Table of Contents1. Interferential StimulationReducing 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

2. T.E.N.S. (Transcutaneous Electrical Nerve Stimulation)Four lead, dual channel, TENS has proven itself to be an effective reliever of both chronic and acute pain. TENS works on the Gate Theory which blocks the pain signal from firing to the brain. TENS will not produce deep tissue or muscle stimulation. Low Back Pain (2 protocols ..................................... 12 Cervical Strain/Sprain ............................................ 13 Shoulder Sprain ................................................... 14 Hip Strain/Pain .....................................................15 Foot or Ankle Pain ................................................ 16DISCLAIMER: These treatment protocols are only the suggestion and/or opinion of Medi-Stim, Inc. based on its experience. None of the techniques contained herein have been evaluated in scientific studies. The frequency and intensity of the various proposed treatments described in these materials depends on the specific condition of the patient. Clinicians should make decisions regarding the specifics of each application based on the situation and needs of individual patients.

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3. Electronic Muscle StimulationMuscle reeducation, relief from muscle spasm and muscle fatigue. Wrist Flexor/Extensor Strengthening .......................... 17 Hand Intrinsic Strengthening ................................... 18 Grip Strengthening .............................................. 19 Quadriceps Strengthening ..................................... 20 Anterior Shoulder Sublaxation ................................. 21 Upper Trap Spasm .............................................. 22 Shoulder Weakness ............................................. 23 Anterior Tibialis Strengthening ................................. 24 Strengthening of VMO .......................................... 25

Low Back Pain

Criss-Cross Placement kept unilaterally from spine

Electrode PlacementA-B Lead 1 C-D Lead 2

] Switch must be on 4 line indicator

Control Settings: 4. Four Channel Combo StimulationStimulation featuring Interferential Vector Stimulation and Muscle Stimulation or Sequential Stimulation. ACL Reconstruction ............................................. 26 Fibromyolgia ...................................................... 27 Chronic Lower Back Pain & Acute Cervical Pain ............28 Home Use Switch: 8/8 Frequency: 250 Treatment Time: 25 minutes Then reset unit Switch: 8/8 Frequency: 10 Treatment Time: 15 minutes Clinic Use Switch: 8/8 Frequency: 250 Treatment Time: 15 minutes

5. High Volt Pulsed-Galvanic StimulatorHigh Volt Pulsed-Galvanic Stimulation is most useful with acute injuries involving major tissue trauma with bleeding or swelling. Wound Care Healing ............................................ 29-30 Reflex Sympathetic Dystrophy ................................. 31 Sciatic Pain ....................................................... 32 Edematous Hands ............................................... 33 DeQuavairs ....................................................... 34 Medial & Lateral Epicondylitis .................................. 35 Commonly Used ICD-9 Codes................................. 36

Combo Settings:IF-High Treatment Time: 15 minutesCh2 Ch1 (+) (-) Ch2 Ch1 (+) (-)

Ch1 (+)

Ch2 (-)

Ch1 Ch2 (-) (+)

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Shoulder PainChronic-Non SurgicalChannel 1: Place over supraspinatus trigger point & pec minor insertion Channel 2: Place over deltoid insertion and upper trapezius

EpicondylitisLateral 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.

MedialSame 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 HzLateral Medial

Control Settings:Switch: 10/10 Frequency: 10 treatment Time: 15 minutes Amplitude: Sensory level to tolerance

Ch2 Ch1 (+) (-)

Combo Settings:IF-Low Treatment Time: 15 minutesCh1 (+) Ch2 (-)

Ch2 Ch1 (+) (-)

Ch1 Ch2 (-) (+)

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Carpal TunnelElectrode PlacementSee diagram below

Cervical Spasms/PainElectrode 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

Ch1 (-) Ch2 (-)

Ch2 (+) Ch1 (+) Ch1 (+) Ch2 (-)

Ch2 (+)

Ch1 (-)

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Knee PainControl 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 FasciitisElectrode PlacementElectrodes 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: 15-20Ch1 (+) Ch1 Ch2

Ch2 Ch2 (-) Ch1 (-)

Ch1

Ch2 (+)

Knee Garment: Place electrodes as shown

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Bone/Soft Tissue Injury of ForefootElectrode PlacementElectrodes are placed on dorsal and plantar surface in tender area

Tarsal Tunnel SurgeryElectrode PlacementAlong medial and lateral border of foot

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 minutesCh1 (+) Ch2 (-)

Combo Settings:IF-Wide Treatment Time: 10 minutes ...Then IF-Low Treatment Time: 10 minutesCh2 (+) 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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Low Back PainElectrode PlacementOption 1: Centralized LBP Channel 1: Bilaterally at level L2-3 Channel 2: Bilaterally at SI level Note: General ruleplace channel 1 above pain level, channel 2 below pain level. Option 2: Radiating LBP Channel 1: Bilaterally at lumbar level involved Channel 2: One patch over SI joint of affected side, other over sciatic notch or just distal to the end point of painOption 1

Cervical Sprain/StrainElectrode PlacementChannel 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

Ch1 Ch1 Ch2 Ch2 Ch2 Ch2

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Shoulder SprainElectrode PlacementChannel 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/PainElectrode PlacementMay 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

Alternate Control Settings:Mode: N Rate: 4 pps Duration: 150 ms Amplitude: Just below MS contraction Treatment Time: 15-20 min.

Ch1 Ch2 Ch2

Ch1 Ch2

Ch1 Ch2

Ch1

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Foot or Ankle PainControl Settings:Chronic Pain: Mode: M Frequency: 150 Pulse Width: 70 ms Amplitude: Maximum Sensory Level Treatment Time: 20-30 minutes Edema Mode: N Frequency: 10 Hz Pulse Width: 150-250 ms Amplitude: Maximum Sensory Level Treatment Time: 20-30 min. Amplitude: Maximum Sensory Level

All-Stim

Control Settings: Chronic IF- HIGH Treatment Time: 20-30 min. Edema IF- LOW Treatment Time: 20-30 min.

Wrist StrengtheningElectrode PlacementChannel 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 contractionCh2

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 StrengtheningElectrode Placement(-) Just proximal to pisiform (+) 23 superior and lateral to (-) electrode

Grip StrengtheningRecommend dual channel to stimulate intrinsics and wrist flexors.

Electrode PlacementUse 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 minutesCh1 Ch2

Combo Settings:MSW300 MSCTR10 MSRLX30 MSRMP03 Treatment Time: 15 minutesCh1 Ch2

Ch1 Ch2

Combo Settings:MSW350 MSCTR10 seconds MSRLX35 seconds MSRMP02 Treatment Time: 15-20 minutes

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Quadriceps StrengtheningRecommend dual channel placement

Anterior Shoulder SubluxationElectrode PlacementPlace one electrode over posterior deltoid, other over suprastinatus

Electrode PlacementChannel 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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Upper Trap SpasmControl Settings:Frequency: 80-100 pulses per second Pulse Width: 200+ ms Ramp: 3 seconds On Time: 10 seconds Off Time: 10 seconds Treatment Time: 15 minutes

Shoulder WeaknessElectrode PlacementChannel 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

Ch1 Ch2 Ch1 Ch1

Ch2

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Anterior Tibialis StrengtheningElectrode PlacementPlace one electrode on superior lateral MS belly of tibialis anterior, other approx. 3-4 below staying on muscle bulk of anterior tib.

Strengthening of VMOElectrode PlacementChannel 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 minutesCh1 Ch1

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ACL ReconstructionGoal: Lower edema, facilitate quad set

FibromyalgiaElectrode PlacementFind trigger points along paraspinals

Electrode PlacementA: 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 minutesCh1 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

Ch1 (+) A Ch2 (+)

Ch2 (-) Ch1 (-)

Ch2 (+)

Ch1 (-)

Ch1 (+) Ch2 (+)

Ch2 (-) Ch1 (-)

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Chronic Lower Back Pain and Acute Cervical PainControl Settings:A: Chronic Lower Back Pain IF-High Treatment Time: 20-30 minutes B: Acute Cervical Pain IF-Wide Treatment Time: 20-30 minutes Lower Back Garment / Cervical Garment Place electrodes as shownCh1 (+) B Ch2 (+) Ch1 (-) Ch2 (-)

Sensible Wound Care Covenants

These suggested treatment protocols are offered as an example, only to treat decubiti and other types of open wounds with the PGS-123

I. Information1. 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. Basis1. 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.

III. Wound ProcedureCh2 (+) Ch1 (+) A Ch1 (-) Ch2 (-)

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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IV. Regimen Dimensions (Dry)1. 80-100 pulses per second (pps). 2. Intensitysubthreshold to muscle contraction. Increase intensity as needed due to acommodation. 3. Polarity a. Negativeinitially if microorganisms are present for 3 days or until a healing plateau is reached. b. Positiveafter wound is culture free or after the wound is culture free for 3 days. After a healing plateau is reached using positive, switch back to negative. Keep switching polarity based upon the wounds healing plateaus. 4. Treatment Time 30-60 minutes per treatment, 1 to 3 times daily and a minimum of 5 times a week. 5. Following the [EMSI-3000] treatment, dress the wound as ordered by the physician.

Suggested RSD ProtocolElectrode PlacementActive: Place one electrode on palm of hand and put in water. Place other electrode in anticubal space. Dispersive: Place on lower back or thigh. Bifurcating technique for all soft tissue injuriesIt is suggested to treat with one channel and two electrodes medially and laterally to the injured site, and one channel and two electrodes anteriorly and posteriorally to the injured site. It is also suggested to treat the closest proximal and distal joints to the injured site. Ch1 Ch2(+) (-) B Ch2 (+) Ch1 (-)

V. Regimen Dimensions (Water)1. RationaleUse the water as a large active electrode for cleansing or to treat numerous areas simultaneously. The PGS-123 can be used for debridement for pain modulation as well as healing. a. Make sure the whirlpool is carefully disinfected b. Attach one active electrode distal to the wound and the other active electrode directly over the wound or in the area of the wound when in water. c. Attach the dispersive so that the current will take the most direct rout through the wound and not around it. The dispersive electrode has to make full skin contact and may be submerged in the water as long as attached to the patient. d. All other treatments apply to treating in water as outlines in Treatment Out of Water.

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.

Ch2 (+) Ch1 (+)

A

Ch1 (-) Ch2 (-)

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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SciaticaElectrode Placement2 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 HandsElectrode PlacementActive: 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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DeQuavairsElectrode PlacementDispersive: Place on lower back.

Medial & Lateral EpicondylitisElectrode PlacementDispersive: Place on 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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Commonly Used ICD-9 CodesCervicalRadiculopathy ................................................................. 721.2 Herniated (displaced) Disc .................................................. 722.2 Degenerative Disc Disease ................................................. 22.52 Pain In Neck .................................................................. 723.1 Radiculitis ..................................................................... 723.4 Sprain/Strain .................................................................. 847

ShoulderDegenerative 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

ArmUpper Arm .................................................................... 719.42 Forearm ....................................................................... 719.43 Hand ........................................................................... 719.44 Pain in Arm/Hand/Limb ..................................................... 729.5

ThoracicThoracic 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

Notes / Special Instructions:

LumbarLumbar 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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