InTENSityTwinStimIV Manual

Twin Stim IV
INSTRUCTION MANUAL
www.roscoemedical.com
InTENSity Twin Stim IV Roscoe Medical
This manual is valid for the

Twin Stim IV
This instruction manual is published by Roscoe Medical Inc.
Roscoe Medical Inc. reserves the right to improve and amend it at any
time without prior notice. Amendments may however be published in
new editions of this manual.
All Rights Reserved.Rev.V1.0 © 2015, 20150211
United States Federal Law restricts this device to sale by or on the order
of a physician or licensed practitioner
Conformity to safety standards
Roscoe Medical Inc. declares that the

device complies with following normative documents:
IEC60601-1, IEC60601-1-2, I EC60601-2-10,

IEC62366, IEC60601-1-11, ISO10993-5, ISO10993-10,
ISO10993-1, ISO7010
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Roscoe Medical InTENSity Twin Stim IV
Table of Contents
1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
1.1 General
1.2 Medical Background
1.3 Indication for use
2. Important Safety Precautions and Warnings . . . . . . . . . . . . 6
3. Package Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
3.1 Front And Rear Panel
3.2 LCD Display
4. Specification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
4.1 Technical Information
4.2 Program Parameters
4.3 Waveform Information
5. Instruction For Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
5.1 Battery
5.2 Connecting Electrodes
5.3 Connecting Lead Wires
5.4 Turn On The Device
5.5 Setting a New Program
5.6 Start Treatment
5.7 Other Important Functions
Safety Lock Feature
Low Battery Indicator
Charging The Battery
5.9 Patient Compliance Meter
6. Cleaning And Storage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
6.1 Cleaning The Unit
6.2 Cleaning The Electrode Pads
6.3 Storing The Electrode Pads And Lead Wires
6.4 Storing The Unit
7. Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
8. Disposal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
9. Glossary Of Symbols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
10. Electromagnetic Compatibility (EMC) Tables . . . . . . . . . . . 36
11. Warranty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
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1. INTRODUCTION
1.1 General
The InTENSity Twin Stim IV is a portable electrotherapy device
featuring two therapeutic modes: Transcutaneous Electrical Nerve
Stimulator (TENS) and Neuromuscular Electrical Stimulation (NMES),
which are used for pain relief and electrical muscle stimulation.
The stimulator sends gentle electrical current to underlying nerves
and muscle group via electrodes applied on the skin. The parameters
of device are controlled by the buttons on the front panel. The intensity
level is adjustable according to the needs of patients.
1.2 Medical Background

Explanation of pain
Pain is an unpleasant sensation that can serve a useful purpose by
alerting us to a possible injury or disease. When the body is functioning
normally, pain serves as a warning system that something is not right.
Without pain a person would not know when to avoid danger or seek
medical help. Pain becomes a problem when it continues after treatment
has started or long after an injury is healed.
There are two types of pain:
Acute — L
imited in duration. Examples include but are not limited to:
• Sprains • Incisional pain • Muscle strain
Chronic — Long-lasting, persistent pain that ceases to serve

as a warning system and becomes a problem.
Examples include but are not limited to:
• Low back pain • Pinched Nerves
• Bursitis • Joint Pain
The Twin Stim IV was developed to help relieve some types

of chronic and acute pain.
-4-
How does TENS work?

There is nothing “magic” about Transcutaneous Electrical Nerve
Stimulation (TENS). TENS is intended to help relieve pain. The TENS unit
sends comfortable impulses through the skin to stimulate the nerve (or
nerves) in the treatment area. In many cases, this stimulation will greatly
reduce or eliminate the pain sensation the patient feels. Pain relief varies
by individual patients, mode selected for therapy, and the type of pain. In
many patients, the reduction or elimination of pain lasts longer than the
actual period of stimulation (sometimes as much as three to four times
longer). In others, pain is only modified while stimulation actually occurs.
You may discuss this with your physician or therapist.
How NMES works

Neuromuscular Electrical Stimulation (NMES) is an internationally
accepted and proven way of treating muscular injuries. It works by
sending electronic pulses to the muscle needing treatment; this causes
the muscle to exercise passively. This device is low frequency and in
conjunction with the square wave pattern allows the stimulation to
work directly on the muscle groups. This is being widely used in
hospitals and sports clinics for the treatment of muscular injuries and
for the re-education of paralyzed muscles, to prevent atrophy in affected
muscles and improving muscle tone and blood circulation.
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
pulses into the body. The pulses stimulate the nerves to send signals to a
specifically targeted muscle, which reacts by contracting, just as it does
with normal muscular activity
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1.3 Indication for Use

Twin Stim IV Stimulator may be used for the following conditions:
1) Symptomatic relief of chronic intractable pain.
2) Post traumatic pain.
3) Post surgical pain.
For Neuromuscular Electrical Stimulation Therapeutic Mode (NMES):

1) Relaxation of muscle spasm.
2) Increase of blood flow circulation.
3) Prevention of disuse atrophy.
4) Muscle re-education.
5) Maintaining or increasing range of motion.
6) Immediate post-surgical stimulation of lower leg muscles
to prevent venous thrombosis.
2. IMPORTANT SAFETY PRECAUTIONS

AND WARNINGS
It is important that you read all the warning and

precautions included in this manual because they are
intended to keep you safe, prevent injury and avoid a
situation that could result in damage to the device.
SAFETY SYMBOLS USED IN THIS MANUAL

Indicates a potentially hazardous situation which, if not
DANGER avoided, could result in death or serious injury.

WARNING avoided, could result in serious injury and equipment
damage.
CAUTION avoided, may result in minor or moderate injury to the user
or patient or damage to the device or other property.
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DANGER
This stimulator must not be used in combination with the following medical
devices:
• Internally transplanted electronic medical devices,
such as a pacemaker.
• Electronic life support equipment, such as respirators.
• Electronic medical devices attached to the body,
such as electrocardiographs.
Using this stimulator with other electronic medical devices may cause errone-
ous operation of those devices.
WARNING
DO NOT USE THIS DEVICE UNDER THESE CONDITIONS

• Consult with your physician before using this device, because the device
may cause lethal rhythm disturbances in certain susceptible individuals.
• If you have a cardiac pacemaker, implanted defibrillator, or other implanted
metallic or electronic device. Such use could cause electric shock, burns,
electrical interference, or death.
• Together with a life-supporting medical electronic device such as an artificial
heart or lung or respirator.
• In the presence of electronic monitoring equipment (e.g., cardiac monitors,
ECG alarms), which may not operate properly when the electrical stimulation
device is in use.
• On open wounds or rashes, or over swollen, red, infected, or inflamed areas
or skin eruptions (e.g., phlebitis, thrombophlebitis, varicose veins); or on top
of, or in proximity to, cancerous lesions.
• Over areas of skin that lack normal sensation.
• On the opposite sides of your head since the effects of stimulation
of the brain are unknown.
DO NOT USE ON THESE INDIVIDUALS
• Pregnant women, because the safety of electrical stimulation during
pregnancy has not been established.
• Children or infants, because the device has not been evaluated for
pediatric use.
• Persons incapable of expressing their thoughts or intentions.
-7-
WARNING (CONTINUED)
DO NOT USE THIS DEVICE DURING THESE ACTIVITIES

• When in the bath or shower
• While sleeping
hile driving, operating machinery, or during any activity in which electrical
W
stimulation can put you at risk for injury.
PAIN MANAGEMENT WARNINGS

• If you have had medical or physical treatment for your pain, consult with your
physician before using this device.
• If your pain does not improve, becomes seriously chronic or severe, or
continues for more than five days, stop using the device and consult with your
physician.
• The mere existence of pain functions as a very important warning telling us
that something is wrong. Therefore, if you suffer from any serious illness,
consult your physician in order to confirm that it is advisable for you to use
this TENS Stimulator.
WARNINGS AND PRECAUTIONS REGARDING THE PADS
• Apply pads to normal, healthy, dry, clean skin (of adult patients) because it
may otherwise disrupt the healing process.
• If you experience any skin irritation or redness after a session, do not continue
stimulation in that area of the skin.
NEVER APPLY THE PADS TO:
• The head or any area of the face.
• Any area of the throat because this could cause severe muscle
spasms resulting in closure of the airway, difficulty in breathing,
or adverse effects on heart rhythm or blood pressure.
•
• Both sides of the thorax simultaneously (lateral or front and
back), or across your chest because the introduction of electrical
current may cause rhythm disturbances which could be lethal.
-8-
CAUTION
WARNINGS AND PRECAUTIONS REGARDING THE PADS

• United States Federal Law restricts this device to sale by or on the order of a
physician or licensed practitioner
• Do not bend or fold because the pad may not function properly. Place the
pads onto the plastic film and then store into the sealed package when not in
use.
• Do not apply ointment or any solvent to the pads or to your skin because it
will disrupt the pads from functioning properly.
• The pads are already pre-gelled and will adhere to your skin.
• To avoid damage to the adhesive surface of the pads, put the pads only on
the skin or on the plastic film provided.
• Place the pads at least 1 inch apart on your skin. The pads should never
touch each other.
• Make sure the components are connected well and the pads are fixed on the
part of the body you wish to treat or the therapy may not be effective.
DO NOT USE YOUR PADS THIS WAY
• Pads should not touch each other when placed onto your skin.
• Do not place on your spine or backbone.
• Pad should not touch any metal object, such as a belt buckle or necklace.
• Pads should not be placed simultaneously on the soles of both feet.
• Pads should not be placed simultaneously on the calves of both legs.
• Do not share pads with another person. This may cause a skin irritation or
infection. Pads are intended for use by one person.
• Do not place or relocate the pads while the device is on.
• Always turn the power off before removing or changing the pad location.
• Do not leave pads attached to the skin after treatment.
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CAUTION (CONTINUED)
CAUTION WHILE USING THE STIMULATOR

• If the stimulator is not functioning properly or you feel discomfort,
immediately stop using the device.
• Do not use for any other purpose except for what it is intended for.
• Do not insert the electrode plug into any place other than the jack
on the main unit.
• Do not mix Alkaline and Manganese batteries as this will shorten
the battery life.
• Do not pull on the electrode cord during treatment.
• Do not use the device while wearing electronic devices such as
watches as this may damage the device.
• Do not use near a cell phone as this may cause the stimulator to malfunction.
• Do not bend or pull the end of the cord.
• When pulling out the cord from the device, hold the plug and pull.
• Replace the cord when broken or damaged.
• Do not throw the batteries into a fire. The batteries may explode.
• Dispose of the device, batteries, and components according to applicable
legal regulations. Unlawful disposal may cause environmental pollution.
• The size, shape and type of pads may affect the safety and effectiveness
of electrical stimulation.
• The electrical performance characteristics of pads may affect the safety
and effectiveness of electrical stimulation.
• Using pads that are too small or incorrectly applied, could result in
discomfort or skin burns.
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GENERAL PRECAUTIONS
• The long-term effects of electrical stimulation are unknown.
• Apply stimulation to only normal, intact, clean, dry, and healthy skin.
• TENS is not effective in treating the original source or cause of the pain,
including headache.
• TENS is not a substitute for pain medications and other
pain management therapies.
• TENS devices do not cure disease or injuries.
• TENS is a symptomatic treatment and, as such, suppresses the sensation
of pain that would otherwise serve as a protective mechanism.
• Effectiveness is highly dependent upon patient selection by a practitioner
qualified in the management of pain patients.
• You may experience skin irritation or hypersensitivity due to the electrical
stimulation or electrical conductive medium (gel).
• If you have suspected or diagnosed heart disease, you should follow
precautions recommended by your physician.
• If you have suspected or diagnosed epilepsy, you should follow precautions
recommended by your physician.
• Use caution if you have a tendency to bleed internally, such as following
an injury or fracture.
• Consult with your physician prior to using the device after a recent surgical
procedure, because stimulation may disrupt the healing process.
• Use caution if stimulation is applied over the menstruating or pregnant uterus.
• Use caution if stimulation is applied over areas of skin that lack
normal sensation.
• Keep unit away from young children. The unit contains small pieces
that may be swallowed. The electrode cord can cause strangulation.
Immediately contact your physician should any of these things occur.
• Use this device only with the leads, electrodes, and accessories
recommended by the manufacturer.
• Keep unit out of the reach of young children.
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POSSIBLE ADVERSE REACTIONS

• Do not use to treat one region for extended periods of time (more than 30
minutes a session, up to 2 times/day) or muscles in that region may become
exhausted and sore.
• You may experience skin irritation and burns beneath the stimulation
electrodes applied to your skin.
• You should stop using the device and consult with your physician if you
experience adverse reactions from the device.
Note: Always use electrodes that are legally marked and sold
in the United States under 510K guidelines.
- 12 -
3. PACKAGE CONTENTS
Twin Stim IV Unit 2 × Lead wires 4 × Electrode pads

(2" x 2")
TM
Twin Stim IV
INSTRUCTION MANUAL
1 x Instruction Manual 1 × LI rechargeable 1 × USB Cable

Battery Pack and Wall Charger
QUICK REFERENCE GUIDE PAGE 1
The purpose of this guide is to assist you in correctly operating your Intensity™ 10 unit. This
device should only be used under the continued supervision of a licensed physician. This guide
is not intended to replace or substitute the Intensity™ 10 Instruction Manual. PLEASE READ
THE INSTRUCTION MANUAL COMPLETELY BEFORE USING THIS DEVICE. Read, understand
and practice the warnings, cautions and operating instructions. Always follow the operating
instructions prescribed by your healthcare provider.
INTENSITY™ 10 UNIT
Top
CH1 CH2 1 Channel 1 and 2 sockets
1 2 AC/DC adapter receptacle
Side Front Back 3 T (time) and S (therapeutic part)
selection buttons
4 Channel 1 intensity increase button
6 10
5 Channel 1 intensity decrease button
6 LCD display
3 7 Channel 2 intensity increase button
2
4 7 8 Channel 2 intensity decrease button
5 8 9 Power on/off button

9 10 Belt clip
11 11 Battery compartment cover
S
LCD DISPLAY
1
1 TENS therapeutic mode
2 Lock function indicator 2 6
ELECTRODES 3
3 Low-battery indicator 4
(2 SETS)
5 7
4 Treatment time
5 Timer symbol
6 Channel 1 intensity level
8
7 Channel 2 intensity level
LEAD WIRES 8 Body part selection
(2 SETS)
For more information about your Intensity™ 10 unit, please visit us online at roscoemedical.com or call 1-800-871-7858.
1 x Quick Start Guide
- 13 -
3.1 Front and Rear Panel

9
12
CH1 CH2
8
Twin Stim IV
1 11
2
7
3 M/ 10
5
4 S 6
1) LCD Display: Operating state of the device

2) Body Part Buttons: Select body part or treatment program
3) Channel 1 Intensity Buttons: Increase or decrease the output
intensity of channel 1.
4) Set button: Press this button to enter the setting status
5) Power Button: Press once to turn on. Press and hold for 3 seconds to
turn off.
6) Channel 2 Intensity Buttons: Increase or decrease the output
intensity of channel 2.
7) Pause/Mode Button: Press this button to change treatment modes
(TENS or NMES). Press button again to pause active treatment status
8) LED: Charging indicator light.
9) Output Sockets: Lead wire output sockets
10) Battery compartment cover.
11) Belt Clip.
12) USB charging port.
- 14 -
3.2 LCD Display
3 12 11
1
2 10
4
13
5
6
14
7
8
9
1) Displays waveform mode.

2) Displays home screen
3) Displays set mode
4) Displays output state: start, pause, lock
5) Hour Indicator
6) Contraction, Relaxation & Ramp
7) Displays output intensity of channel 1 , pulse width and pulse rate
8) Displays therapeutic body part: hand, foot, shoulder, arm,
leg and back
9) Displays therapeutic mode: TENS, NMES
10) Low-battery indicator
11) Load indicator
12) Indicates compliance meter mode
13) Displays the treatment time
14) Display output intensity of channel 2
- 15 -
4. SPECIFICATIONS
4.1 Technical Information
Channel Dual, isolated between channels
Power Supply 3.7V LI rechargeable battery pack
Charger output: 5.0V DC, 300mA (optional)
Operating Conditions 5°C to 40°C (41°F to 104°F) with a relative
humidity of 30% – 75%,atmospheric pressure
from 700 to 1,060 Hpa
Storage and -10°C to 55°C (14°F to 131°F) with a relative
Transport Conditions humidity of 10%-90%,atmospheric pressure
from 700 to 1,060 Hpa
Dimensions 11.7 × 6 × 2.1 cm (L*W*H)
Weight 3.5 oz. (Without battery)
Electrode Detection The amplitude level will be reset to 0mA when the
Function amplitude level is 10mA or greater and an open
circuit at either channel is detected.
Technical Specifications (TENS & NMES)

Waveform TENS: Symmetrical bi-phase rectangular wave
NMES: Biphasic rectangular
Pulse Amplitude TENS/NMES: Adjustable, 0 to 100mA at 1,000 ohm
Load each channel, 1mA/Step
Pulse Width TENS: From 50 to 400us microseconds
NMES: From 200 to 400us (microseconds)
Pulse Rate TENS: From 1 to 150Hz
NMES: From 1 to 100Hz
Treatment Time 5 to 90 minutes
Technical Specifications (NMES ONLY)

Contraction Time 5 to 30 seconds
Relaxation Time 5 to 60 seconds
Ramp Up/Down Time 1 to 9 seconds
Treatment Time 5 to 90 minutes
- 16 -
4.2 Program Parameters

TENS
Body Treatment Pulse Pulse Cycle
Program
Part Time Rate Width Time
P1 20 Min. 80 – 100Hz 100 – 120µs 10 Sec
Neck P2 20 Min. 4Hz 150 – 200µs 20 Sec
P1 20 Min. 80 – 100Hz 100µs 10 Sec
Shoulder P2 20 Min. 10Hz 220 – 260µs 20 Sec
P1 20 Min. 100Hz 100µs Fixed
Hand P2 20 Min. 1 – 10Hz 200µs 20 Sec
P1 20 Min. 80 – 100Hz 100µs 10 Sec
Low back P2 20 Min. 4Hz 200 – 260µs 20 Sec
P1 20 Min. 120Hz 100 – 120µs 10 Sec
Knee P2 20 Min. 1 – 10Hz 150 – 200µs 20 Sec
P1 20 Min. 80 – 120Hz 100 – 120µs 10 Sec
Foot P2 20 Min. 1 – 10Hz 200µs 20 Sec
Treatment Pulse Pulse

Body Part Program
Time Rate Width
All
Adjustable Adjustable Adjustable
Therapeutic U1
5 – 90 mins 1 – 150 Hz 50 – 400µs
Parts
- 17 -
4.2 Program (Continued)
NMES
Body Treatment Pulse Pulse Contract Relax Ramp
Program
Part Time Rate Width Time Time Up/Down
P1 20 Min. 40Hz 300µs 12 Sec 20 Sec 2 Sec
Neck P2 20 Min. 50Hz 300µs 12 Sec 30 Sec 2 Sec
Shoulder P2 20 Min. 55Hz 300µs 12 Sec 35 Sec 2 Sec
Hand P2 20 Min. 5Hz 300µs 12 Sec 30 Sec 2 Sec
Low back P2 20 Min. 70Hz 300µs 12 Sec 30 Sec 2 Sec
Knee P2 20 Min. 25Hz 300µs 12 Sec 50 Sec 2 Sec
Foot P2 20 Min. 5Hz 300µs 12 Sec 30 Sec 2 Sec
Min: 5 - 60s
1 - 100Hz 200 - 400µs 5 - 30s 1 - 9s
5 - 90, Step:
All Step: Step: 5 Step:1s Step: 1s
Step: 1s
Body U1 1Hz Default: Default: Default:
5min Default:
Parts Default: 300uS 12s 2s
Default: 20s
40Hz
20Min
- 18 -
4.3 Waveform Information — TENS

Continuous
Pulse Width Modulation
Cycle time
Pulse Rate Modulation
Cycle time
Modulation (Pulse rate and width modulation)
Cycle time
Waveform Information — NMES

Synchronous
intensity
CH1
CH2
time
- 19 -
5. INSTRUCTIONS FOR USE
5.1 Battery
Installation of Battery
Push down on the belt clip to release it. Remove the battery cover and
insert the battery, as shown on the diagram. Replace the battery cover
and belt clip. For battery charging instructions, please see page 29.
Disposal of Battery
Depleted batteries do not belong in the household waste.
Dispose of the batteries according to the your federal,
state and local regulations. As a consumer, you are
obligated by law to return depleted batteries.
CAUTION
1) Keep the battery and the product out of the range of children.
2) Battery may not be dismantled, thrown into fire or short-circuited.
3) Protect battery from excess heat; Take the battery out of the product if
the product is not used for a long period of time.
4) Always replace with the same type of battery.
5.2 Connecting Electrodes

Take the pads out of the sealed package; insert the pin of the lead wire
into the electrodes pigtail. Make sure there is no bare metal exposed.
- 20 -
CAUTION
Always use electrodes with CE mark, or which are legally marketed
in the US under 510(K) procedure.
5.3 Connecting Lead Wires

1) B efore proceeding to this step, be sure the device is completely
turned OFF.
2) Insert the lead wires into the output sockets located on the top
of the device.
3) Holding the insulated portion of the connector, push the plug end
of the wire into one of the sockets (see drawing); one or two sets
of wires may be used.
4) This device has two output receptacles controlled by Channel 1 and
Channel 2 at the top of the unit. You may choose to use one channel
with one pair of lead wires or both channels with two pairs of lead
wires. Using both channels gives the user the advantage of stimulat-
ing two different areas at the same time.
Note: If you use only one Channel, only plug in 1 lead wire
at the top of the unit
- 21 -
5.4 Turn on The Device

Press the [ ] button to turn on the device.
CAUTION
Before using the device for the first time, you are strongly advised
to take careful note of the contraindications and safety measures
detailed at the beginning of this manual (Safety information),
as this powerful equipment is neither a toy nor a gadget!
5.5 Setting a New Program

There are 6 therapeutic body part buttons available — neck, shoulder,
hand, low back, knee and foot. Each therapeutic part has 3 programs –
P1, P2 and U1 for a total of 36 programs.
1. Press [ M/II ] button to select the treatment mode (TENS or NMES).
2. Select a body part on the device and press it.

3. The body part will display on the LCD screen.
4. Press the same button again to select one of the 3 programs
(such as P1, P2 or U1).
Twin Stim IV
3
2
1 M/
- 22 -
Manual TENS Program — U1
A. Select Body Part
Press the “M/II” button to choose TENS mode. Then select the body
part which you want to treat. Press the body part button until the LCD
displays program “U1”
B. Set Pulse Rate

Press [ S ] button to enter the pulse rate and the "Hz" will flash.
Press [ + ] or [ − ] button to adjust pulse rate.
C. Set Pulse Width

Press [ S ] button to enter the pulse width and the "µs" will flash. Then
press [ + ] or [ − ] button to adjust the pulse width.
- 23 -
D. Set Treatment Time

Press [ S ] button to enter treatment time and the "min." will flash.
Then press [ + ] or [ − ] button to adjust the treatment time.
Set Preset TENS Programs — P1 and P2

A. Select Body Part
Press the “M/II” button to choose TENS mode. Then select the body
displays program “P1” or “P2”
B. Set Treatment Time

Press [ S ] button to enter the treatment time and the "Min" will flash.
Press [ + ] or [ − ] button to adjust treatment time. After you finished
settings, press the [ S ] or [ ]button to confirm, the device will go back
to the home screen.
C. Start Treatment
Press [CH1+] or [CH2+] to increase the output intensity of channel 1
and/or channel 2. Press [CH1−] or [CH2−] to decrease the output
intensity of channel 1 and/or channel 2.
- 24 -
Manual NMES Program — U1

A. Select Body Part
Select the body part which you want to treat. Then press the body part
button until the LCD displays program "U1" like the following:

Press [ S ] button to enter treatment time and the “min.” will flash.
C. Set Pulse Rate

Press [ S ] button to enter the pulse rate and the “Hz” will flash.
Press [ + ] or [ − ] button to adjust pulse rate.
D. Set Pulse Width

Press [ S ] button to enter the pulse width and the “µs” will flash. Then
press [ + ] or [ − ] button to adjust the pulse width.
- 25 -
E. Set Ramp Up Time

Press [ S ] button to set the ramp up and down time and the “sec.”
will flash and you will see the below image circled in red on the screen.
F. Set Contraction Time

Press [ S ] button to set the contraction time and the “sec.” will flash
along with the symbol circled in red below. Then press [ + ] or [ − ]
button to adjust the time.
G. Set Relaxation Time

Press [ S ] button again to set the relaxation time and the “sec.” will
flash along with the picture circled in red below. Then press [ + ] or [ − ]
button to adjust the time.
- 26 -
After you have finished settings, press [ ] button to confirm, the device
will go back to the home screen.
H. Start Treatment
Set Preset NMES Programs — P1 and P2

A. Select Body Part
Press the “M/II” button to choose NMES mode. Then select the body
displays program “P1” or “P2”

Press [ S ] button to enter the treatment time and the "Min" will flash.
Press [ + ] or [ − ] button to adjust treatment time. After you finished
settings, press the [ S ] or [ ]button to confirm, the device will go back
to the home screen.
C. Start Treatment
- 27 -
CAUTION
1) If the electrodes are not placed firmly on skin or the device has not
connected with the electrodes or lead wires securely, and the output
intensity level is equal to or greater than 10mA, the intensity will stop
automatically.
2) If the stimulation levels become uncomfortable, reduce the intensity
to a comfortable level. Contact your medical practitioner if the
problems persist.
D. Pause or Stop Treatment

If there is an immediate need to pause treatment, press the [ M/II ] button
and the “II” will display on the LCD. Press it again to continue treatment
or press [ ] button to stop treatment and the device will return to the
home screen.
5.7 Turn OFF Device
Press and hold [ ] button until the device turns off.
CAUTION
If there is no operation in the panel for 3 minutes in the standby status,
the device will shut off automatically and you will hear a beep sound.

Safety Lock Feature
The lock function automatically activates after there is no operation
in the panel for 20 seconds while in treatment status. The indicator " "
will display on the LCD .
This is a safety feature to prevent accidental changes to your settings

and to prevent accidentally increasing the output intensity level. Press
[CH1−] or [CH2−] button to unlock.
- 28 -
Low Battery Indicator

When the low power indicator " " displays on the LCD, stop the
device and charge the battery.
Charging the Battery

NOTE: Battery comes pre-charged.
Proceed as follows to recharge the battery:
• This device cannot be used while charging.
• Make sure that the device has been switched off.
• Make sure that the device is no longer connected to
the patient (the output cables and electrodes must be
disconnected).
• Connect the USB cable to the charging port on the top of device.
• Connect the USB cable to the wall outlet or USB port.
• When the device is charging, the indicator light will be red.
• It could take up to 6 hours to reach a full charge.
• When charging is completed, the indicator light will be green.
After the battery has been recharged, disconnect the cable from the wall
outlet or USB port and the device is ready to be used again.
The life of a rechargeable battery depends on the number of recharging/

rundown cycles it undergoes and how these cycles are performed.
The following suggestions will help prolong the life of the battery:
• Whenever the device is not used frequently, charge
the battery once a month.
• For longer battery life, discharge the battery as much
as possible.
CAUTION
1) P lease use the standard charger provided by the manufacturer or agent.
2) D o not use the device for treatment when in charging status as
it will not work. When you are using the device, never connect it
to the charger. If you do, the device will turn off automatically as
a safety precaution and you will not be able to turn it back on until
you disconnect the charger from the device.
3) When charging is complete, you are strongly advised to disconnect
the charger
- 29 -
5.9 Patient Compliance Meter

You can store 60 sets of treatment records and a total treatment time of
up to 100 hours on this device.
A. Check and Delete Individual Records

In standby, press [ M/II ] button and hold for 3 seconds to enter the
compliance meter records. The LCD will show the number of records
and treatment time (as shown in the below picture). Press [ + ] or [ − ]
buttons to check each record. To delete a record, press [ S ] button and
hold for 3 seconds.

B. Check and Delete Accumulative Records

Individual records menu, press [ II ] button to switch to accumulative
records menu. Press [ S ] button holding for 3 seconds and all of records
will be deleted followed by a beeping sound.
CAUTION
The records will be permanently deleted and can be not restored if you
follow the delete records method mentioned above.
- 30 -
6. CLEANING AND STORAGE
6.1 Cleaning the Unit

1) Turn unit off and disconnect the lead wires from the unit.
2) Clean the device after use with a soft, slightly moistened cloth
and wipe gently.
• Do not use chemicals (like thinner, benzene).
• Do not let water get into the internal area.
Note:
This device and accessories (including the electrodes) do not
require sterilization.
6.2 Cleaning the Electrode Pads

1) Turn the power off and remove the lead wires from the electrodes.
2) Wash the electrodes when the adhesive surface becomes dirty and/or
the electrodes are difficult to attach.
• To “wash” the pads, place a small drop of water on your clean
fingertip and rub the water across the entire gel part. Place the
adhesive part face up and let it air dry until the water is absorbed
and has been reconstituted. Do not wipe with a tissue paper or
cloth. If the electrode still does not stick properly, replace them
with new electrodes.
- 31 -
CAUTION
1) The life of electrodes may vary by the frequency of washing,
skin condition, and storage state.
2) If the electrodes no longer stick to your skin or the electrodes are broken,
you should replace new electrodes.
3) Before applying the self-adhesive electrodes, it is recommended
to wash and degrease the skin, and then dry it.
4) Do not turn on the device when the electrodes are not positioned
on the body.
5) Never remove the self-adhesive electrodes from the skin while the
device is still turned on.
6) If replacement electrodes are necessary, use only electrodes that
are the same size (2" x 2") as the electrodes provided with the
Twin Stim IV.
7) Use of larger electrodes may reduce the effect of the stimulation.
Use of electrodes that are much smaller than the electrodes provided
with the Twin Stim IV may increase the chance of skin irritation or
electrode burns occurring under the electrodes.
8) Always use electrodes that have been cleared for marketing in the
USA by the FDA.
6.3 Storing The Electrode Pads and Lead Wires

1) Turn the device off and remove the lead wires from the unit.
2) Remove the electrodes from your body and disconnect the lead wires
from the electrodes.
3) Place the electrodes onto the plastic film and then store into the
sealed package.
4) Wrap the lead wires and store into the sealed package.
6.4 Storing the Unit

1) Place the unit, electrodes, lead wires and manual back into
the carrying case. Store the box in a cool, dry place, -10ºC ~ 55ºC;
10% ~ 90% relative humidity.
2) Do not keep in places that can be easily reached by children
3) When not in use for a long period, remove the battery before storage.
- 32 -
7. TROUBLESHOOTING
Problem Possible Causes Possible Solution

Are the batteries Charge or replace the
The unit cannot exhausted? batteries.
power on Are the batteries installed Insert the batteries
correctly? observing polarity.
Electrodes dried out or Replace with new
contaminated electrodes
Stimulation weak
Electrodes are not securely
or cannot feel any Reconnect the electrodes
attached to the skin.
stimulation
Lead wires Replace with new
Old/worn/damaged lead wires
Intensity is too high Decrease intensity.
Electrodes are too close Reposition the electrodes
together at least 1-1∕2" apart.
Replace electrodes with
Stimulation is Electrode active area size ones that have an active
uncomfortable is too small. area no less than 25.0cm2
(5cm*5cm).
May not be operating the
Please check the manual
device according to the
before use
manual.
Verify connection is
secure.
Turn down the intensity.
Rotate lead wires in socket
90°. If still intermittent,
Intermittent output Lead wires replace lead wire.
If still intermittent after
replacing lead wire, a
component may have
failed. Call the repair
department.
- 33 -
7. TROUBLESHOOTING (Continued)
Problem Possible Causes Possible Solution

Improper electrode place- Reposition the electrodes
Stimulation is ment at least 1-1∕2” apart.
ineffective.
Unknown Contact clinician.
Re-position the
Using the electrodes on the electrodes. If at any time
same site every time. you feel pain or discomfort
stop use immediately.
Ensure the electrodes
The electrodes aren’t stuck
The skin becomes are stuck securely on
onto the skin properly
red and/or you feel the skin.
a stabbing pain Clean the electrodes
according to description
The electrodes are dirty.
in this manual or replace
with new electrodes.
The surface of the electrode Replace with a new
was scratched. electrode.
The electrodes come Turn off the device and
off the skin. place the electrodes again.
Output current
The lead wires are Turn off the device and
stops during
disconnected reconnect the lead wires.
therapy
The power of the batteries Charge or replace the
has been exhausted. batteries.
This is normal operation.
Please charge and use in
Brand new or stored
Li rechargeable device. You must do this
batteries
battery pack 3 – 5 times before
doesn’t last or life full capacity is reached.
is short Used Li rechargeable Charge the battery. If this
battery has reached end does not work, replace
of life the battery.
- 34 -
8. DISPOSAL
Used fully discharged batteries must be disposed of in

a specially labeled collection container, at toxic waste
collection points or through an electrical retailer. You are
under legal obligation to dispose of batteries correctly.
Please dispose of the device in accordance with the

legal obligation.
9. GLOSSARY OF SYMBOLS
Electrical devices are recyclable material and should not

be disposed of with household waste after their useful life!
Help us to protect the environment and save resources
and take this device to the appropriate collection points.
Please contact the organization which is responsible for
waste disposal in your area if you have any questions.
Type BF Applied Part
Please refer to instruction manual because of the higher

levels of output.
- 35 -
10. ELECTROMAGNETIC COMPATIBILITY

(EMC) TABLES
Information for accompanying documents in the scope of

IEC60601-1-2:2007
Important information regarding Electro Magnetic Compatibility (EMC)

With the increased number of electronic devices such as PC’s and mobile
(cellular) telephones, medical devices in use may be susceptible to
electromagnetic interference from other devices. Electromagnetic
interference may result in incorrect operation of the medical device and
create a potentially unsafe situation. Medical devices should also not
interfere with other devices.
In order to regulate the requirements for EMC (Electro Magnetic
Compatibility) with the aim to prevent unsafe product situations,
the EN60601-1-2 standard has been implemented. This standard
defines the levels of immunity to electromagnetic interferences as well as
maximum levels of electromagnetic emissions for medical devices.
Medical devices manufactured for Roscoe Medical Inc. conform to this

EN60601-1-2:2007 standard for both immunity and emissions.
Nevertheless, special precautions need to be observed:
• The use of accessories and cables other than those specified by
Roscoe Medical, with the exception of cables sold by Roscoe Medical
as replacement parts for internal components, may result in increased
emission or decreased immunity of the device.
• The medical devices should not be used adjacent to or stacked with
other equipment. In case adjacent or stacked use is necessary, the
medical device should be observed to verify normal operation in the
configuration in which it will be used.
• Refer to further guidance below regarding the EMC environment in
which the device should be used.
- 36 -
Guidance and manufacturer’s declaration — electromagnetic emissions

The device is intended for use in the electromagnetic environment
specified below. The customer or the user should assure that it is used
in such an environment.
Electromagnetic Environment
Emissions Test Compliance
— Guidance
The device uses RF energy only for
its internal function. Therefore, its
RF emissions
Group 1 RF emissions are very low and are
CISPR 11
not likely to cause any interference
in nearby electronic equipment.
RF emissions
Class B
CISPR11
The device is suitable for use in all
Harmonic establishments including domestic
emissions lEC Not applicable and those directly connected to the
61000-3-2 public low-voltage power supply
network that supplies buildings used
Voltage fluctuations
for domestic purposes.
/ flicker emissions Not applicable
lEC 61000-3-3
- 37 -
Guidance And Manufacturer’s Declaration — Electromagnetic Immunity

The device is intended for use in the electromagnetic environment
specified below. The customer or the user should assure that it is used
in such an environment.
Electromagnetic
EC 60601 Compliance
Immunity Test Environment
Test Level Level
— Guidance
Floors should be wood,
concrete or ceramic tile.
Electrostatic
±6 kV contact ±6 kV contact If floors are covered with
discharge (ESD)
±8 kV air ±8 kV air synthetic material, the
lEC 61000-4-2
relative humidity should
be at least 30 %.
Electrical fast
transient/ burst Not applicable Not applicable Not applicable
IEC 61000-4-4
Surge IEC
Not applicable Not applicable Not applicable
61000-4-5
Voltage dips,
short
interruptions and
voltage varia- Not applicable Not applicable Not applicable
tions on power
supply IEC
61000-4- 11
Power frequency
Power frequency magnetic fields should
(50/ 60 Hz) mag- be at levels characteristic
3 A/m 3 A/m
netic field IEC of a typical location in
61000-4-8 a typical commercial or
hospital environment.
- 38 -

(Continued)
Electromagnetic
Immunity EC 60601 Compliance
Environment
Test Test Level Level
— Guidance
Conducted Portable and mobile RF
RF IEC Not applicable communications equipment
61000-4-6 should be used no closer to any
part of the Electrical Stimulator
including cables, than the
recommended separation
distance calculated from the
equation appropriate to the
frequency of the transmitter.
Recommend separation
distance
d = 1.2 √P
d = 1.2 √P 80 MHz to 800 MHz
d = 2.3 √P 800 MHz to 2.5 GHz
Where P is the maximum output

Radiated 3 V/m power rating of the transmitter in
RF IEC 80 MHz to 3 V/m watts (W) according to he
61000-4-3 2.5 GHz transmitter manufacturer and
d is the recommended
separation distance in meters (m).
Field strengths from fixed RF
transmitters as determined by an
electromagnetic site survey,
(a) should be less than the com-
pliance level in each frequency
range.
(b) Interference may occur in the
vicinity of equipment marked
with he following symbol:
- 39 -

(Continued)
Note1: At 80 MHz and 800 MHz, the higher frequency range applies.
Note2: These guidelines may not apply in all situations. Electromagnetic
propagation is affected by absorption and reflection from structures, objects,
and people.
a F
ield strengths from fixed transmitters, such as base stations for radio
(cellular/ cordless) telephones and land mobile radio, AM and FM radio
broadcast, and TV broadcast cannot be predicted theoretically with
accuracy. To assess the electromagnetic environment due to fixed RF
transmitters, an electromagnetic site survey should be considered. If the
measured field strength in the location in which the Electrical Stimulator are
used exceeds the applicable RF compliance level above, the Electrical
Stimulator should be observed to verify normal operation. If abnormal
performance is observed, additional measures may be necessary, such as
reorienting or relocating the Electrical Stimulator.
b O
ver the frequency range 150 kHz to 80MHz, field strengths should be
less than 3 V/m.
- 40 -
Recommended separation distance between portable and mobile RF

communications equipment and the Electrical Stimulator
The Electrical Stimulator are intended for use in an electromagnetic
environment in which radiated RF disturbances are controlled. The
customers or the users of these Electrical Stimulator can help prevent
electromagnetic interference by maintaining a minimum distance between
portable and mobile RF communications equipment (transmitters) and the
Electrical Stimulator as recommended below, according to the maximum
output power of the communications equipment.
Separation distance according to frequency of
Output Power of transmitter in meter
Transmitter in 150 kHz to 80 MHz to 800 MHz to
Watt 80 MHz 800 MHz 2.5GHz
d = 1.2 √P d = 1.2 √P d = 2.3 √P
0.01 0.12 0.12 0.23
0.1 0.38 0.38 0.78
1 1.2 1.2 2.3
10 3.8 3.8 7.3
100 12 12 23
For transmitters rated at a maximum output power not listed above, the
recommended separation distance d in meters (m) can be estimated using
the equation applicable to the frequency of the transmitter, where P is the
maximum output power rating of the transmitter in watts (W) according to the
transmitter manufacturer.
Note: A t 80MHz and 800MHz, the separation distance for the higher pole
frequency range applies
Note: T
hese guidelines may not apply in all situations. Electromagnetic
propagation is affected by absorption and reflection from structures,
objects, and people.
Note: E
MC tests conducted including attached electrode cord
of 1.5 m length.
- 41 -
11. WARRANTY
Please contact your dealer or the device center in case of a claim

under the warranty. If you have to send in the unit, enclose a copy
of your receipt and state what the defect is. The following warranty
terms apply:
1) The warranty period for device is one year from date of purchase.
In case of a warranty claim, the date of purchase has to be proven
by means of the sales receipt or invoice.
2) Repairs under warranty do not extend the warranty period either
for the device or for the replacement parts.
3) The following is excluded under the warranty:
• All damage which has arisen due to improper treatment, e.g.
nonobservance of the user instruction.
• All damage which is due to repairs or tampering by the customer or
unauthorized third parties.
• Damage which has arisen during transport from the manufacturer to
the consumer or during transport to the service center.
• Accessories which are subject to normal wear and tear.
4) Liability for direct or indirect consequential losses caused by the
unit is excluded even if the damage to the unit is accepted as a
warranty claim.
- 42 -
Manufactured for:
Roscoe Medical
21973 Commerce Parkway
Strongsville, Ohio 44149
Ph: (800) 3-ROSCOE (376-7263)
www.roscoemedical.com

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Twin Stim IV

This manual is valid for the

This instruction manual is published by Roscoe Medical Inc.

All Rights Reserved.Rev.V1.0 © 2015, 20150211

Conformity to safety standards

Roscoe Medical Inc. declares that the

IEC60601-1, IEC60601-1-2, I EC60601-2-10,

1.2 Medical Background

There are two types of pain:

Chronic — Long-lasting, persistent pain that ceases to serve

The Twin Stim IV was developed to help relieve some types

How does TENS work?

How NMES works

The goal of electrical muscle stimulation is to achieve contractions or

1.3 Indication for Use

For Neuromuscular Electrical Stimulation Therapeutic Mode (NMES):

2. IMPORTANT SAFETY PRECAUTIONS

It is important that you read all the warning and

SAFETY SYMBOLS USED IN THIS MANUAL

Indicates a potentially hazardous situation which, if not

DO NOT USE THIS DEVICE UNDER THESE CONDITIONS

DO NOT USE THIS DEVICE DURING THESE ACTIVITIES

PAIN MANAGEMENT WARNINGS

WARNINGS AND PRECAUTIONS REGARDING THE PADS

CAUTION WHILE USING THE STIMULATOR

POSSIBLE ADVERSE REACTIONS

Twin Stim IV Unit 2 × Lead wires 4 × Electrode pads

1 x Instruction Manual 1 × LI rechargeable 1 × USB Cable

5 8 9 Power on/off button

1 x Quick Start Guide

3.1 Front and Rear Panel

1) LCD Display: Operating state of the device

3.2 LCD Display

1) Displays waveform mode.

Technical Specifications (TENS & NMES)

Technical Specifications (NMES ONLY)

4.2 Program Parameters

P1 20 Min. 80 – 100Hz 100 – 120µs 10 Sec

Neck P2 20 Min. 4Hz 150 – 200µs 20 Sec

P1 20 Min. 80 – 100Hz 100µs 10 Sec

Shoulder P2 20 Min. 10Hz 220 – 260µs 20 Sec

P1 20 Min. 100Hz 100µs Fixed

Hand P2 20 Min. 1 – 10Hz 200µs 20 Sec

P1 20 Min. 80 – 100Hz 100µs 10 Sec

Low back P2 20 Min. 4Hz 200 – 260µs 20 Sec

P1 20 Min. 120Hz 100 – 120µs 10 Sec

Knee P2 20 Min. 1 – 10Hz 150 – 200µs 20 Sec

P1 20 Min. 80 – 120Hz 100 – 120µs 10 Sec

Foot P2 20 Min. 1 – 10Hz 200µs 20 Sec

Treatment Pulse Pulse

P1 20 Min. 40Hz 300µs 12 Sec 20 Sec 2 Sec

Neck P2 20 Min. 50Hz 300µs 12 Sec 30 Sec 2 Sec

P1 20 Min. 45Hz 300µs 12 Sec 20 Sec 2 Sec

Shoulder P2 20 Min. 55Hz 300µs 12 Sec 35 Sec 2 Sec

P1 20 Min. 10Hz 300µs 12 Sec 20 Sec 2 Sec

Hand P2 20 Min. 5Hz 300µs 12 Sec 30 Sec 2 Sec

P1 20 Min. 60Hz 300µs 12 Sec 20 Sec 2 Sec

Low back P2 20 Min. 70Hz 300µs 12 Sec 30 Sec 2 Sec

P1 20 Min. 20Hz 300µs 12 Sec 30 Sec 2 Sec

Chronic — Long-lasting, persistent pain that ceases to serve

It is important that you read all the warning and

4.2 Program Parameters

Electrical devices are recyclable material and should not

Please refer to instruction manual because of the higher