METRON

Metron Medical Australia Pty Ltd
A.C.N.050 240 527

P.O. Box 2164,
57 Aster Avenue
Carrum Downs Victoria Australia 3201
Tel: (03) 9775 1234 Fax: (03) 9775 1990
Int: 61 3 9775 1234 Int: 61 3 9775 1990
OPERATING MANUAL
METRON VECTORSURGE 5
COMBINED INTERFERENTIAL
&
TNS ELECTROTHERAPY UNIT
MODEL VS-470
Prepared by
Metron Medical Australia P/L
Version 1V5 SEPTEMBER 2011
Metron ____________ Vectorsurge 5
WARRANTY STATEMENT
Metron Medical Australia Pty Ltd., will warrant this device/instrument/appliance (excluding
accessories) against defects in manufacture for a period of two years from the date of
purchase.
Accessories including patient leads, cables and electrodes will be covered under this warranty
for a period of three months from the date of purchase.
- PROVIDING -
The instrument has not been serviced by persons not authorised by Metron Medical
Australia Pty Ltd., and has not been misused or tampered with and has been used on the
correct voltage as branded on it.
- THIS WARRANTY EXCLUDES -
Parts of the device/instrument/appliance failure of which in the opinion of the dealer or
manufacturer is a result of misuses or abuse or any other reason not directly attributed to fault in
manufacture. Batteries are excluded from this warranty except where it can be demonstrated
that any battery failure was caused by a malfunction in the Metron equipment. This warranty
also excludes glass or ceramic portions.
- IN THE EVENT OF FAILURE -
The complete device/instrument/appliance should be returned to the dealer from which it was
purchased or to the nearest authorised service agent, together with a full report, freight paid
and insured.
- UNDER NO CIRCUMSTANCES -
Shall Metron Medical Australia Pty Ltd., or their agents or dealers be liable in any manner
whatsoever for any compensation or damages to any person occasioned by this
device/instrument/appliance for any loss, injury or any damage occasioned by or as a result of
the misuse or abuse of this device/instrument/appliance.
- LOSS IN TRANSIT -
The warrantor does not accept any responsibility for loss or damage to the
device/instrument/appliance in transit.
Any express or applied conditions, statements or warranty, statutory or otherwise (save
specifically provided above) is hereby excluded.
____________________________________________________________
Version: 1V5 September 2011
Metron _____________ Vectorsurge 5
CONTENTS
Section Page
1. Specifications ............................................................................................................... 1
2. Operational Information................................................................................................. 6
2.1 Electromagnetic Interference ........................................................................... 6
2.2 Inflammable Gases and Anaesthetics ............................................................ 6
2.3 Prevention of Cross Infection ......................................................................... 6
2.4 Damage to the Therapy Device .................................................................... 6
2.5 Correct Mains Voltage .................................................................................... 6
3. Introduction ....................................................................................................................7
3.1 General ............................................................................................................. 7
3.2 Quality Assurance ............................................................................................8
4. General Features ......................................................................................................... 9
4.1 General ............................................................................................................. 9
4.2 Function of the Controls and Displays .........................................................10
4.2.1 Patient Circuits .................................................................................. 10
4.2.2 Current Intensity ............................................................................... 10
4.2.3 Targeting the Desired Treatment Area.............................................10
4.2.4 Surged Output .................................................................................11
4.2.5 The Treatment Timer ........................................................................11
4.2.6 Bipolar and Quadripolar ...................................................................12
4.2.7 Dual Operation ................................................................................. 13
4.2.8 FOCUS Button and Vector Rotation .......................................... 14
4.2.9 Current Monitoring ............................................................................14
4.2.10 STOP Button ................................................................................. 14
4.2.11 Output Selection (A/B) Button ....................................................... 15
4.2.12 Using Stored Programs; PROGRAM Button ............................15
4.2.13 Storing Own Programs: PROGRAM Button ............................. 16
4.2.14 Prestored Programs .........................................................................16
4.3 Prestored Programs ......................................................................................17
4.4 Practitioner Stored Programs ........................................................................18
5. Operating Procedures ...............................................................................................21
5.1 General ...........................................................................................................21
5.2 Use of Stored Programs .............................................................................. 21
5.3 2 Pole Treatment ........................................................................................... 21
5.4 Dual Stimulator Mode ................................................................................... 22
5.5 Storing Programs ...........................................................................................23
5.6 Electrodes ...................................................................................................... 23
5.7 Electrode Use/Preparation ........................................................................... 24
5.8 Suction Electrodes .........................................................................................24
5.9 Using the Vectorsurge in Dual Mode .......................................................... 24
5.10 Monitoring, Adjusting and Terminating Output Current ..............................25
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CONTENTS
Section Page
6 Conventional Interferential Therapy .........................................................................26
6.1 Operational Information ................................................................................. 26
6.1.1 Indications For Use For Interferential Therapy ...............................26
6.1.2 Contraindications .............................................................................. 26
6.1.3 Therapeutic Warnings ......................................................................26
6.1.4 Precautions ........................................................................................27
6.1.5 Adverse Reactions .......................................................................... 27
6.2 Operating Procedures ...................................................................................28
6.2.1 Interferential Beat Frequency Selection ......................................... 28
6.2.2 Interferential Carrier Frequency Selection ...................................... 28
6.2.3 Applying Interferential Therapy ......................................................29
7 TNS Therapy .............................................................................................................32
7.1 Operational Information ................................................................................. 32
7.1.1 Indications For Use For TNS Therapy ...........................................32
7.1.2 Contraindications .............................................................................. 32
7.1.3 Therapeutic Warnings ......................................................................32
7.1.4 Precautions ........................................................................................33
7.1.5 Adverse Reactions .......................................................................... 33
7.2 Operating Procedures ...................................................................................33
7.2.1 TNS Stimulation Frequency Selection ........................................... 33
7.2.2 TNS Pulse Width Selection ............................................................ 33
7.2.3 Applying Interferential TNS ............................................................ 34
8. Electrotherapy ............................................................................................................37
8.1 Conventional Interferential Therapy .............................................................37
8.1.1 Introduction ........................................................................................37
8.1.2 Depth Efficiency ............................................................................... 37
8.1.3 Vector Rotation .................................................................................37
8.1.4 Surging .............................................................................................. 38
8.1.5 Beat Frequencies .............................................................................39
8.1.6 Carrier Frequencies ..........................................................................40
8.1.7 Phase Switching ............................................................................... 42
8.2 Conventional TNS Therapy .........................................................................43
8.2.1 General ..............................................................................................43
8.2.2 Effect of Pulse Width ....................................................................... 44
8.2.3 Effect of Pulse Frequency ............................................................... 45
8.3 Interferential TNS Therapy ........................................................................... 48
8.3.1 Obtaining a TNS Interferential Effect .............................................. 48
8.3.2 Using Interferential TNS Therapy ................................................... 49
8.3.2.1 Energy Considerations ................................................... 50
8.3.2.2 Physiological Responses ...............................................50
9. References ... 51
Declaration of Confromity ............................................................................. 52
Authorised Representative .......................................................................... 53
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1. SPECIFICATIONS
MAINS POWER SUPPLY REQUIREMENTS:
Voltage 90 - 264 Volts AC
Frequency 50/60 Hz
Power 75 VA Nominal
FUSES:
Primary External 2 of 1 A 5x20 mm Delay
Secondary 1 of 4 A 5x20 mm Delay
MAINS TRANSFORMER:
Integrated switchmode power supply complying with international standard IEC 601-1: 1988
(EN 60601-1) and all subsequent amendments.
Secondary voltages 48 Volts @ 1.7A
OUTPUT SPECIFICATION - INTERFERENTIAL:
Maximum current in each patient circuit 80 mA
Indicator resolution 1 Segment = 4 mA
Indicator accuracy +/- 10% for currents greater than 10 mA
Maximum voltage in each patient circuit 160 V peak-to-peak
Current Surge Programmes Disabled or Enabled
Enabled Rise 0 - 20 seconds
On 0 - 40 seconds
Fall 0 - 20 seconds
Off 0 - 40 seconds
Waveform Beat Frequencies
Preset Ranges 0 - 15 Hz
0 - 150 Hz
80 - 150 Hz
Adjustable Range 0 - 300 Hz
Current Waveform Type Modulated Rectangular, 50% Duty Cycle
Waveform Pulse Frequencies 2.5, 4 or 10 kHz
Frequency accuracy Better than +/- 1%
Waveform Pulse Widths 50, 125 or 200 s
Current Delivery Modes 2 Pole (Amplitude Modulated) or
4 Pole (Phase Modulated)
OUTPUT SPECIFICATION - TNS:
Maximum current in each patient circuit 80 mA
Indicator resolution 1 Segment = 4 mA
Indicator accuracy +/- 10% for currents greater than 10 mA
Maximum voltage in each patient circuit 160 V peak-to-peak
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Version: 1V5 September 2011 Page 1 of 47
Current Waveform Type Modulated Rectangular, 50% Duty Cycle
Pulse Shape Biphasic
Waveform Pulse Widths 50, 125 or 200 s
Pulses per Burst 1
Pulse Frequencies
Preset Ranges 0 - 15 Hz
0 - 150 Hz
80 - 150 Hz
Adjustable Range 0 - 300 Hz
Current Surge Programmes Disabled or Enabled
Enabled Rise 0 - 20 seconds
On 0 - 40 seconds
Fall 0 - 20 seconds
Off 0 - 40 seconds
Frequency accuracy Better than +/- 1%
TIMER:
Operating range 0 - 40 minutes
Timer accuracy Better than +/- 1%
CURRENT LIMIT AND ALARM FEATURE SPECIFICATION:
Stimulator types Interferential and TNS
Meter peak reference current enable level Current set > 12.5% of full scale
Output current limit activates when Output current > 95% of full scale or
Output current > Meter peak reference
Output current alarm activates when Output current/Surge factor < 1/2 Peak
current and Modulation frequency > 5 Hz
ELECTRICAL SAFETY:
Manufactured to Australian standards:
AS 3200.1 - 1990 Approval and test specification - Electromedical equipment -
General requirements (direct equivalent of IEC 601-1, 1988,
Second edition).
IEC 601-2-10 - 1987 Medical Electrical Equipment, Partr 2: Particular requirements for the
safety of nerve and muscle stimulators.
Applied parts Patient Connections
Applied part classification BF
Chassis classification
1
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DIMENSIONS:
Width 370 mm
Height 120 mm
Depth 250 mm
WEIGHT:
Packed 3.5 kg
Unpacked 2.5 kg
ENVIRONMENTAL CONDITIONS:
Operating: Temperature Range 10 - 40
o
C
Relative Humidity 30% - 90%
Transport & Storage: Temperature Range 0 - 70
o
C
Relative Humidity 10% - 100%
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OUTPUT WAVEFORMS:
Conventional Interferential
Output: 40 mA Load: 500 Ohms Vertical Scale: 20 V/Div
Horizontal Scale: 320 us/Div (2.5 KHz), 100 us/Div (4 KHz), 80 us/Div (10 KHz)
Premodulated Interferential

Horizontal Scale: 320 us/Div (2.5 KHz), 100 us/Div (4 KHz), 80 us/Div (10 KHz)
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Russian

Horizontal Scale: 400 us/Div Modulation Frequency: 50 Hz
TNS
Pulse Width: 200 us Pulse Frequency: 120 Hz Horizontal Scale: 2 ms/Div
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2. OPERATIONAL INFORMATION
2.1 Electromagnetic Interference
The Vectorsurge 5 complies with IEC 601-1-2: 1993 but this does not guarantee that other
equipment in the vicinity will not be affected by the electromagnetic emissions
from this unit. Similarly, other equipment in the vicinity may effect the operation of the
Vectorsurge 5.
It is recommended that all equipment used near this unit complies with the relevant
electromagnetic compatibility requirements for that equipment and to check before use that no
interference is evident or disruptive. Increasing the distance between offending devices, and
keeping interconnecting leads as short as possible will help reduce the effect.
2.2 Inflammable Gases and Anaesthetics
The Vectorsurge 5 is NOT SUITABLE for use in the presence of inflammable gases and
anaesthetics.
2.3 Prevention of Cross Infection
Even though the patient electrodes do not contact open wounds or broken skin it is still
possible for them to carry infections by the mere fact that they contact bare skin.
The electrodes should be thoroughly cleaned after a treatment session with one patient is
completed prior to a new session beginning with another patient. They can be cleaned with
any standard medical grade surface disinfectant. The electrodes are not suitable for
autoclaving.
2.4 Damage to the Therapy Device
If when the unit is unpacked, or if it is mishandled at any stage of its life, and there appears to
be physical damage to the machine it should not be used. Use should only commence or
continue after it has been thoroughly checked by an appropriately qualified technician to
ensure its functional and safety performance has not been impaired.
2.5 Correct Mains Supply Voltage
It is important that the Vectorsurge 5 be operated from a mains supply which has a nominal
supply voltage equal to that indicated on the label on the Vectorsurge 5 rear panel. Safety
and performance specifications are only valid if these voltages are the same.
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3. INTRODUCTION
3.1 General
The Vectorsurge 5 combined interferential and TNS therapy unit is the most advanced of its
kind and offers special features not found on other machines. Unlike most other machines, the
interferential currents available from the Vectorsurge can be selected for both beat frequency
and carrier frequency. It is the carrier frequency which sets the discrimination between sensory,
motor and pain thresholds. It is the beat frequency which determines the physiological
response to stimulation - whether twitch muscle contractions, a forceful tetanic contraction or
analgesia and muscle relaxation.
The Vectorsurge also functions as a dual stimulator and as an interferential TNS unit. In dual
mode, the Vectorsurge acts as two independent stimulators. In interferential TNS mode,
short-duration biphasic TNS pulses can be applied with the depth efficiency of conventional
interferential stimulation.
This manual describes the use of interferential therapy, conventional TNS and interferential
TNS. It also describes technical aspects of the Vectorsurge and how to use the Vectorsurge
5 unit. Please read the manual carefully before using the machine.
The manual is not intended as a substitute for textbooks on the subject of interferential therapy
(some are listed as references at the end of the manual). Rather it is a guide to safe and
proper usage for those familiar with the techniques, principles and uses of interferential
therapy.
As with any electrotherapeutic modality, interferential currents should only be applied by
therapists who are qualified practitioners and who are familiar with appropriate settings of the
machine controls.
If you, as a user of the Vectorsurge 5 and this manual, have any relevant comments or
questions, on either the equipment or the manual, your communication with us would be
welcomed. You may contact us by mail or fax as detailed below:
P.O. Box 2164
CARRUM DOWNS AUSTRALIA 3201
Fax: (03) 9775 1990 from within Australia or
+61 3 9775 1990 International
____________________________________________________________________
3.2 Quality Assurance
It is recommended that a program of regular and appropriate quality assurance, including
calibration and electrical safety inspections, be instituted for this equipment. It is
recommended that calibration of this equipment be performed at least once every twelve
months. Information on the type and frequency of electrical safety testing may be obtained
from Australian Standard AS 3551 (1988) - Acceptance and In-Service Testing,
Electromedical Equipment or from relevant locally published Standards.
A hospital Biomedical Engineering Department or a third party service organisation nominated
by the manufacturer or distributor should be capable of performing the necessary calibration,
testing and documentation. A program of electrical safety inspections is recommended to
confirm continued operator and patient safety. Local statutory requirements for electrical safety
inspections may also apply.
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4. GENERAL FEATURES
4.1 General
The Metron Vectorsurge 5 is a combined interferential therapy unit which offers four modes of
stimulation: conventional interferential and interferential TNS; bipolar interferential, bipolar TNS
and Russian. Conventional and bipolar (premodulated) interferential need no introduction and
they are available at the touch of a button. Conventional (bipolar) TNS is also selectable,
either in single or dual channel mode. Russian stimulation is likewise a well accepted
stimulation mode. Interferential TNS is something new. Now you have TNS stimulation which
can be focussed between four electrodes to target the region of maximum stimulation. These
treatment options are described in the 'background information' section of this manual (page
37).
The Vectorsurge 5 carries on the tradition of its predecessors. It is a lightweight, portable
machine designed for simplicity and reliability of operation. It uses the latest microprocessor
technology and incorporates sophisticated programming to anticipate your needs and
guarantee performance.
The Vectorsurge dispenses with the multiplicity of knobs and switches used on conventional
interferential therapy units. Instead a single rotary control and four pushbuttons are used to
choose the treatment; either by selecting from ten stored treatment programs or by manually
setting all the treatment variables in a simple and straightforward manner.
The diagram below shows the arrangement of controls and displays on the front panel.
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4.2 Functions of the Controls and Displays
4.2.1 Patient Circuits
On the right hand side of the front panel is a bar graph display which shows the output
current delivered to the patient. In 4 POLE mode the display shows the average current
for the two pairs of electrodes. In 2 POLE mode if output display a is selected then
the display shows the channel a output current. Likewise for b. In DUAL mode,
both outputs a and b are active and the output selection button can be pressed
to separately show the current in each channel.
Current may be applied to the patient either via the two pairs of patient-circuit output
sockets on the front of the machine or via a socket on the rear. Standard electrode
configurations (quadripolar, paired bipolar) can be connected to the separate channel a
and b output sockets on the lower front panel. Alternatively the output may be
connected through the rear socket to a Metron Vacupulse suction unit for simple and
rapid electrode placement.
The patient circuits are designed to meet the requirements of apparatus with class BF
patient protection as specified in Standards Association of Australia publications AS
3200-1 and in International Electrotechnical Commission Standard IEC 601-1.
Note Several symbols are used on the lower front panel which are defined as
follows:
This symbol indicates that the instructions for use should be
consulted before operation is attempted.
This symbol indicates that the applied parts (patient connections) of this
equipment are rated as Type BF which means that the patient
connections are suitable for placement on the external surface of the
body.
4.2.2 Current Intensity
The current intensity is set by pressing the start-focus button (located on the right
hand side of the front panel) and adjusting the "intensity-set" control. The amount of
current in the patient circuits is indicated on the bar graph display.
In 4 POLE mode, the output meter shows the average current in the two patient circuits.
In DUAL mode, the output display button can be pressed to switch between the
two outputs and monitor the current in each circuit.
4.2.3 Targeting the Desired Treatment Area
In 4 POLE mode, the focus of the pattern of stimulation can be shifted by vector rotation
(see the 'background information' section, page 37). The clover-leaf stimulation pattern
is rotated by holding the "start-focus" button depressed and
adjusting the "intensity-set" control. This will enable the practitioner to target the
desired treatment area. This feature can also be used to equalize the sensation under
the electrodes. If the patient feels more stimulation from one electrode pair, for example
due to electrode placement or variations in tissue impedance, the variation can be
compensated by holding the "start-focus" button depressed and rotating the
"intensity-set" control.
____________________________________________________________________
4.2.4 Surged Output
Current may be applied to the patient either in continuous mode or surged mode.
When the SURGE is off, the output intensity is held at a constant level. When the
SURGE is on, the current intensity changes rhythmically at a rate selected by the
operator. The output current display shows the current variation during the surge cycle
and also has a flashing marker, indicating the maximum current to be reached during the
surge cycle. Complete flexibility in surging is available as the surge rise time, on time,
fall time and off time can each be set independently with the time display showing the
values chosen.
A bar graph display next to the surge time indicators is used both to show the surge
cycle and to show whether surging is on or off. This display actively cycles when surging
is on and is constantly illuminated to maximum when surging is off. During surged
intensity treatment, the bar graph display always ranges from zero to maximum,
regardless of the selected output intensity. This makes it easy to follow the surge cycle,
even at very low output intensities when the OUTPUT current meter would be difficult to
use for this purpose.
A further important safety feature is that the peak intensity during the surge cycle is the
same as obtained in continuous mode i.e. when the SURGE is off. When surging is
being used, the cycle will not begin until after the intensity has been set to the maximum
value required. This means that the intensity can be set with confidence that it will not
surge to higher currents as would occur if the intensity was increased during the cycle
when the intensity was not at maximum. If the output current is adjusted during
treatment, surging stops and holds at peak while the adjustment is made. A few
seconds after adjustment is completed, surging automatically resumes with a flashing
marker showing the peak intensity which has been set.
4.2.5 Treatment Timer
The treatment timer is located immediately above the SURGE setting indicators.
When first switched on, the treatment time display will show the treatment time stored in
program 0, together with the treatment settings stored in this program. You can store
your most frequently used treatment settings as program 0 so that they are immediately
available at switch-on and no manual setting is required (see pages 15 and 16).
The treatment time can be changed by pressing the set-pause button until the
TREATMENT (min) indicator is flashing and then rotating the "intensity-set"

control. Clockwise rotation will increase the treatment time. Rotating the "intensity-set"
control anticlockwise will decrease the treatment time.
Once the start-focus button is pressed, patient output can be set and timing begins.
The timer will count down and terminate the patient current when the selected time has
elapsed. Treat can also be paused with the set-pause button : if the treatment is
paused by pressing this button, the timer stops and does not continue until the start-
focus button has been pressed again and current is reapplied to the patient.
The end of the treatment period is indicated by a clearly audible signal.
4.2.6 Bipolar and Quadripolar Operation
In order to obtain a true interferential effect and greatest depth efficiency in treatment it is
necessary to use two pairs of electrodes positioned so that the currents flowing
between each pair interfere within the tissue volume being treated (see background
information, page 37). This is described as quadripolar treatment and for this it is
necessary to set the 4 POLE/2 POLE/DUAL selector to 4 POLE. When used in this
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mode, minimum stimulation is produced immediately beneath the electrodes. The
machine is operating in conventional interferential mode and maximum stimulation is
produced in a clover-leaf shaped pattern centred at the intersection of the current
pathways (figure 1, page 37). The production of maximum stimulation at depth has
always been a major advantage of interferential currents. For true interferential treatment,
first INTERFERENTIAL then 4 POLE should be selected.
By using electrically isolated patient circuits, the Vectorsurge 5 is also able to produce
interferential TNS i.e. stimulation in a clover-leaf shaped pattern centred at the intersection
of the current pathways but using biphasic TNS pulses rather than bursts of interferential
current. In this way, the advantages of conventional TNS can be combined with the
depth efficiency of interferential currents and it also has the ability to move and focus the
region of maximum stimulation by vector rotation. Selecting TNS then 4 POLE allows
this option.
In some circumstances it may be convenient to use just two electrodes for bipolar
stimulation: depth efficiency may be a secondary consideration. In these cases the 4
POLE/2 POLE/DUAL selector should be set to either 2 POLE or DUAL. When
interferential mode is selected together with 2 POLE or DUAL, the two interferential
currents are mixed within the machine and a beat frequency signal is sent to the output.
In 2 POLE mode, the signal appears on channel A.
It should be noted that in 2 POLE (or DUAL) mode, different size electrodes can be
used i.e. a large 'indifferent' electrode and a smaller 'active' electrode positioned over the
motor point or area to be treated. If a smaller active electrode is used consideration of
current and power density for that electrode should be considered prior to use. The
maximum power density recommended is 0.25 watts/square cm (W/cm
2
) of electrode
area.
If the worst case patient impedance, for power transfer, is assumed then for a round
electrode the maximum current that should be used, in milliamps, approximately
equates to:
I
max
= 14 x Electrode Diameter in cm
4.2.7 Dual Operation
When DUAL mode is selected, the Vectorsurge functions as two completely separate
bipolar stimulators. For example, the output of one channel can be 50 Hz TNS pulses,
surged over a 30 second cycle time and a treatment time of 20 minutes while the other
channel is bipolar interferential with a frequency sweep from 0-15 Hz, not surged and a
treatment time of 15 minutes.
In DUAL mode, the treatment settings for each channel are independent and are chosen
separately. Once DUAL mode has been selected the set-pause button is pressed
to step through treatment settings for channel a. Once this is completed, the output
display button is pressed to allow choice of the channel b settings.
After the treatment parameters for both channels have been set, the start-focus
button is pressed. The output display selection indicator will have b illuminated and the
"intensity-set" control can be rotated to set the output current in channel b. Next the
output display button is pressed to select channel a and the channel a intensity is
set by rotating the "intensity-set" control.
Alternatively, the machine can be operated in DUAL mode with one channel only used
initially. Channel a settings can be chosen and the start-focus button can be
pressed to set the output current. At any time during treatment using channel a, the
output display button can be pressed to select channel b. The treatment
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parameters and treatment time can be set and the current applied in channel b by
pressing the start-focus button and setting the stimulation intensity. Channel a
operates independently and current ceases at the end of the channel a preselected
treatment time.
During treatment, the output display button can be pressed to monitor the current in
each channel. If any adjustment is needed, the "intensity-set" control can be rotated to
increase or decrease the current in the selected channel. Do not press set-pause or
STOP for this adjustment. Pressing set-pause will reduce the output current in the
selected channel to zero, but will not affect the other channel. If set-pause has been
pressed, pressing start-focus will allow you to reset the current in the selected
channel. Pressing STOP will terminate the flow of current in both channels and to
resume treatment the particular channel must be selected (by pressing the output
selection button) followed by pressing the start-focus button to enable current to
be applied and then by rotating the "intensity-set" control.
If you wish to simultaneously switch-off the current in both channels, simply press the
STOP button below the output intensity display. The STOP button is the master
'output off' control. To switch off the current in one channel, select the
particular channel (using the output selection control) then press the set-pause
button.
If DUAL mode is in use, to switch from DUAL mode to 2 pole or 4 pole treatment you
have to first switch off the current in both circuits. Press STOP to do this, then select 2
pole or 4 pole treatment.
4.2.8 'FOCUS' Button and Vector Rotation
When 4 POLE mode is selected, either conventional interferential or interferential TNS
can be selected. In either case, four electrodes are applied and the stimulation pattern
produced depends on the vector sum of the two applied currents. Because of this, the
regions of maximum stimulation are in the form of a 'clover-leaf' shaped pattern centred
at the intersection of the current pathways (see the 'background information' section of
this manual, page 37).
The clover-leaf stimulation pattern can be manually rotated by increasing the current in
one channel and simultaneously decreasing the current in the other. In this way it is
possible to move and focus the region of maximum stimulation by vector rotation.
To rotate the vector field and so change the focus of stimulation, press and hold down
the "start-focus" button then rotate the "intensity-set" control in either direction to
rotate the vector field. The "start-focus" button must be held depressed during this
rotation. Once the "start-focus" button is released, the "intensity-set" control reverts
to controlling the output intensity.
4.2.9 Current Monitoring
Another important safety feature of the Vectorsurge is the provision of 'intelligent current
monitoring' on the output circuits. Once the output intensity has been set, the
Vectorsurge monitors the output current in each circuit and, if the current in either channel
changes by more than a calculated amount, an alarm sounds and the current intensity is
reduced to zero. Thus if an electrode becomes detached, or loosens and does not
make adequate skin contact, the alarm will be activated. It is, however, normal for the
current to change slightly during treatment (this can come about through changing tissue
impedance due to increased blood flow in the region, perspiration, etc.) and is likely to
affect both channels to a similar extent. Such changes are ignored so as to minimize
'nuisance' interruptions to patient treatment.
Bad electrode contact is thought to be the reason for relatively rare but nonetheless
____________________________________________________________________
serious reports of 'burns' or skin irritation as a result of transcutaneous electrical nerve
stimulation. The provision of intelligent current monitoring, together with the automatic
alarm, minimizes the risk of skin irritation or damage.
4.2.10 STOP Button
The STOP button, located immediately below the output current display, is the quick
and easy method of terminating current flow from the patient circuits.
Pressing STOP will terminate the current from channels A and B regardless of whether
the Vectorsurge is being used in quadripolar, bipolar or dual stimulator mode. It is the
master 'off' control.
In DUAL mode, it is possible to stop the current output of just one channel without
affecting the other by first selecting the channel using the A/B selector button, then
pressing the set-pause button. This will stop current flow in the selected channel. In 4
POLE mode, pressing set-pause will terminate current flow in both channels.
4.2.11 Output Selection (a/b) Button
When DUAL output is selected, both channel a and channel b are activated and the
output intensity of each channel can be set separately. In DUAL mode, the channel a
treatment parameters are set first and channel a is indicated on the output display.
The output intensity of channel a can be set when the channel a indicator is illuminated
by pressing start-focus and then rotating the "intensity-set" control until the desired
current level is reached. To set channel b, press the output selection button and
the ' b' indicator will be illuminated. Next press the start-focus button and rotate the
"intensity-set" control until the desired current level in channel b is reached. To switch
between channels a and b: subsequently and adjust the intensity, it is only
necessary to press the output selection button to chose the desired channel then
rotate the "intensity-set" control.
4.2.12 Using Stored Programs: PROGRAM Button
The program button of the Vectorsurge 5 is a powerful feature. Ten treatment
programs are stored in the Vectorsurge for immediate recall. The Vectorsurge comes
with a set of preinstalled programs, but you can tailor these to suit your needs and create
a set of preferred treatment programs for immediate selection. The programs are
numbered 0 to 9. The settings in program 0 are the ones which automatically appear
when the Vectorsurge is switched on. If you have a particular
program which you use most frequently, this should be stored as program 0. This
means that if this program is to be used, all you need to do is to switch on the machine,
press start-focus and adjust the output current to the desired intensity.
If you want to use a different prestored program, this can be selected using the
program button. First switch on the machine. Next press the program button to tell
the Vectorsurge that you want to recall a preset program. Program 0 will be
automatically selected. The TIMER/PROGRAM display will flash between "P0" and
the preprogrammed (program 0) treatment time while the treatment settings shown on
the displays (surge, sweep range, frequency, etc.) will be those stored in program 0.
To select one of programs 1 to 9, simply rotate the "intensity-set" control and the
TIMER/PROGRAM display will show "P1", "P2" and so on, up to "P9". In each case
the settings shown on the displays (the timer, surge, sweep range and frequency
controls etc.) will be those in the stored program. Once the desired program has been
selected, simply press the start-focus button and rotate the "intensity-set" control
to set the output intensity. If a 2 POLE program has been selected, this will set the
channel A intensity.
To recall two programs for DUAL stimulation, first select DUAL output then press the
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program button to select the channel A settings. Next press the output selection
button to select channel b then press the program button to select the program you
want for channel b. Press start-focus then rotate the "intensity-set" control to set
the output intensity of channel b. Next press the output selection button to select
channel a, press start-focus then rotate the "intensity-set" control to set the output
intensity of channel a.
4.2.13 Storing Your Own Programs: PROGRAM Button
The program button of the Vectorsurge 5 is a powerful feature. Ten treatment
programs are factory provided and stored for instant recall. Should you wish to change
or replace any of these programs and customize the Vectorsurge to your own needs,
you have this option.
To store your own treatment program, first set the treatment parameters to those you
want, either by manually stepping through each of the treatment settings using the set-
pause button and the "intensity-set" control or by selecting a preset program then
using the set-pause button and the "intensity-set" control to change particular
settings. After setting the Vectorsurge, the treatment parameters can be stored by
pressing the program button. When the program button is pressed, "P 0" will
appear on the TIMER/PROGRAM display. If you wish to store the program as
program 0, the one which automatically appears when the Vectorsurge is switched-on,
press the program button again and it will be stored as program 0. The Vectorsurge
beeps twice to indicate that the program has been stored. If you wish to store the
program under some other number between 1 and 9, rotate the "intensity-set" control
to change the program number to the one you want then press the program button
again. A double beep indicates that the program has been stored.
4.2.14 Prestored Programs
The Vectorsurge 5 stores ten treatment programs in memory. A set of programs is
preinstalled but, as described above, you can change any of these to create your own
personal set of programs. We recommend that the program which you use the most is
stored as program 0 as this is the one which is automatically selected when the
Vectorsurge is switched on. To treat a patient using program 0, once the patient has
been prepared and the electrodes secured, simply switch on the Vectorsurge,
pressstart-focus then adjust the output intensity by rotating the "intensity-set"
control. To select a different prestored program, after switching on the Vectorsurge,
press the program button and rotate the "intensity-set" control to select the desired
treatment program. As the "intensity-set" control is rotated, the programs are
displayed and the treatment settings for each are shown on the Vectorsurge displays.
The ten factory prestored programs are listed following. If you change one or more of
the stored programs, you can make your own ready-reference list of stored programs
using the proforma on pages 18 to 20.
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4.3 PRESTORED PROGRAMS
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PROGRAM 0 4 pole interferential
treatment time: 15 min carrier frequency: 4 kHz
sweep range: 0 - 150 Hz surging: none
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treatment time: 15 min carrier frequency: 2.5 kHz
sweep range: fixed 30 Hz
surging: rise time: 1 sec on time: 2 sec
fall time: 0 sec off time: 1 sec
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PROGRAM 5 russian stimulation/bipolar interferential
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PROGRAM 6 russian stimulation/bipolar interferential
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PROGRAM 7 4 pole TNS (interferential TNS)
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treatment time: 15 min pulse width: 50 us (carrier = 10 kHz)
sweep range: 80-150 Hz surging: none
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treatment time: 15 min pulse width: 125 us (carrier = 4kHz)
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treatment time: 15 min pulse width: 50 us (carrier = 10 kHz)
sweep range: 80-150 Hz surging: none
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4.4 Practitioner Stored Programs
Circle as applicable or record the treatment setting in the space provided.
PROGRAM ___ ________________________________
4 pole / 2 pole interferential / TNS treatment time: _______ min
surging: on / none sweep range: ________ Hz
carrier frequency: ___ kHz
surging: rise time: _____ sec on time: _____ sec
fall time: _____ sec off time: _____ sec
Notes:
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PROGRAM ___ ________________________________
Notes:
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PROGRAM ___ ________________________________
____________________________________________________________________
Notes:
____________________________________________________________________
PROGRAM ___ ________________________________
Notes:
____________________________________________________________________
PROGRAM ___ ________________________________
Notes:
PROGRAM ___ ________________________________
Notes:
____________________________________________________________________
PROGRAM ___ ________________________________
Notes:
____________________________________________________________________
____________________________________________________________________
PROGRAM ___ ________________________________
Notes:
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Note: that if you wish to revert to the original factory-stored programs (and erase your
prestored programs), this can be achieved as follows. Switch off the Vectorsurge.
Hold down the program button and switch on the machine. A long beep indicates
that the factory preset programs have been reinstalled. Release the program
button.
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5. OPERATING PROCEDURES
5.1 General
Step by step sets of instructions for operating the Vectorsurge 5 are given on this and the
following pages. It is recommended that you read these instructions carefully to completely
familiarize yourself with the detailed features of operation of the unit.
5.2 Use of Stored Programs
With the Vectorsurge 5, you have the option of automatic selection of preset programs.
These can be the set provided with the Vectorsurge or your own customized set which can
be changed, at any time, should you wish. The treatment settings for each program can be
viewed simply by selecting the program. Settings will be shown on the displays on the front
panel. Simply switch on the Vectorsurge and step between programs by pressing the
program button to inspect the settings in each.
Here are the steps in a little more detail:
1. Plug the apparatus into the mains and switch on the power. The default settings on
power up are the treatment settings stored in program 0. The output indicator will be
flashing, showing conventional interferential or TNS mode. The other indicators will
show the particular treatment settings.
2. Program 0 is automatically selected. To select another program, press the program
button and rotate the "intensity-set" control. The TIMER/ PROGRAM display will
show the program selected (programs 0, 1, 2 through to 9).
3. Once the required program has been selected, the output current intensity can be set.
Press the start-focus button momentarily. Next adjust the current intensity to the
required level by rotating the "intensity-set" control.

A description of the factory preset programs is given on pages 17 and 18 of this manual.
Pages 18 to 20 are where your own programs can be recorded. We suggest that you
photocopy pages 18 to 20 and make a record of your stored programs. These can be kept
in the storage compartment of the Vectorsurge for ready reference and replaced if you should
change your prestored programs. Remember that you can review the prestored programs
by pressing the program button and rotating the intensity-set control.
5.3 2 Pole Treatment
For stimulation of relatively superficial and easily accessible structures, it is often convenient to
use just two electrodes for bipolar stimulation. In 2 POLE mode there is the choice of
premodulated interferential or conventional TNS. When interferential mode is selected
together with 2 POLE output, the two interferential currents are mixed within the machine and a
beat frequency signal is sent to the output.
In 2 POLE mode, different size electrodes can be used i.e. a large 'indifferent' electrode and a
smaller 'active' electrode positioned over the motor point or area to be treated.
To select bipolar interferential or conventional TNS treatment, switch on the machine, and
chose a preset treatment program (as described previously) or set the machine manually by
choosing the treatment settings. The manual setup procedure is as outlined previously under
'conventional interferential' and 'interferential TNS': the only difference being that 2 POLE
should be selected in step 1.
If two channels of 2 pole treatment are required then DUAL mode should be selected.
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5.4 Dual Stimulator Mode
When DUAL mode is selected, the Vectorsurge functions as two completely separate
bipolar stimulators. The patient can thus be treated in two areas simultaneously and you have
the choice of completely different stimulation of each area. For example, the output of one
channel can be 50 Hz TNS pulses, surged over a 30 second cycle time and a treatment time
of 20 minutes while the other channel is bipolar interferential with a frequency sweep from 0-15
Hz, not surged and a treatment time of 15 minutes. Alternatively, the two channels can have
the same treatment settings with only the output intensity being different. Whichever the case,
the current intensity must be set separately for each channel.

To select DUAL treatment, switch on the machine, press set-pause and select DUAL
output. Next press the program button to chose a preset treatment program (as described
previously) or set the machine manually by choosing the treatment settings. The manual
setup procedure is as outlined previously under 'conventional interferential' and 'interferential
TNS': the only difference is that DUAL is selected in step 1.
Setting channel a
Once DUAL mode has been selected the set-pause button is pressed to step through
treatment settings for channel a. During this time, the channel a indicator under the output
selection button will be illuminated. Once channel a settings have been chosen the
start-focus button can be pressed and the channel a intensity can be set by rotating the
"intensity-set" control. Alternatively, channel b can be set-up before any output is
delivered.
Setting channel b
Next press the output selection button to allow choice of the channel b settings. The
channel b indicator will become illuminated and the settings will initially be identical to those
set for channel a. If these are the correct settings, press start-focus and rotate the
"intensity-set" control to set the channel b intensity. If different settings are required, press
the set-pause button to step through and adjust each of the treatment settings for channel
b.
After the treatment parameters have been set, the start-focus button is pressed. The
output display indicator will show the relevant channel and the "intensity-set" control can be
rotated to set the output current in this channel. Next the output selection button can be
pressed to select the other channel and its intensity can be set by rotating the "intensity-set"
control.
During treatment
During treatment, the output selection button can be pressed to monitor the current in each
channel. If any adjustment is needed, the "intensity-set" control can be rotated to increase or
decrease the current in the selected channel. The output display indicators show which channel
is selected. Pressing set-pause will reduce the output current in the selected channel to
zero, but will not affect the other channel. Pressing start-focus will allow you to reset the
current in the selected channel. The two channels can thus be used and adjusted quite
separately.
If you wish to simultaneously switch-off the current in both channels, simply press the STOP
button below the output intensity display. The STOP button provides the means of
immediately terminating the current in each channel. To terminate current flow in just one
channel, the set-pause button is pressed to switch off the current flow in the channel shown
under output display.
To adjust the intensity of either channel, simply select the channel by pressing the output
selection button and rotate the "intensity-set" control.
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5.5 Storing Programs
Ten treatment programs are factory provided and stored for instant recall. Should you wish to
change or replace any of these programs and customize the Vectorsurge to your own needs,
follow these simple steps:
1. First set the treatment parameters to those you want, either by manually stepping
through each of the treatment settings using the set-pause button and the "intensity-
set" control or by selecting a preset program then using the set-pause button and
the "intensity-set" control to change particular settings.
2. Press the program button "P 0" will appear on the TIMER/PROGRAM display. If
you wish to store the program as program 0, the one which automatically appears when
the Vectorsurge is switched-on, press the program button again momentarily and it
will be stored as program 0 replacing the previously stored program. Successful
storage will be indicated by a double beep. A single beep indicates that storage has
not been successful. If you wish to store the program under some other number
between 1 and 9, rotate the "intensity-set" control to change the program number to
the one you want then press the program button again.
3. You may wish to record the program settings which you have stored and make notes as
to its use. Record sheets, which can be photocopied in case stored programs are
changed at a future date, are provided as pages 18 to 20 of this manual. Pages 17 and
18 show the factory preset programs.
5.6 Electrodes
The Vectorsurge is supplied with a set of four separate circular conductive rubber electrodes
(Carbonflex electrodes) as standard equipment. Larger electrodes, 75 mm diameter, are
available as an option. This combination provides the flexibility necessary to treat the widest
range of conditions encountered by the physiotherapist.
Four separate conductive rubber electrodes are used when large volume treatment or
treatment of deeply located structures is required. The electrode size required depends on
the area to be treated. Small electrodes would be selected for treatment of, for example, the
elbow or ankle joints. Large electrodes are more appropriate for areas such as the low back or
quadriceps. Electrodes should be positioned in diagonally opposite pairs so that the currents
intersect in the region to be treated. Bear in mind that the current spreads within the tissue and
that maximum stimulation is in four lobes midway between electrode pairs (see figure 1 of the
background information, page 37).
Two electrodes are used for bipolar treatment. Bipolar treatment is used when depth
efficiency of stimulation is not a prime consideration and/or when the structure to be treated is
such that it would be difficult to position four diagonally opposing electrodes. The therapist
has the option either of using two equal size electrodes, both positioned over the region to be
treated or of using a small "active" electrode over the area to be treated and a larger
"indifferent" electrode positioned elsewhere. The use of two unequal size electrodes results in
maximum stimulation immediately beneath the smaller electrode. The large electrode should
be positioned away from motor points or sensitive tissue regions.
5.7 Electrode Use/Preparation
Before using Carbonflex electrodes, or if the electrodes are to be reused, they should be
thoroughly washed in a mixture of water and mild soap. The Carbonflex electrodes are non-
sterile. However, they can be autoclaved, if required.
The skin at the electrode site should be washed with mild soap and water to reduce skin
resistance. A liberal amount of conductive electrode gel should be applied to the electrode.
Note that many ultrasound gels are not sufficiently conductive for electrical stimulation. Only
use a gel which is stated to be suitable for the purpose.
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Electrodes may be secured in place over the appropriate stimulation sites with velcro straps,
elastic bandages or hypoallergenic spunlace tape. The strapping should be tight enough to
keep the whole of the electrode surface in contact with the patient to ensure a uniform
distribution of current.
5.8 Suction Electrodes
The Vectorsurge 5 can be used with a Metron Vacupulse suction unit for simple and rapid
electrode placement. Please note that the Vacupulse suction unit is currently not available.
Suction cup electrodes avoid the need for either electrode gel and straps to secure the
electrodes or expensive disposable adhesive electrode pads. The operator's manual for the
Vacupulse describes how to use the unit in conjunction with the Vectorsurge.
5.9 Using the Vectorsurge in Dual Mode
When dual mode is selected, the Vectorsurge operates as two separate stimulators which can
operate concurrently. The output of one channel can be TNS pulses, while the other channel
is bipolar interferential or the two channels can be the same. Completely different treatment
settings can be made for each channel.
Once dual mode has been selected the set-pause button is pressed to step through
treatment settings for channel a. Once this is completed, the output selection button is
pressed to allow choice of the channel b settings.
After the treatment parameters for both channels have been set, an output should be set.
Press the output selection button to select the appropriate channel and then press the
start-focus button. Rotate the "intensity-set" control to set the output current in the
selected channel. Next press the output selection button to select the other channel.
Press start-focus and rotate the "intensity-set" control to set the output current in this
channel.
Pressing STOP will terminate the flow of current in both channels. To terminate current flow in
one channel, select the channel using the output selection button and press set-pause.
To change from DUAL to 4-pole or 2 pole mode, the output of both channels must be off.
5.10 Monitoring, Adjusting and Terminating Output Current
During treatment, the output selection button can be pressed to monitor the current in each
channel. If any adjustment is needed, the "intensity-set" control can be rotated to increase or
decrease the current in the selected channel. Pressing set-pause will reduce the output
current in the selected channel to zero, but will not affect the other channel. Pressing start-
focus will allow you to reset the current in the selected channel.
If you wish to simultaneously switch-off the current in both channels, press the STOP button
below the output intensity display.
If you wish to adjust the current in either channel without first reducing it to zero, select the
channel by pressing the output selection button then rotate the "intensity-set" control.
____________________________________________________________________
6. CONVENTIONAL INTERFERENTIAL THERAPY
6.1 OPERATIONAL INFORMATION
6.1.1 Indications For Use For Interferential Therapy
The indications for use of this device are:
1. Relaxation of muscle spasm.
2. Prevention or retardation of disuse atrophy.
3. Increasing local blood circulation.
4. Muscle re-education.
5. Immediate post-surgical stimulation of calf muscles to prevent venous
thrombosis.
6. Maintaining or increasing range of motion.
The Vectorsurge 5 should only be used under medical supervision for adjunctive
therapy for the treatment of medical diseases and conditions.
6.1.2 Contraindications
The Vectorsurge 5 should not be used on patients with cardiac demand pacemakers.
6.1.3 Therapeutic Warnings
Before the application of the Vectorsurge 5 to a patient for therapeutic purposes the
following factors should be duly considered and evaluated:
1. The long term effects of chronic electrical stimulation are unknown.
2. Stimulation should not be applied over the carotid sinus nerves, particularly in
patients with a known sensitivity to the carotid sinus reflex.
3. Stimulation should not be applied over the neck or mouth. Severe spasms of
the laryngeal and pharyngeal muscles may occur and the contractions may be
strong enough to close the airway or cause difficulty in breathing.
4. Stimulation should not be applied transthoracically in that the introduction of
electrical current into the heart may cause cardiac arrhythmias.
5. Stimulation should not be applied transcerebrally.
6. Stimulation should not be applied over swollen, infected, or inflamed areas or
skin eruptions, e.g. phlebitis, thrombophlebitis, varicose veins, etc.
7. Stimulation should not be applied over, or in proximity to, cancerous lesions.
6.1.4 Precautions
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6.1.4 Precautions
The following precautions should considered and implemented as appropriate:
1. Safety of the use of the Vectorsurge 5 during pregnancy has not been
established.
2. Caution should be used for patients with suspected or diagnosed heart problems.
3. Caution should be used for patients with suspected or diagnosed epilepsy.
4. Caution should be used in the presence of the following:
a) When there is a tendency to hemorrhage following acute trauma or
fracture;
b) Following recent surgical procedures when muscle contraction may
disrupt the healing process;
c) Over the menstruating or pregnant uterus; and
d) Over areas of the skin which lack normal sensation.
5. Some patients may experience skin irritation or hypersensitivity due to electrical
stimulation or electrical conductive medium. The irritation can usually be reduced by
using an alternative conductive medium, or alternate electrode placement.
6. Electrode placement and stimulation settings should be based on the guidance of
the prescribing practitioner.
7. The Vectorsurge 5 should be kept out of the reach of children.
8. The Vectorsurge 5 should be used only with the leads and electrodes
recommended for use by the manufacturer.
6.1.5 Adverse Reactions
Skin irritations and burns beneath the electrodes have been reported with the use of
powered muscle stimulators.
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6.2 OPERATING PROCEDURES
6.2.1 Interferential Beat Frequency Selection
Complete flexibility of frequency selection is an important feature of the Vectorsurge.
Beat frequencies available are in the range 0 to 300 Hz, depending on the setting of the
'upper' and 'lower' frequency selectors.
The most commonly used interferential frequency sweeps of 0-150 Hz, 80-150 Hz or
0-15 Hz are preset in the machine and may be obtained simply by selecting them.
When different frequencies or frequency ranges are required the SWEEP RANGE
indicator should be set to SELECT. In this position, pressing the set-pause button
causes the 'upper' light to flash and the highest frequency of the sweep range can be
selected by pressing the set-pause button then rotating the "intensity-set" control
until the desired upper limit is displayed. Next the lower frequency is set by pressing
the set-pause button to choose 'lower' and rotating the "intensity-set" control
anticlockwise until the desired lower limit is displayed. Once the upper frequency has
been selected, pressing the set-pause button allows selection of the lower
frequency.
Fixed frequencies are obtained by setting the upper and lower frequencies to the same
value and this happens automatically. When the set-pause button is pressed and the
upper frequency is selected, the lower frequency is also set to the chosen frequency.
So for fixed frequency selection, set the 'upper' frequency to that required then press
the set-pause control. The 'lower' frequency is automatically set the same value as
the upper frequency so no adjustment is required. Simply press set-pause to
continue with treatment selection and set the carrier frequency.
Frequently used frequency protocols can, of course, be kept in the Vectorsurge as
stored programs which can be recalled at the push of a button.
6.2.2 Interferential Carrier Frequency Selection
Most interferential therapy machines operate with a fixed carrier frequency of 4 kHz. The
Vectorsurge offers the operator the choice of either a 2.5 kHz, 4 kHz or 10 kHz carrier
frequency. The carrier frequency is chosen simply by setting the FREQUENCY
selector to the appropriate choice.
When the machine is being used for muscle re-education a carrier frequency of 2.5 kHz
should be used.
When best discrimination between sensory, motor and pain responses is required a
carrier frequency of 10 kHz should be used. This frequency is recommended for all
treatment conditions where efficient and comfortable treatment is needed.
A carrier frequency of 4 kHz is a compromise between the best conditions for muscle
stimulus and patient comfort.
6.2.3 Applying Interferential & Russian Therapy
The Vectorsurge 5 is, first and foremost, an interferential therapy machine. To select
interferential treatment, switch on the machine, and chose a preset interferential treatment
program (see above) or set the machine manually by choosing the treatment settings. The
procedure for manual setup is outlined below.
1. When the machine is switched on, the PATIENT MODE indicator will be flashing.
Rotating the intensity-set control allows the appropriate selection to be made.
Once selection has been made press the set-pause button to move onto the next
parameter selection.
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Note: If DUAL mode is selected only 2 pole output mode will be available.
2. The next selection involves choosing the OUTPUT MODE required. Select
INTERFERENTIAL (or RUSSIAN if required) using the intensity-set control. Once
completed press the set-pause button to move to the next selection.
Note: It is not necessary to step through all of the steps detailed. Once the settings are as
required, the output can be initiated at any time by pressing the start-focus button and the
desired output current can be set by manipulation of the intensity-set control.

3. The TREATMENT time indicator will now be flashing. If a change in the treatment time
from that shown is desired, rotate the "intensity-set" control clockwise or anticlockwise
(clockwise to increase, anticlockwise to decrease) until the appropriate value is shown.
If no further changes are needed initiate treatment or press set-pause to proceed to
the next step.
4. The SURGE TIME parameters will now be available for selection. Surging can then
be switched on or off by rotating the "intensity-set" control. Anticlockwise rotation
turns surging off, clockwise rotation turns surging on, indicated by the RISE, ON, FALL
and OFF indicators being illuminated .
If surging is switched off (RISE, FALl, ON and OFF indicators are not illuminated, only
the SELECT indicator flashing), depressing the set-pause button will take you to
sweep range selection.
If surging is switched on (RISE, ON, FALL and OFF indicators are all illuminated),
press the set-pause button and the RISE indicator will flash. Rotate the "intensity-
set" control to change the rise time, which is shown (in seconds) on the
TIMER/PROGRAM display. Proceed to set the on time, fall time and off time in the
same way i.e. press the set-pause button to move to the next setting and rotate
the "intensity-set" control to change the setting to the value required. Once the surge
times have been selected, depressing the set-pause button will move to sweep
range selection. If no further changes are needed at this stage treatment can be
initiated by pressing the start-focus button.
Note: Users should be aware that surge durations longer than several seconds, including
continuous stimulation, may result in muscle fatigue. Relaxation of muscle spasm is the only
valid indication for surge durations greater than several seconds.
5. The sweep range selection can now accessed. If the sweep range indicated is the
one desired press the set-pause button to proceed to the next step. To change
the chosen sweep range, rotate the "i nt ensi t y- set " control to the setting
required. If a preset sweep range (0-15 Hz, 0-150 Hz or 80-150 Hz) is selected
activation of the set-pause button will step to the next selection.
If a sweep range is required which is not a preset one, chose SELECT then press
set-pause and the upper frequency indicator will flash. The upper frequency can
then be adjusted by rotating the "intensity-set" control. Pressing the set-pause
button again allows the lower frequency to be set. The lower frequency is adjusted by
rotating the intensity-set control. Pressing the set-pause button will lock in the
values chosen and move the sequence to the next parameter, output configuration.
6. Set the output configuration , 4 pole or 2 pole, to the desired value by rotating the
"intensity-set" control clockwise or anticlockwise. Press the set-pause button to
move to the final selection, carrier frequency.
7. Set the carrier frequency to the desired value by rotating the "intensity-set" control
clockwise or anticlockwise.
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8. Now that the treatment conditions have been selected, the output current intensity can
be set. Depress the start-focus button momentarily. The output current intensity
can be set to an appropriate level by rotating the "intensity-set" control.
Note: If the SURGE is set on, the maximum intensity can be set with confidence: the surge
cycle does not begin until approximately ten seconds after the peak intensity has been set.
At this point the output current will drop to zero at a rate determined by the FALL setting and
the surge cycle will begin with the first OFF period. If subsequent adjustment to the intensity is
needed, it can be made by rotating the "intensity-set" control.

Rotating the "intensity-set" control clockwise will result in the current increasing only to
the previously set peak value. Not until the peak value has been reached can a higher
current be set. Rotating the "intensity-set" control anticlockwise will, however, result
in an immediate decrease in the output.
9. If the targeted tissue is not stimulated optimally, or if greater stimulation intensity is felt
under one electrode or pair of electrodes, the interferential currents can be balanced by
pressing the "start-focus" button and rotating the "intensity-set" control. The 'focus'
adjustment provides a means of optimally targeting the tissue volume to be treated. It
also allows compensation for different tissue conductance between the electrode pairs.
When the patient feels equal (or no) sensation under the electrodes, the targeted
tissue should be optimally stimulated.
10. During treatment the intensity setting may need to be increased slightly to
compensate for accommodation effects. For example, with a typical treatment of 20
minutes duration the intensity may need to be increased once, after the first five
minutes of treatment. This is achieved simply by rotating the "intensity-set" control.
11. At the end of the treatment period:
* remove the electrodes from the patient.
* if the machine is not to be used again for some time, switch off.
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7. TNS THERAPY
7.1 OPERATIONAL INFORMATION
7.1.1 Indications For Use For TNS Therapy
The indications for use of this device are:
1. Relief of chronic intractable pain, acute post traumatic pain or acute post
surgical pain.
The Vectorsurge 5 should only be used under medical supervision for adjunctive
therapy for the treatment of medical diseases and conditions.
7.1.2 Contraindications
The contraindications for using the Vectorsurge 5 to provide TNS therapy are;
1. Any electrode placement that applies current to the carotid sinus (neck).
2. Any patients who have a cardiac demand-type pacemakers.
3. Any electrode placement that causes current to flow transcerebrally (through
the head).
4. Any situation where pain syndromes are undiagnosed, until etiology is
established.
7.1.3 Therapeutic Warnings
Before the application of the Vectorsurge 5 to a patient for therapeutic purposes the
following factors should be duly considered and evaluated:
1. The long term effects of chronic electrical stimulation are unknown.
2. The safety of TNS devices for use during pregnancy or birth has not been
established.
3. TNS therapy is not effective for pain of central origin. (This includes
headache).
4. Stimulation should not be applied transthoracically in that the introduction of
electrical current into the heart may cause cardiac arrhythmias.
5. TNS devices should only be used under continued supervision of a licensed
practitioner.
6. TNS devices have no curative value.
7. TNS is a symptomatic treatment and as such suppresses the sensation of
pain which would otherwise serve as a protective mechanism.
8. The user must keep the device out of the reach of children.
9. Electronic monitoring equipment (such as ECG monitors and ECG alarms)
may not operate properly when TNS stimulation is in use.
7.1.4 Precautions
The following precautions should considered and implemented as appropriate:
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1. Isolated cases of skin irritation may occur at the site of electrode placement
following long-term application.
2. Effectiveness is highly dependent upon patient selection by a person
qualified in the management of pain patients.
3. The Vectorsurge 5 should be used only with the leads and electrodes
supplied and recommended for use by the manufacturer.
7.1.5 Adverse Reactions
Skin irritations and burns beneath the electrodes have been reported with the use of
powered muscle stimulators.
7.2 OPERATING PROCEDURE
7.2.1 TNS Stimulation Frequency Selection
When used in TNS mode, the stimulation frequency is set in the same way as the
interferential beat frequency. Thus preset frequency sweeps of 0-150 Hz, 80-150 Hz
or 0-15 Hz can be selected directly or other frequency ranges or a fixed frequency can
be set.
As with interferential treatment, frequently used TNS frequency protocols can be kept in
the Vectorsurge as stored programs which can be recalled at the push of a button (see
pages 17 to 20).
7.2.2 TNS Pulse Width Selection
When used in TNS mode, the stimulus waveform is a rectangular biphasic pulse with
pulse widths selectable from 200 s, 125 s or 50 s. The pulse width is chosen
simply by setting the FREQUENCY(PULSE WIDTH) selector to the appropriate
choice. When different frequencies are chosen, the Vectorsurge produces one biphasic
pulse at the frequency selected. The duration of the biphasic pulse is 1/frequency and
the width of the individual pulses is one half of this. Thus if TNS mode is selected and a
frequency of 10 kHz is chosen, the TNS pulse will be biphasic with a 50 s positive
pulse followed by a 50 s negative pulse.
The interferential frequency and the corresponding widths of the TNS biphasic pulses
are as follows:
2.5 KHz 200 us
4 KHz 125 us
10 KHz 50 us
The effect of pulse width is described more fully in the 'background information' section of
this manual, beginning on page 37.
7.2.3 Applying Interferential TNS
A special feature of the Vectorsurge 5 is the ability to apply rectangular biphasic current pulses
('conventional TNS') in interferential mode. Thus you can combine the advantages of
conventional TNS treatment with the ability to target the stimulating current in the region of
intersection of the two current pathways. With conventional TNS, greatest stimulation is
produced immediately beneath the electrodes. With interferential TNS, the region of
maximum stimulation has the familiar clover-leaf pattern traditionally associated with
conventional interferential stimulation. This feature is explained in more detail in the
____________________________________________________________________
'background information' section beginning on page 37.
To select interferential TNS treatment, switch on the machine, and chose a preset interferential
TNS treatment program (as described previously) or set the machine manually by choosing
the treatment settings. The procedure for manual setup is outlined below.
1. When the machine is switched on, the PATIENT MODE indicator will be flashing.
Rotating the intensity-set control allows the appropriate selection to be made.
Once selection has been made press the set-pause button to move onto the next
parameter selection.
Note: If DUAL mode is selected only 2 pole output mode will be available.
2. The next selection involves choosing the OUTPUT MODE required. Select TENS
using the intensity-set control. Once completed press the set-pause button to
move to the next selection.
Note: It is not necessary to step through all of the steps detailed. Once the settings are as
required, the output can be initiated at any time by pressing the start-focus button and the
desired output current can be set by manipulation of the intensity-set contro
3. The TREATMENT time indicator will now be flashing. If a change in the treatment time
from that shown is desired, rotate the "intensity-set" control clockwise or anticlockwise
(clockwise to increase, anticlockwise to decrease) until the appropriate value is shown.
If no further changes are needed initiate treatment or press set-pause to proceed to
the next step.
4. The SURGE TIME parameters will now be available for selection. Surging can then
be switched on or off by rotating the "intensity-set" control. Anticlockwise rotation
turns surging off, clockwise rotation turns surging on, indicated by the RISE, ON, FALL
and OFF indicators being illuminated .
If surging is switched off (RISE, FALl, ON and OFF indicators are not illuminated, only
the SELECT indicator flashing), depressing the set-pause button will take you to
sweep range selection.
If surging is switched on (RISE, ON, FALL and OFF indicators are all illuminated),
press the set-pause button and the RISE indicator will flash. Rotate the "intensity-
set" control to change the rise time, which is shown (in seconds) on the
TIMER/PROGRAM display. Proceed to set the on time, fall time and off time in the
same way i.e. press the set-pause button to move to the next setting and rotate
the "intensity-set" control to change the setting to the value required. Once the surge
times have been selected, depressing the set-pause button will move to sweep
range selection. If no further changes are needed at this stage treatment can be
initiated by pressing the start-focus button.
Note: Users should be aware that surge durations longer than several seconds, including
continuous stimulation, may result in muscle fatigue. Relaxation of muscle spasm is the only
valid indication for surge durations greater than several seconds.
5. The sweep range selection can now accessed. If the sweep range indicated is the
one desired press the set-pause button to proceed to the next step. To change
the chosen sweep range, rotate the "i nt ensi t y- set " control to the setting
required. If a preset sweep range (0-15 Hz, 0-150 Hz or 80-150 Hz) is selected
activation of the set-pause button will step to the next selection.
If a sweep range is required which is not a preset one, chose SELECT then press
set-pause and the upper frequency indicator will flash. The upper frequency can
then be adjusted by rotating the "intensity-set" control. Pressing the set-pause
button again allows the lower frequency to be set. The lower frequency is adjusted by
____________________________________________________________________
rotating the intensity-set control. Pressing the set-pause button will lock in the
values chosen and move the sequence to the next parameter, output configuration.
6. Set the output configuration , 4 pole or 2 pole, to the desired value by rotating the
"intensity-set" control clockwise or anticlockwise. Press the set-pause button to
move to the final selection, pulse width.
7. Set the pulse width to the desired value, 200, 125 or 50 us, by rotating the
"intensity-set" control clockwise or anticlockwise.
8. Now that the treatment conditions have been selected, the output current intensity can
be set. Depress the start-focus button momentarily. The output current intensity
can be set to an appropriate level by rotating the "intensity-set" control.
Note: If the SURGE is set on, the maximum intensity can be set with confidence: the surge
cycle does not begin until approximately ten seconds after the peak intensity has been set.
At this point the output current will drop to zero at a rate determined by the FALL setting and
the surge cycle will begin with the first OFF period. If subsequent adjustment to the intensity is
needed, it can be made by rotating the "intensity-set" control.

Rotating the "intensity-set" control clockwise will result in the current increasing only to
the previously set peak value. Not until the peak value has been reached can a higher
current be set. Rotating the "intensity-set" control anticlockwise will, however, result
in an immediate decrease in the output.
9. If the targeted tissue is not stimulated optimally, or if greater stimulation intensity is felt
under one electrode or pair of electrodes, the interferential currents can be balanced by
pressing the "start-focus" button and rotating the "intensity-set" control. The 'focus'
adjustment provides a means of optimally targeting the tissue volume to be treated. It
also allows compensation for different tissue conductance between the electrode pairs.
When the patient feels equal (or no) sensation under the electrodes, the targeted
tissue should be optimally stimulated.
10. During treatment the intensity setting may need to be increased slightly to
compensate for accommodation effects. For example, with a typical treatment of 20
minutes duration the intensity may need to be increased once, after the first five
minutes of treatment. This is achieved simply by rotating the "intensity-set" control.
11. At the end of the treatment period:
* remove the electrodes from the patient.
* if the machine is not to be used again for some time, switch off.
____________________________________________________________________
8. ELECTROTHERAPY
8.1 CONVENTIONAL INTERFERENTIAL THERAPY
8.1.1 Introduction
Interferential therapy is an important part of the range of treatment modalities available to the
practising physiotherapist. Interferential apparatus provides the means of focussing-in on and
selectively stimulating deeply located tissue. By using two pairs of electrodes and two distinct
patient circuits, maximum stimulation of the patient's tissue is achieved in a region at the
intersection of the two current pathways.
8.1.2 Depth Efficiency
Figure 1 illustrates the depth efficiency of true interferential stimulation (i.e. quadripolar) as
compared with that produced by conventional apparatus (TNS. units or faradic apparatus), or
interferential apparatus used in bipolar mode.
Figure 1: Regions of maximum stimulation.
(a) Quadripolar interferential stimulation
(b) Bipolar stimulation
With conventional (bipolar) treatment (Figure 1(b)) greatest stimulation is achieved in regions
close to each electrode (i.e. superficially). This is because the current spreads within the
patients tissue so that the regions of highest current density, and thus greatest stimulation, are
close to each electrode.1
Interferential therapy works on the premise that if two currents are applied to the patient the
region of greatest current density and hence greatest stimulation will be at the intersection of
the two current pathways. By applying two currents at right angles, maximum stimulation is
produced in deeply located tissue rather than in the superficial tissue beneath each electrode.
8.1.3 Vector Rotation
The pattern of electrical stimulation produced by interferential therapy is in the form of a clover-
leaf (Figure 1(a)). This pattern is commonly referred to as a static interference field. This
means that maximum stimulation of the patient's tissue is not produced simply
at the centre of the current pathways but is produced in four distinct lobes positioned along
lines between adjacent electrodes (Figure 2(a)). The reason for this is that the interfering
currents add vectorially, producing a maximum stimulation in the four regions shown.
The rotation of this vector field is achieved by rhythmically increasing and decreasing the
current in one pair of electrodes while the current in the opposite pair of electrodes is kept
constant.
Figure 2 below shows the effect of vector rotation.
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(a)
(b)
areas of
maximum
stimulation
current
pathways
Rotation of the interference field as shown provides stimulation of the tissue not treated when
only a static field is used.
Slow rotation of this interference field is clearly inefficient as it takes several seconds for the
stimulation pattern to rotate through the tissue, thus the tissue is treated in stages as if by a
series of static vector fields.
The high speed rotation of the vector field in the Vectorsurge 5 ensures that all of the tissue in
the treatment region is stimulated almost simultaneously. With the vector field rotating at 200
times per second, the nerve fibres are continuously stimulated at the beat frequency, because
the interval between successive stimulations by the vector field as it passes through the
individual nerve fibres is sufficiently short to ensure that the beat frequency is not interrupted.
The continuous and simultaneous stimulation of the tissue in this manner is extremely efficient
and of superior therapeutic benefit than with slow speed vector rotation. This improved
efficiency in the Vectorsurge 5 over all other interferential units means that improvement in
condition will be recognised earlier when Vectorsurge 5 is used.
8.1.4 Surging
To be suitable for muscle re-education an electronic stimulator should be capable of producing
a stimulus intensity which increases and decreases gradually over a period of several
seconds. Faradic stimulators achieve this by surging the output intensity in a gradual manner
but the stimulation produced is superficial (Figure 1) and the stimulus
frequency is fixed in the tetanic frequency range (normally 50 Hz). Some interferential
machines are claimed to be suitable for muscle re-education when used with a low beat
frequency range (normally 0-10 Hz) but no surging of the output is provided.
The Vectorsurge 5 offers complete flexibility in the choice of stimulus frequencies and in
addition offers the option of surging the output and choosing an appropriate surge rate. Thus
a tetanic frequency (e.g. 30 Hz) or a slow motorneurone frequency range (5-15 Hz) or a
frequency range spanning the two (for example 5-35 Hz) can be selected and the output can
be surged to allow rest periods between stimuli and to minimize accommodation affects.
8.1.5 Beat Frequencies
(i) Sweep Ranges
Traditionally, interferential units have offered three sweep ranges: a low frequency
sweep (normally 0-10 Hz or 0-15 Hz), a high frequency sweep (normally 80-100 Hz
or 80-150 Hz) and a wide sweep (0-100 Hz or 0-150 Hz). Since these low, high and
wide sweeps are often required they are provided on the Vectorsurge 5 and can be
selected simply and directly. The preset frequency sweeps on the Vectorsurge 5 are
0-15 Hz, 80-150 Hz and 0-150 Hz.
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Static
field
Effect of
vector rotation
A fourth position on the beat frequency selector allows the operator to set different
sweep ranges or a fixed beat frequency. Both the lower and upper frequency can be
set to any value up to 300 Hz. Thus the beat frequency may be fixed anywhere in
the range up to 300 Hz or may be set to sweep over a narrow range (e.g. 0-10 Hz, 5-
35 Hz, 100-150 Hz) or any wider range which might be required (e.g. 0-100 Hz, 50-
150 Hz, 100-200 Hz). A fixed beat frequency is obtained when both the lower
frequency and upper frequency are set to the same value.
(ii) Low Frequencies
A sweep range of 0-15 Hz is recommended for producing gentle twitching/ tugging
responses for increasing blood flow.
A sweep range of 5-15 Hz is recommended for muscular re-education via stimulation
at slow motorneurone frequencies. The process of atrophy due to denervation or
disuse includes a progressive change in the metabolic properties of skeletal muscle,
most notably oxidative properties.
(iii) Intermediate Frequencies
Frequencies in the range 30 to 100 Hz are suitable for producing forceful muscle
contraction. In this frequency range the response is a tetanic contraction. To avoid
fatigue and discomfort and to produce comfortable graded, sequential contractions the
surge facility should be used.
The best Vectorsurge carrier frequency for maximum muscle torque production is 2.5
kHz and selection of lower beat frequencies will result in a less rapid onset of
fatigue. For these reasons a beat frequency sweep of 30-50 Hz at a carrier frequency
of 2.5 kHz is recommended for production of strong muscle contraction.
(iv) Higher Frequencies
It was originally believed that the optimum beat frequency for analgesic stimulation was
80-100 Hz, however recent research indicates that higher beat frequencies (up to 150
Hz) are more effective for controlling pain.
A sweep range of 80-150 Hz at an intensity which produces mild tingling with little or
no motor stimulation is recommended for pain control. The output need not be surged.
The carrier frequency should be set at 10 kHz.
Because of the overlap in appropriate frequency ranges for electroanalgesia (80-150
Hz) and motor responses (30-100 Hz) a frequency sweep which combines two
treatments can be chosen. To combine a gentle and comfortable motor response with
mild analgesia a frequency sweep of 80-150 Hz is recommended. The output
intensity should be high enough to produce an appropriate motor response and
surged at a low or medium rate.
For a maximum electroanalgesic effect with no motor response a sweep range of 250-
300 Hz is recommended, with the intensity set at a comfortable sensory level and
below the motor threshold.
8.1.6 Carrier Frequencies
Until now, interferential therapy machines have used an operating frequency of typically 4 kHz
to 5 kHz and the waveforms used have been sinusoidal in shape. This frequency range and
waveform was thought to be best for reducing physical discomfort to the patient.
In recent times it has been shown that higher carrier frequencies around 10 kHz are optimum
____________________________________________________________________
for minimizing physical discomfort
3
and that lower carrier frequencies around 2.5 kHz are best
suited to producing maximum muscle torque
4
. 4 kHz to 5 kHz thus represents a compromise
between these two best frequencies.
Moreno-Aranda and Siereg
3
first showed that although greater muscle force is produced at
lower frequencies, a higher carrier frequency (around 10 kHz) was capable of producing good
muscle contractions with minimum sensation of pain. More recently Ward and Robertson
5
,
using a different experimental procedure, showed that discrimination between motor and pain
thresholds was maximum at frequencies near 10 kHz. Figure 3 shows a graph of pain
threshold/motor threshold versus frequency.
The results shown as figure 3 were obtained using small electrodes located over the
brachioradialis motor point and stimulating with alternating currents in the frequency range 1 kHz
to 35 kHz. It is clear from the graph that best discrimination between pain and motor
responses is achieved with frequencies in the range 8 kHz to 12 kHz.
Figure 3: Pain threshold/motor threshold versus frequency for stimulation over
Brachioradialis motor point (adapted from Ward and Robertson
5
).
1 2 5 10 20 40
0.8
1.0
1.2
1.4
1.6
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
++
+
+
+
+
+
p
a
i
n

t
h
r
e
s
h
o
l
d
m
o
t
o
r

t
h
r
e
s
h
o
l
d
frequency (kHz)
Figure 4: Maximum electrically induced torque of the wrist extensors at carrier
frequencies of 2 kHz, 4 kHz and 10 kHz (from Ward and Robertson
4
).
____________________________________________________________________

1 2 4 10
20
40
60
t
o
r
q
u
e

(
%

o
f

M
V
C
)
frequency (kHz)
Ward and Robertson
4
compared carrier frequencies in the range 1 kHz to 15 kHz for torque
production in the wrist extensors and found the lowest frequencies to be appreciable more
efficient. A graph of maximum electrically induced torque versus frequency is shown in figure
4. The advantage of a 2.5 kHz carrier frequency over 4 kHz or 10 kHz is clearly apparent.
The torque at 2.5 kHz is almost 20% greater than at 4 kHz and approximately 40% greater
than at 10 kHz.
Carrier frequencies of 2.5, 4 or 10 kHz can be selected on the Vectorsurge 5 simply by
choosing from the three options. Hence the carrier frequency can be chosen to provide
optimum stimulation characteristics depending on the condition to be treated.
8.1.7 Phase Switching
Older interferential machines generate two sinusoidal alternating currents with slightly differing
frequencies. When the two currents intersect in the patients' tissue they interfere, producing a
beat frequency signal in the biological frequency range. The waveforms used are sinusoidal in
shape.
The Vectorsurge 5 has two innovative features designed to improve the stimulation efficiency
and comfort of interferential therapy:
* The carrier waveform is rectangular rather than sinusoidal in shape. It is well known that
a rapidly rising stimulus waveform is more efficient than one which rises slowly. This is
because nerve fibres can accommodate to a slowly rising stimulus. The use of a
rectangular waveform thus minimizes accommodation and produces maximum
stimulation efficiency.
* The carrier waveforms are identical in frequency but are shifted in and out of phase at
the beat frequency. Rapid phase shifting of the signals results in a beat-frequency
stimulus which switches rapidly from minimum to maximum. Again, the effect of this
rapid phase shifting is to minimize accommodation of nerve fibres and maximize
efficiency.
Figure 5 shows the rectangular signal waveforms produced by the Vectorsurge 5 and how
____________________________________________________________________
they are combined to produce a rectangular beat frequency envelope. When the currents are
applied to the patient via two pairs of electrodes (4 pole operation) the phase shifted signals
combine and the beat frequency envelope is generated in the patient's tissue, in the region of
intersection of the current pathways. The clover-leaf pattern of stimulation in the region of
intersection is shown in figure 1 previously.
When the machine is switched to 2 pole operation the beat frequency signal is generated
within the machine and applied directly to the patient via one pair of electrodes. In 'dual'
mode the beat frequency signal is available at both outputs of the machine, so either output A
or output B can be used, or both outputs used simultaneously for treating two areas of the
patient. It should also be noted that different beat frequencies or frequency sweeps can be
chosen for each channel. In dual mode, the frequency sweeps (and all other treatment
settings) can be independently set for each channel.
Figure 5: Combination of two phase-shifted signals to produce a rectangular beat-
frequency envelope.
In summary the Vectorsurge 5 has a range of carrier frequencies and beat frequencies which
ensure optimum treatment conditions to be achieved in every case. This, together with
surging of the output, rapid phase switching of the carrier waveforms and the option of bipolar
or quadripolar treatment makes the Vectorsurge 5 the most advanced machine available for
interferential stimulation.
8.2 CONVENTIONAL TNS THERAPY
8.2.1 General
Transcutaneous electrical nerve stimulation (TNS) strictly refers to any form of through-the-skin
nerve stimulation. However in common usage, the term 'TNS stimulator' is often used in a
more restricted sense, to identify a device which produces short duration rectangular pulsed
current, either monophasic or biphasic, with pulse frequencies typically in the range 0-100 Hz.
Many of these devices are pocket-size, battery operated units with limited output, intended
for pain control and safe for home usage by the patient. Some clinical TNS stimulators have
output intensities high enough to elicit a forceful muscle contraction. Here we adopt the
common usage definition and use the term 'TNS therapy' to refer to stimulation using short-
duration rectangular pulsed current.
The Vectorsurge 5 produces short-duration rectangular biphasic pulses with pulse widths of
____________________________________________________________________
50 s, 125 s or 200 s. The pulse frequency is selectable in the range 0-300 Hz and
frequency sweeps in this range can also be selected. Figure 6 shows the TNS pulses
produced by the Vectorsurge. The biphasic stimulus pulse ensures charge neutrality and no
risk of electrolytic effects which could produce skin irritation under the electrodes.
Figure 6: Output stimulus waveforms produced in TNS mode.
The Vectorsurge provides 'top-end' TNS performance by offering:
* pulse width selection down to 50 s
* stimulation frequencies as high as 300 Hz together with the ability to set a sweep
range
* surging of the output
* an output intensity high enough to meet all clinical needs.
8.2.2 Effect of Pulse Width
If skin surface electrodes are attached to a patient and stimuli of increasing intensity are applied,
three distinct responses may be obtained. Each response has a different threshold for its
onset.
As the stimulus intensity is increased the first response normally noticed is sensory. The
patient perceives the electrical stimulation before any muscular or pain response is elicited. A
further increase in intensity will result in the onset of either a motor response or pain. This
depends on the electrode placement. Motor fibres have larger diameters than pain fibres and
are intrinsically more easy to stimulate but if the motor fibres are deeply located, pain fibres
closer to the electrodes may be stimulated first. If the electrodes are placed over a motor
point i.e. a point where the motor nerves are located superficially, then the order of stimulation
will normally be sensory then motor then pain.
The sequence of responses and their separation in terms of the intensity required actually
depend on four factors: the placement of electrodes, the electrode size, the stimulus pulse
width and the stimulus frequency.
* Electrode placement is important in that to obtain a pronounced motor response,
without pain, the electrodes should be over a motor point or region where the motor
nerve supply is located superficially.
* The electrode size should be as large as possible to avoid concentrating the current in
a small superficial region and preferentially stimulating pain fibres in the region.
* The stimulus pulse width should be sufficiently small. Experimentally it has been
shown that best discrimination between sensory, motor and pain responses is
____________________________________________________________________
achieved using relatively narrow stimulus pulses. This point is discussed further below.
* The stimulus frequency would be expected to influence discrimination because the
nerve fibres associated with sensory, motor and pain responses have different
refractory periods. To date, no studies of discrimination as a function of pulse
frequency have been published.
The importance of pulse width was highlighted in studies by Alon et al
7
and Howson
8
. The
differences in electrical characteristics of nerve fibre types and their different depths of location
in tissue results in separate strength-duration curves for sensory, motor and pain responses.
Representative curves similar to those obtained by Alon et al
7
and Howson
8
are shown in
figure 7. Both of these studies used electrodes placed over a motor point so that the order of
stimulation was sensory, motor, then pain. The (peak pulse) current required to reach each
threshold was measured for a range of pulse widths in the range 5 s to 1000 s (1 ms).
Two things are apparent from the graphs shown. First that the order of stimulation is sensory,
then motor, then pain at all pulse durations. Second, that as we go to smaller pulse widths the
separation between the curves increases.
Figure 7: Strength-duration curves for sensory, motor and pain responses.
It is clear that as one goes to smaller pulse widths the ease of discrimination between sensory,
motor and pain responses is increased.
This observation regarding pulse width has an important practical implication for therapy. If
long duration pulse widths are used then smaller changes in intensity will be needed to change
from a sensory response to a motor or pain response. If short duration pulses are used, much
larger changes in intensity will be needed to recruit motor and pain fibres. So if the objective is
to produce a sensory response with minimal motor or pain responses then short duration
pulses are preferred. Short duration pulses will also be capable of producing an effective
motor response with minimum pain sensation.
To the extent that pain modulation is achieved by the activity of sensory fibres, with greater
____________________________________________________________________
sensory activity inhibiting pain perception, we have an explanation as to why sensory nerve
fibre stimulation reduces the sensation of pain. Even without a proven and comprehensive
explanation in terms of neurophysiological mechanisms, it has been established empirically
that the sensation of pain can be reduced by sensory stimulation in various forms. A variety of
different stimuli including massage, heat, ice, lineaments and TNS have been implicated in
reducing the subjective sensation of pain. The common factor is sensory stimulation. Sensory
nerve fibre stimulation has thus been established as serving an important role in pain
suppression. By using relatively narrow pulses (50 s or less), selective stimulation of
sensory fibres can be achieved. Thus short duration pulses can be argued to be most
effective for pain control via stimulation of sensory neurones.
8.2.3 Effect of Pulse Frequency
Pulse frequency is important as different physiological responses are produced in different
frequency ranges. Sensory fibres can respond to higher frequency stimuli than can motor or
pain fibres. At low frequencies, sensory, motor and pain fibres can be stimulated with each
stimulus pulse of current. As the frequency is increased, pain and motor fibre responses do
not keep track with the electrical stimuli. Above approximately 10 Hz, pain fibre activity
ceases to increase. Above approximately 100 Hz, motor fibre activity becomes less than
the stimulus frequency. Sensory fibres continue to fire in response to each pulse of current but
the pain and motor fibres do not. Hence, while sensory nerves will continue to produce action
potentials at relatively high frequencies (by biological standards), pain and motor nerves reach
an upper limit to their firing at appreciably lower frequencies.
The effect of rectangular pulse stimulus frequencies well above 100 Hz has not been
examined in any detail but the balance of evidence suggests that the higher the frequency, the
greater the selective stimulation of sensory fibres. By producing a maximum rate of firing of
sensory fibres, maximum inhibition i.e. gating, of pain fibre signals is achieved.
For therapeutic applications, three frequency ranges are distinguished.
The sub tetanic frequency range: 0-15 Hz.
This is the frequency range associated with a gentle prickling sensation at the sensory level
and twitch muscle contractions at the motor level. For a gentle twitching, tugging motor
response, such as might be used to increase blood flow, this frequency range can be used.
The output can be continuous (no surging is needed) as the motor response is discrete, rather
than tetanic.
This is also the frequency range over which pain fibres operate. Pain fibres, because of their
small diameter, conduct nerve impulses at relatively low speed and fire at low frequencies.
That pain control can be effected by electrical stimulation has been demonstrated in a number
of clinical studies. Low stimulus frequencies (1-15 Hz) have been reported as effective, as
have higher frequency stimuli (80-150 Hz). The physiological explanation is different for each.
In the case of low frequency stimulation, pain relief is though to be achieved by pain fibre
stimulation, resulting in adaptation at the cortical level and suppression of the response to pain
fibre input. To obtain effective stimulation of pain fibres requires a long duration stimulus
pulse (> 100 s, see figure 7) rather than the short duration pulses intended for selective
stimulation of sensory nerves. The maximum pulse width of the Vectorsurge, 200 s, should
be selected for this purpose.
The tetanic frequency range: 30-80 Hz.
As the stimulation frequency is increased, the motor response produced at sufficiently high
intensities changes from a twitch response to a fused motor, or tetanic, response. Slow twitch
muscle fibres fuse at frequencies as low as 20-30 Hz, while fast twitch fibres do not fuse until
the frequency is 50 Hz or more. Thus for a smooth, forceful muscle contraction, frequencies in
the range 30-80 Hz are needed. Higher frequencies are not normally used for muscle
contraction as the rate of fatigue increases with increasing frequency. For a sustained motor
____________________________________________________________________
response with minimum fatigue, the lowest frequencies which can produce a fused contraction
are to be preferred.
When frequencies in this range are used, the output is normally surged to allow periods of rest
between periods of contraction. A surge rise time of a 1 or 2 seconds or more should be
chosen to avoid startling the patient. The surge fall time is normally unimportant and can be set
to zero.
To work the muscle hard, for example to reduce the rate of atrophy of immobilized muscle, the
surge on time should be equal to the combined rise, fall and off times. This produces an
effective stimulation to rest ratio of 1:1 as most of the rise and fall time results in negligible force
production.
The analgesic frequency range: 80 Hz and above.
In the case of higher frequency stimulation (80 Hz and above), electroanalgesia is believed to
be produced by pain impulse modulation. The theory is essentially that stimulation of
sensory fibres results in inhibition of transmission of pain fibre signals to the brain. If pain fibres
only are active, the brain interprets the signal as pain and a pain sensation is perceived. If
sensory fibres are also activated the sensation perceived is modified because less pain fibre
signals are transmitted. The sensory fibre signals are able to 'gate' the transmission of pain
fibre signals through neural integration of the nerve fibre signals. The greater the sensory
input, the less sensitive the central nervous system is to pain fibre activity.
Electrical stimulation is routinely used for pain control, though the neurophysiological
mechanism has not been fully explained. It is known that short duration stimuli (200 s or
less), administered at relatively high frequencies by biological standards (100 Hz or
more) are effective in reducing pain. The effect is not produced by suppressing pain fibre
activity as such but rather by suppressing the subjective sensation of pain which is registered
by the brain.
The perception depends on the totality of signals supplied by the different receptors and is
explicable in terms of inhibitory and excitatory synapses in the nervous system. It is
generally accepted that the greater the sensory input, the lower the sensation of pain i.e. the
less sensitive the brain is to pain fibre signals. On this basis one might expect that stimulation
of sensory nerve fibres at rates close to their maximum firing frequency (up to 300 Hz) would
produce a maximum electroanalgesic effect. Motor and pain fibres would be unable to
respond at such high frequencies so maximum sensory stimulation, relative to motor or pain,
would be produced.

8.3 INTERFERENTIAL TNS THERAPY
In first of these notes (page 37) the depth efficiency of interferential stimulation was described.
If two currents are applied to the patient, the region of greatest current density and hence
greatest stimulation will be at the intersection of the two current pathways. By applying two
currents at right angles, maximum stimulation is produced in deeply located tissue rather than in
the superficial tissue beneath each electrode. Figure 1(a) shows the clover-leaf pattern of
stimulation which is produced in the region where the two interferential currents combine. This
is in contrast to the relatively superficial stimulation pattern produced in bipolar mode (figure
1(b)).
Conventional interferential therapy machines produce two channels of medium (kHz)
frequency alternating current which are applied to the patient using a quadripolar technique to
produce the clover-leaf vector field. The currents summate to produce a beat frequency signal
within the patient's tissue. Figure 5 shows how this is achieved using the Vectorsurge.
____________________________________________________________________
8.3.1 Obtaining a TNS Interferential Effect
An innovative feature of the Vectorsurge 5 is the ability to produce a clover-leaf pattern of
stimulation at depth using a conventional TNS waveform (figure 6). To achieve this effect, an
interferential TNS stimulator must have two independent, electrically isolated outputs with the
stimulus waveforms perfectly synchronized. Synchrony of the two waveforms is essential so
that the currents can add vectorially and reinforce as shown in figure 8.
Currents from the two outputs will summate in the tissue, with a maximum effect being
produced in the clover-leaf shaped interference field.
Figure 8: Reinforcement of synchronized currents in tissue.
It is important that the two output channels of the machine be electrically isolated as current will
'take the path of least resistance'. If the channels are not electrically isolated, current will most
readily flow between the electrodes which are closest to each other. The interferential effect
shown in figure 9(a) will not occur as current will more readily flow between adjacent electrodes
than opposite electrodes. Without or with less interference, maximum stimulation is more
likely to occur under the electrodes as shown in figure 9(b).
Figure 9: Areas of maximum stimulation in tissue: (a) electrically isolated outputs and (b)
not electrically
isolated
The stimulation pattern shown in figure 9(b) is no different to that produced by a single
channel, bipolar stimulator and using four electrodes.
8.3.2 Using Interferential TNS Therapy
____________________________________________________________________
The value of interferential TNS therapy as implemented on the Vectorsurge 5 is that all of the
benefits of a high output clinical TNS stimulator are provided together with the ability to
produce a region of maximum stimulation which is not restricted to the tissue immediately
beneath the electrodes. The depth efficiency of interferential stimulation is
obtained using narrow-pulse, low average energy, TNS stimulation. In addition, the 'focus'
control can be used to rotate the vector field and target the area to be treated without having to
reposition the electrodes. The therapist can also manually rotate the vector field during
treatment, to obtain maximum therapeutic benefit.
8.3.2.1 Energy considerations
Interferential TNS stimulation is advantageous as the average current and total electrical
energy delivered to the patient is a minimum. The energy is less because single pulses
(figure 6) are used rather than continuous AC (figure 5). In conventional interferential
mode, if the peak current is 60 mA, the average current is also 60 mA as the output is
continuous AC. For a TNS pulse frequency of 50 Hz and a pulse width of 200 s, a
peak current of 50 mA represents an average current of only 0.625 mA.
For patients with sensitive skin, where relatively high intensity stimulation is required,
TNS pulses rather than conventional interferential currents should be chosen as the
average current and consequently the average energy delivered to the patient's tissue
is less.
Where skin type and sensitivity is less of an issue, and a maximum physiological
response is desired, conventional interferential current is the modality of choice.
8.3.2.2 Physiological Responses
Conventional interferential currents and interferential TNS are similar in many respects.
Electroanalgesia via stimulation of large diameter sensory fibres is achieved either with
high beat frequencies or high pulse frequencies. A tetanic motor response is produced
either with beat frequencies of 30-50 Hz and above or pulse frequencies in the same
range. Twitch responses are produced at lower frequencies in either case.
The subjective sensations and physiological responses to conventional interferential
currents and interferential TNS differ, however, in important respects and this affects the
choice of modality for patient treatment. With TNS stimulation, as the frequency is
increased the physiological response becomes markedly stronger because the average
energy delivered to the patient's tissue increases in direct proportion to the stimulus
frequency. Subjectively, the perception of stimulation intensity is greater because even
though the pulse intensity is constant, the average energy delivered is greater. Thus if
the pulse frequency is set to sweep from say 0-150 Hz, the patient's perception could
change from mild at the lower frequencies to very uncomfortable at the high end. This
effect is much less pronounced with conventional interferential stimulation as the current
from each patient circuit, and the average energy delivered to the patient, remains
constant. For this reason if a wide frequency sweep is required conventional interferential
stimulation is recommended. For narrower sweep ranges (for example 80-150 Hz or
250-300 Hz), or fixed frequencies, either modality could be used.
We recommend that you apply electrodes to yourself and compare the sensations and
responses to conventional and interferential TNS stimulation.
____________________________________________________________________
9. REFERENCES
1. Ward, A.R. 'Electricity, Fields and Waves in Therapy' Science Press (1986).
2. Nix, W.A. and Vbrova, G. 'Electrical Stimulation and Neuromuscular Disorders'
Springer-Verlag (1986).
3. Moreno-Aranda, J. and Siereg, A. J. Biomech. 14, 579-585 (1981).
4. Ward, A.R. and Robertson, V.J. Arch. Phys. Med. Rehabil. 79, 1399-1404 (1998).
5. Ward, A.R. and Robertson, V.J. Arch. Phys. Med. Rehabil. 79, 273-278 (1998).
6. Kots, Y. Electrostimulation (Canadian-Soviet exchange symposium on
electrostimulation of skeletal muscles, Montreal, Concordia University, 1977) Quoted in
Kramer J, Mendryk SW. J. Orthop. Sports Phys. Ther. 4, 91-98 (1982).
7. Alon, G. et al. Aust. J. Physio. 29, 195-201 (1983).
8. Howson, D.C. in 'Transcutaneous Electrical Nerve Stimulation' Am. Phys. Ther. Assoc.
(1979).
9. Low, J.A. and Reid, M.J. 'Electrotherapy explained'. (2nd ed.) Butterworth-
Heinemann Ltd (1994).
10. Nelson, R.M. and Currier, D.P. 'Clinical electrotherapy'. (2nd ed.) Appleton & Lange
(1991).
____________________________________________________________________
A.C.N.050 240 527
P.O. Box 2164,
57 Aster Avenue
Carrum Downs Victoria Australia 3201
Tel: (03) 9775 1234 Fax: (03) 9775 1990
Int: 61 3 9775 1234 Int: 61 3 9775 1990
EC DECLARATION OF CONFORMITY
57 Aster Avenue
Carrum Downs, Australia, 3201
declares that the medical devices described hereafter:
Metron Vectorsurge 5
Interferential / TNS
Therapy Unit
Models: VS 470
is in conformity with the essential requirements and provisions of Council Directive 93/42/EEC
is subject to the procedure set out in Annex II of Directive 93/42/EEC under the supervision
of Notified Body Number 0805, Therapeutic Goods Administration, Office of Devices, Blood
& Tissues, Po Box 100 Woden, ACT 2606, Australia
Melbourne, 9th September 2007
Ashley Williams
Managing Director
____________________________________________________________________

0805
The Metron Vectorsurge 5 Interferential / TNS Therapy Unit bears the above marking in
accordance with the requirements of Council Directive 93/42/EEC.
Should you as the purchaser and/or user of this product wish to make any comment about the
product or the manner in which it may be used our Authorised Representative within the
European Union may be contacted as follows:
Metron Medical
c/- Patterson Medical Limited
Nunn Brook Road,
Huthwaite. Sutton in Ashfield,
NOTTINGHAMSHIRE, NG17 2HU, UNITED KINGDOM
____________________________________________________________________

METRON

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