Cefar RehabX2
Cefar RehabX2
PATIENT INFORMATION
4. OVERVIEW..............................................................................7
CONTROL BUTTONS..................................................................................7
DISPLAY SYMBOLS...................................................................................8
5. OPERATION............................................................................9
STEP-BY-STEP USE....................................................................................9
CEFAR EASY TOUCH™ – AUTO STIMULATION MODE..................................11
SPECIAL INSTRUCTIONS..........................................................................12
TIMER....................................................................................................13
PROGRAM PAUSE....................................................................................13
6. REPLACEMENT OF BATTERIES...............................................14
PROFESSIONAL INFORMATION
7. PROGRAMS..........................................................................15
PRESET PROGRAMS................................................................................15
CUSTOM PROGRAMS..............................................................................19
PROGRAM LOCK.....................................................................................23
DISABLE THE AUTO FUNCTION.................................................................23
COMPLIANCE..........................................................................................23
ADDITIONAL INFORMATION
8. ACCESSORIES......................................................................24
9. CARE INSTRUCTIONS............................................................24
10. TROUBLESHOOTING...........................................................25
11. FREQUENTLY ASKED QUESTIONS (FAQ)...............................26
12. TECHNICAL DATA................................................................28
key to the symbols............................................................................29
APPENDIX
CLINICAL GUIDE.......................................................................30
1. INTRODUCTION
CEFAR Medical AB has been a medical supplier of electrotherapy products for more than 30 years. The
company was established in Sweden in 1975 and is today one of Europe’s leading companies in electro
therapy. The Cefar stimulators are widely used by public and private health care professionals around the
world.
Electrical nerve and muscle stimulation is effective, has no side effects and is economical. Through clini-
cal research, areas of application for TENS (Transcutaneous Electrical Nerve Stimulation) and NMES
(NeuroMuscular Electrical Stimulation) are rapidly expanding. Cefar is working actively to further develop
the method towards a natural treatment alternative for both health care professionals and consumers.
More information about TENS, NMES and our products can be found on our web site: www.cefar.se
CEFAR REHAB X2 is a dual channel nerve stimulator intended for both muscle rehabilitation (NMES) and
pain relief (TENS). The stimulator features 27 preset programs and 3 custom programs. The channels
are simultaneous, which means that a selected program applies for both channels. By using CEFAR EASY
TOUCH™ the stimulation is automatically set to the correct intensity for each person.
2. MEDICAL BACKGROUND
NMES
NMES (NeuroMuscular Electrical Stimulation) is used successfully both in medical rehabilitation and as a
complement to athletic training on all levels.
The goal of electrical muscle stimulation is to achieve contractions or vibrations in the muscles. Normal
muscular activity is controlled by the central and peripheral nervous systems, which transmit electrical
signals to the muscles. NMES works similarly but uses an external source (the stimulator) with electrodes
attached to the skin for transmitting electrical impulses into the body. The impulses stimulate the nerves
to send signals to a specifically targeted muscle, which reacts by contracting, just as it does with normal
muscular activity.
Electrical muscle stimulation is suitable for all the muscles in the body. It can be used to strengthen
muscles weakened by surgery, a fracture, etc., and improve mobility. It is also an excellent tool for stroke
rehabilitation, helping patients in handgrip and gait training.
Electrical muscle stimulation for rehabilitation purposes should be tried out individually by a physiothera-
pist or other caregiver for the best results.
TENS
TENS (Transcutaneous Electrical Nerve Stimulation) gives good results in acute and chronic pain condi-
tions of many kinds. It is clinically proven and used daily by physiotherapists, other caregivers and top
athletes around the world.
High-frequency TENS activates the pain-inhibiting mechanisms of the nervous system. Electrical impulses
from electrodes, placed on the skin over or near the painful area, stimulate the nerves to block the pain
signals to the brain, and the pain is not perceived. Low-frequency TENS stimulates the release of endor-
phins, the body’s natural painkillers.
TENS is a safe treatment method and has, in contrast to drugs and other pain relief methods, no side
effects. It may be sufficient as the only treatment form, but it is also a valuable complement to other
pharmacological and/or physical treatments. TENS does not always treat the cause of pain. Consult your
doctor if pain persists.
3. PRECAUTIONARY MEASURES
• Inspect the equipment prior to use.
• Use the stimulator only as stated in the operating instructions.
• Only Cefar accessories should be used with the stimulator
WARNING!
• People with implanted electronic equipment, such as pacemakers and intracardiac defibrillators, must not be treated
with CEFAR REHAB X2.
• Pregnant women should not be treated with CEFAR REHAB X2 during the first trimester (12 weeks).
• Due to the location of the carotid arteries and the carotid bodies, do not stimulate the front or sides of the neck, since
a drop in blood pressure can occur.
• Stimulation should not take place while the user is connected to high-frequency surgical equipment. It may cause
burn injuries on the skin under the electrodes, as well as problems with the stimulator.
• Do not use the stimulator in the vicinity of shortwave or microwave therapy equipment, since this may affect the output
power of the stimulator.
• Keep the stimulator out of reach of children.
CAUTION
• Stimulate with precaution while treating angina pectoris and the thoracic region on patients with cardiac arrhythmia.
• The electrodes are only to be placed on healthy skin. Avoid skin irritation by ensuring that good contact is achieved
between electrodes and skin.
• Do not place electrodes directly over the uterus or connect pairs of electrodes across the abdomen if you are preg-
nant. The reason is that, theoretically, the current could affect the foetus’s heart (although there are no reports of it
being harmful).
• If skin irritation should occur, treatment should be temporarily discontinued. If problems continue, contact your health
care provider. Hypersensitivity to tape and gel can occur in isolated cases. The problem usually disappears when the
tape or gel is changed to another type.
• Do not use electrodes with a surface < 16 cm2, as there will be a risk of suffering a burn injury. Caution should always
be exercised with current densities > 2 mA/cm2.
• Observe caution when using electrotherapy at the same time as the patient is connected to monitoring equipment with
body worn electrodes. The stimulation might interfere with the signals to the monitoring equipment.
• Never open the battery cover during stimulation in order to avoid electrical shock.
• Turn off the stimulation before removing the electrodes from the skin. If an electrode comes off, turn off the stimula-
tion before picking it up. Getting electrical stimulation through the fingers is unpleasant but not harmful.
• Observe caution when stimulating in the immediate vicinity of cellular phones that are switched on, since this may
affect the output power of the stimulator.
• Observe caution if you use the stimulator while driving. Unintentional stimulation changes might extract focus from the
driving and create a hazardous situation.
4. OVERVIEW
CONTROL BUTTONS
1. ON/OFF
· Turns the stimulator on and off.
· Turns the stimulator off even when the key lock
is activated.
· Can be used for terminating the stimulation at all
times.
2. INCREASE (left and right channel)
· Increases the amplitude (intensity of stimulation).
Press and hold the button to increase the amplitude
continuously.
Note! Always increase the amplitude cautiously. 1
· Terminates AUTO stimulation mode.
· Increases the number of minutes when setting the
timer (right button). 2 2
· Used when turning the program lock on and off (left
button)*.
· Scrolls through choices in programming mode*. 3 3
3. DECREASE (left and right channel)
· Decreases the amplitude (intensity of stimulation). 4 4
Press and hold the button to decrease the amplitude
continuously. 5 6
· Deactivates the key lock. 5
· Terminates AUTO stimulation mode.
7
· Decreases the number of minutes when setting the
timer (right button).
· Used when turning the program lock on and off (left
button)*. 9 8
· Scrolls through choices in programming mode*. 6. TIMER
4. AUTO (left and right channel) · Initiates the timer setting.
· Starts the AUTO test mode. 7. PROGRAMMING/CONFIRMATION (S=SET)
· Confirms the selected amplitude level in AUTO test · Turns the stimulator into programming mode for cus-
mode. tom programs P28–P30 when pressed for 2 seconds.
5. PROGRAM · Confirms settings in programming mode.
· Selects a program (P1–P30). 8. HAND SWITCH CONNECTION
Use P+ to step forward through the programs and P– · By using the hand switch, the contractions in pro-
to step backward. grams with intermittent stimulation can be manually
· Pauses an ongoing program. controlled.
· Used when activating/deactivating the program lock
(P+)*. 9. CABLE HOLDER
*Professional use
DISPLAY SYMBOLS
1 2 3 4 5 1
6
7
8 8
9 10 11 10 9
A. Connect the electrodes to B. Attach the electrodes to C. Connect the cable to the
the cable. your body. CEFAR REHAB X2.
skin. P S
5. SELECT A PROGRAM (P1–P30) AUTO
AUTO
AUTO
AUTO
P S
NMES
Press the INCREASE button for each channel until you get visible muscle contractions. Press and hold
the button to increase the amplitude continuously.
Note! Both channels must be used for programs P5 and P17–P18.
AUTO AUTO
P S
Note! Always increase the amplitude cautiously!
An automatically activated key lock prevents unintentional changes during treatment. The key lock is acti-
vated if no button is pressed for 20 seconds. Press any of the DECREASE buttons to deactivate the
key lock.
The treatment time is preset, but can be changed by using the timer function, see section TIMER.
AUTO AUTO
P S
AUTO AUTO P S
The last used program is saved when the stimulator is turned off and then pre-selected the next time the
P S
stimulator is turned on.
The stimulator turns off after 5 minutes of inactivity to spare batteries.
CEFAR EASY TOUCH™ – AUTO STIMULATION MODE
To provide a pain relieving effect, the level of stimulation should be perceived as a little bit stronger than
the pain intensity. Since the body initially adapts to the set level of stimulation, it is often required to adjust
11
the amplitude a couple of times to reach the optimal level of stimulation. By using CEFAR EASY TOUCH™ the
amplitude is automatically adjusted, and the optimal level is reached after a few minutes of stimulation.
For NMES the primary aim is to cause a strong but not painful muscular contraction. With CEFAR EASY
TOUCH™ it is easy to reach the correct stimulation level. By using the patient’s individual sensory-motor
threshold CEFAR REHAB X2 applies a coefficient to reach the optimal intensity of stimulation.
To use CEFAR EASY TOUCH™:
Follow steps 1–5 in the section STEP-BY-STEP USE.
Even if you are in AUTO stimulation mode, you can increase or decrease the amplitude at any time by press-
ing the INCREASE or DECREASE buttons until the stimulation feels pleasant. If doing so, the
automatic amplitude setting is lost.
AUTO AUTO
P S
SPECIAL INSTRUCTIONS
Mixed frequency stimulation (P4)
12 Mixed frequency stimulation is a combination of high (80 Hz) and low (2 Hz) frequency stimulation with
separate amplitude settings.
1. First set the amplitude for 80 Hz stimulation when the upper part of the high/low frequency symbol
is flashing
2. When the bottom part of the symbol flashes for the first time, the amplitude for 2 Hz stimulation will
start at the same level as is set for 80 Hz. Adjust the amplitude until you get visible muscle contractions.
The period between the frequency changes is preset to 3 seconds.
See chapter FREQUENTLY ASKED QUESTIONS for further information on mixed frequency stimulation.
P S
You can pause the programs up to five minutes.
To pause a program:
1. If key lock is on, press any of the DECREASE buttons
AUTO
AUTO
AUTO
AUTO to deactivate it.
2. Press any of the PROGRAM buttons P+ P+ or
S S P– P– to pause the program.
AUTO
AUTO
AUTO
AUTO
Start stimulation again by pressing any of the PROGRAM buttons P+ P+ SorS AUTO AUTO .
P– P–
P S
If stimulation is paused for more than five minutes, the stimulator turns off automatically to
spare batteries.
6. REPLACEMENT OF BATTERIES
A battery symbol is shown on the display when the batteries are almost empty . As long as the
14
stimulator is working normally you can continue the treatment. When stimulation feels weaker than usual or
the stimulator turns off, it is time to replace the batteries.
If the stimulator is not used for some time (approximately 3 months), the batteries should be removed from
the stimulator.
The stimulator operates on either two non-rechargeable 1.5 V AA batteries or two rechargeable 1.2 V AA
batteries, recharged in a separate charger.
Programming
1. Press the ON/OFF button to turn the stimulator on.
AUTO
AUTO
AUTO
AUTO
2. Press the PROGRAM button P+ P+ SorS P– P– to step forward or backward until Program 28, 29 or 30 is
5. Level 2 P S
For Continuous stimulation there are no choices at Level 2. You are moved directly to Level 3.
If you chose Intermittent stimulation on Level 1, you now have two choices:
• Simultaneous (SI) stimulation
• Alternating (Alt) stimulation
Press the increase (or decrease) button to toggle between SI and Alt. Confirm your choice
AUTO AUTO
6. Level 3 P S
The available stimulation types on this level depend on your previous choices.
Press the increase (or decrease) button to see the different stimulation types alternate on
the display. The programming chart shows the parameter setting possibilities for each stimulation type.
Continuous stimulation types: AUTO AUTO
• Conventional (C)
P S
• Burst (B)
• Pulse width/duration modulation (PWM)
• Frequency modulation (FM)
Intermittent/Simultaneous stimulation types:
• Conventional (C)
• Frequency modulation (FM)
For Intermittent/Alternating stimulation your only choice is Conventional stimulation, which is not shown
on the display. You are moved directly to the next stage in the programming procedure (see step 7).
AUTO AUTO
9. Repeat step 7 and 8 until the parameter value in the last stage is set.
10. The programming procedure is finished and you will automatically exit the programming mode. The new
program is now selected and ready for use. The program is also stored in the stimulator for future use.
A custom program can be changed by redoing the programming.
Programming chart
21
Programming
CEFAR REHAB X2
P28, P29, P30
Level 1
CONTINUOUS INTERMITTENT
(C) (I)
See the programming chart on next
page for intermittent stimulation
Level 3
Conventional Burst Pulse width/duration Frequency
(C) (B) modulation modulation
(PWM) (FM)
Time Time
Preset: – – min. Preset: – – min.
Range: 1-99, – – min. Range: 1-99, – – min.
Level 1
INTERMITTENT
(I)
22
Level 2
SIMULTANEOUS ALTERNATING
(SI) (ALT)
Level 3
Frequency
Conventional
modulation
(C)
(FM)
COMPLIANCE
Compliance gives you the possibility to monitor the use of the stimulator:
1. Turn the stimulator ON.
2. Press the TIMER button and the right DECREASE button simultaneously for 2 seconds.
3. The left side of the display shows the usage time in hours and the right side in minutes. To reset the
usage time, press the right DECREASE button
AUTO AUTO
for 2 seconds. AUTO AUTO
5. The left side of the display shows the total usage time in hours and the right side in weeks. The total
AUTO AUTO
AUTO AUTO
P S
8. ACCESSORIES
CEFAR REHAB X2 comes with a neck strap and a belt clip, allowing you to wear the stimulator around your
24
neck or on your belt and have your hands free during treatment.
The electrodes will eventually wear out and have to be replaced. It is recommended to replace the elec-
trodes after approximately 20–40 times of usage.
The hand switch included can be used in some NMES programs for full manual control of the time of
contractions.
The cables are best preserved if left attached to the stimulator between sessions.
For purchase information, contact your Cefar dealer or visit www.cefar.se.
9. CARE INSTRUCTIONS
Taking care of and cleaning the Cefar equipment is simple with the following instructions:
• Keep stimulator and accessories in the original case when they are not in use. It may, however, be
practical to allow the electrodes to remain on the body between treatments. Carbon rubber electrodes
can generally remain for 2–3 hours without the electrode gel drying out (does not apply to adhesive
gel). They must then be taken off, washed, and dried before being applied again. This is especially
important for persons with sensitive skin. In connection with stimulation, make sure that the electrodes
are firmly in place.
• hen using carbon rubber electrodes, use plenty of electrode gel and avoid drying out by applying tape
W
around all the edges of the electrodes. Rinse the carbon rubber electrodes and the skin with water after
use. Do not use detergent for the electrodes.
• Self-adhesive multi-use electrodes are re-moistened if necessary with a few drops of water and kept
air-tight (in a plastic bag) on protective paper when they are not in use.
• Never expose the stimulator to water. Wipe it off with a damp cloth if necessary.
• Do not jerk cables or connections.
• The cables are best preserved if left attached to the stimulator between sessions.
10. TROUBLESHOOTING
THE STIMULATION DOES NOT FEEL THE SAME AS USUAL
25
· Check that all settings are correct (see section STEP-BY-STEP-USE) and make sure that the electrodes are
correctly placed.
· Slightly change the position of the electrodes.
THE STIMULATION FEELS UNPLEASANT
· The skin is irritated. For advice on skin care, see chapter PRECAUTIONARY MEASURE.
· The electrodes begin to lose their stickiness and do not stick properly to the skin. Moisten the adhesive
surface with a few drops of water before placing on the skin.
· The electrodes are worn out and need to be replaced.
· There is insufficient electrode gel on the carbon rubber electrodes.
· Slightly change the position of the electrodes.
THE STIMULATION FEELS WEAK OR NOT AT ALL
· Check if the batteries need to be replaced, see chapter REPLACEMENT OF BATTERIES.
· Electrodes are too old and need replacement.
THE BROKEN CIRCUIT SYMBOL IS SHOWN ON THE DISPLAY SYMBOL
The broken circuit symbol indicates that the resistance is too high, or that a cable is broken.
· A too high resistance can be caused by a bad connection between the electrodes and your skin, or that
the electrodes need to be replaced.
· A cable breakage can be checked by pressing the cable’s pins against one another while increasing the
amplitude for the corresponding channel to 11 mA. If the amplitude now drops to 0.0 mA and starts
flashing, the cable needs to be replaced.
Note! Never increase the amplitude above 20 mA when you check for cable breaks, since this can damage
the stimulator.
If the error symbol appears on the display when you start the stimulator, it means that the stimulator is
broken and needs to be replaced.
Note! Do not use the stimulator – contact your Cefar dealer.
Cefar will only be responsible for service and repairs performed by Cefar or a distributor appointed by
Cefar.
11. FREQUENTLY ASKED QUESTIONS (FAQ)
CAN ANYONE USE ELECTRICAL STIMULATION?
26
People with implanted electrical equipment, for example a pacemaker or an intracardiac defibrillator,
must not be treated with electrical stimulation. Pregnant women should not use electrical stimulation
during the first 12 weeks of the pregnancy. Read the safety precautions in this manual (PRECAUTIONARY
MEASURES).
CEFAR REHAB X2
Number of channels . . . . . . . . . . . . . . . . . . . . . . . . . 2 (non-independent)
Constant current . . . . . . . . . . . . . . . . . . . . . . . . . . . . Up to a resistance of 1000 ohm
Stimulation current/channel . . . . . . . . . . . . . . . . . . . 0–99,5 mA
Waveform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Symmetrical biphasic pulse, 100% compensated
Number of preset programs . . . . . . . . . . . . . . . . . . . . 27
Number of custom programs . . . . . . . . . . . . . . . . . . . 3
Stimulation forms . . . . . . . . . . . . . . . . . . . . . . . . . . . Conventional
Burst
Modulated frequency/pulse duration
Mixed frequency
Alternated modulated pulse duration (CEFAR Flow TENS)
Intermittent
Max pulse duration . . . . . . . . . . . . . . . . . . . . . . . . . . 400 μs
Max frequency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 Hz
Timer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 to 99 min./Off
Environment for
storage, use and shipping . . . . . . . . . . . . . . . . . . . . . Temperature 10º C–40º C
Air humidity 30%–75%
Air pressure 700 hPa–1060 hPa
Power source . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 x 1.5 V AA non-rechargeable or
2 x 1.2 V AA rechargeable batteries
Current consumption for
one channel, 80 Hz, 30 mA . . . . . . . . . . . . . . . . . . . . 150 mA
I r.m.s. max/channel . . . . . . . . . . . . . . . . . . . . . . . . . 31 mA
Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 x 50 x 30 mm
Weight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ca. 180 g
KEY TO THE SYMBOLS
29
Read the operating instructions before to use.
Dispose of the worn-out stimulator in accordance with local and national regulations.
0413
Complies with the European Medical Device Directive (93/42/EEC). Notified body Intertek ETL Semko
(0413).
Complies with CSA C22.2 No. 69050-1. Certification mark issued by SGS.
1 ø 32 mm
2 ø 50 mm
3 40 x 60 mm
1 2 3 4 5 6 7
4 50 x 100 mm
5 80 x 130 mm
6 50 x 50 mm
7 50 x 90 mm
NECK/THORACIC SPINE – NOCICEPTIVE MUSCLE PAIN
Examples of indications
1. Tension type headache. 31
2. Myalgia in the trapezius.
Goal
1. Reduced headache.
2. Pain alleviation.
Placement of electrodes
Place the electrodes over M. Trapezius.
Suggested programs
CEFAR REHAB X2: 1, 3, 4, 5
ANKLE – INSTABILITY
Examples of indications
1. Ankle instability after distorsion etc.
2. Pes planus (flatfoot).
Goal
Increased stability of the ankle and increased strength in the posterior
tibial muscle.
Placement of electrodes
Place one pair of electrodes over the lower part of the posterior tibial
muscle.
Suggested programs
CEFAR REHAB X2: 9, 11, 13
FOOT – HALLUX VALGUS
Examples of indications
42 Hallux valgus.
Goal
Increased abduction of the big toe.
Placement of electrodes
Place one pair of electrodes over the abductor hallucis.
Suggested programs
CEFAR REHAB X2: 9, 11, 13