatively low. Therefore, the patient should certainly not feel any heat at the start of treatment. Later on in the course of treatment, this is permissible, as the skin has been heated by the muscles by means of conduction. The set dose must not be increased during treatment. If the patient has no feeling in certain areas, the dose should be set and a test carried out in advance on the healthy side where the patient does have feeling. When treating the affected side, the determined intensity should then be decreased by 30%. Schliephake has drawn up a system determining the dose according to the sensation of heat, in four grades: 1. submitis dose: no heat is felt; 2. mitis dose: the patient fells a slight sensation of heat; 3. normalis dose: the patient feels a clear and pleasant sensation of heat; 4. fortis dose: the patient feels a strong but, as yet not unpleasant sensation of heat. If any pain or muscle hypertonia occur during treatment due to trophic disorder, the maximum peak output (or the average output) must be reduced. 5.3 Treatment frequency This depends partly on the dosage; with a low dosage, treatment can be given every day, with a high dosage treatment frequency should be kept down to 1-3 times per week. The clinical results must indicate whether treatment frequency must be changed. 5.4 Number of treatments The total number of treatments is determined by the clinical results. 5.5 Contact control It is very important to treatment quality that the set output is also actually transferred to the tissue. The Phyaction Performa is equipped with an optical and acoustic contact control, which ensures optimum energy transfer. If the power emitted deviates more than 10% from the set output, the Performa is automatically switched off. The contact control led on the Circuplode then flashes, as does the power indicator on the appliance. Above all, a pulsing acoustic signal sounds to indicate that contact should be restored. It is important for good contact that the Circuplode is placed at not more than 1 cm from the part of the body to be treated, and that the part of the body to be treated is large enough in relation to the Circuplode. Direct contact with the part of the body to be treated is to be preferred, with a towel as intervening substance. 5.6 Treatment guidelines A general distinction can be made between treatment guidelines which apply in the case of severe inflammatory action, and those which apply in the case of mild inflammatory action. The parameter settings indicated must only be used as a guideline, as the dosage is often dependent on the subjective heat sensations of the patient.

5. PARAMETERS AND TREATMENT GUIDELINES

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For further information on the various phases of the inflammation process, please see paragraph 7.5. 5.6.1 Severe inflammatory action Severe inflammatory action is marked by pain during rest and/or movement during clinical examination. Movement is restricted and strain capacity is reduced. The immune systems can be stimulated by stimulating the athermal effects. This is achieved by setting a low average output with a high peak output, short pulse lengths and a low pulse repeat frequency. Treatment lasts 10 to 20 minutes and is given daily or even several times a day. Possible parameter settings for a submitis dosage: Pulse length 65 µs Pulse repeating frequency 26 Hz Treatment duration 10 minutes Treatment frequency daily Peak output 200 Watt Average output 0.34 Watt 5.6.2 Mild inflammatory action Mild inflammatory action can be marked by pain during or after movement (particularly in an extreme position). The tissues can be strained increasingly. The objective to "stimulate blood circulation" can be achieved during the production phase by stimulating the thermal effects, for which the dosage is increased from mitis to normalis. A high average output with a high peak output, long pulse time and high pulse repeat frequency is set. Treatment lasts 20 to 30 minutes and is given 2 to 3 times a week. Possible parameter settings for a mitis dosage: Pulse length 150 µs Pulse repeat frequency 110 Hz Treatment duration 20 minutes Treatment frequency 3 times a week Peak output 200 Watt Average output 3.30 Watt Possible parameter setting for a normalis dosage: Pulse length 300 µs Pulse repeat frequency 200 Hz Treatment duration 20 minutes Treatment frequency 3 times a week Peak output 200 Watt Average output 12 Watt During the remodelling phase, a fortis dosage can be administered during treatment: Possible parameter settings for a fortis dosage: Pulse length 400 µs Pulse repeat frequency 300 Hz Treatment duration 30 minutes Treatment frequency once a week Peak output 200 Watt Average output 24 Watt

5. PARAMETERS AND TREATMENT GUIDELINES

Instructions for use Phyaction Performa - Page 16