Intelect Advanced EPR - 2011-10-04¢  Intelect advanced Standard accessories. Standard accessories included:

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    2762CC Intelect Advanced Color Combo + EMG

    2752CC Intelect advanced color Combo

    2772MC Intelect Advanced Monochromatic Combo 2778 Intelect Mobile Combo

    2776 Intelect Mobile Ultra sound

    2778 Intelect Mobile Laser (without probe)

    2778 Intelect Mobile Stim

    Intelect Advanced EPR

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    Objectives  Chattanooga PMM Overview  Business objectives.  Markets  Product positioning.  Value proposition.  Chattanooga EPR review  Features & Benefits.  Clinical Indications / Contraindications

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    Chattanooga PMM Overview

    Recovery sciences

    Level 2

    Combo*

    Ultrasound *

    Laser*

    BiofeedbackPhysical medicine modalities

    Tables and traction

    Mobility and active training

    Hot & Cold

    Tables

    Traction

    NMES

    PT equipment

    PT consumables

    OT consumables

    Level 1

    Electrodes

    Iontophoresis/DD

    TENS

    Clinical *

    Shockwave

    Diathermy

    Continuous passive motion

    Acute care therapy

    Vital stimulation

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    Chattanooga PMM Overview cont-

     Clinical electrotherapy is a medium sized market with a total size of $200M globally.

     Estimated growth at 3-5% annually. DJO participates in several markets within this including clinical devices, iontophoresis, diathermy, shockwave, and electrodes.

     Chattanooga has a strong 40% share of the $50M market, primarily from the legacy and intelect advanced Chattanooga brands.

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    Chattanooga EPR positioning

    Convenience

    Functionality

    Hospitals,Out-patient Clinics, Institutions

    Private practices ,on-field sport mobile usages

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    EPR Review Intelect advanced platform

    2762CC Intelect Advanced Color Combo + EMG

    2752CC Intelect advanced color Combo

    2772MC Intelect Advanced Monochromatic Combo

    •25 + waveforms! •2 independent electrotherapy channels. •Over 200 clinical protocols. •Ability to program over 100 user defined protocols. •Over 10 quick link indications for quicker access. •Clinical & Pathological library designed by Physiotherapists for every clinician. •Patient data storage cards. •1 & 3 MHz ultrasound frequencies. •Continuous & Pulsed 10,20,50 delivery modes. •Ergonomically designed U.S. applicators- 1,2,5 & 10cm . •Audio & visual coupling systems. •Head-warming option for patient comfort.

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    Only with combo +EMG

    Intelect advanced Standard accessories

    Standard accessories included:

    •Patient data card (1) •5 cm applicator •Nylatex wrap, •Flexible electrodes and sponges 6x8cm (4) •Ultrasound gel, •CD user manual, •EMG and sEMG+Stim module (2762CC only), •Intravaginal probe (2762CC only) • 3 cm electrodes (2762CC only)

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    Intelect Advanced Optional Accessories

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    Overview of Clinical Modules  EMG  Three broad purposes : • To increase muscle activity.

    • To decrease muscle activity.

    • To re-educate muscle activities.

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    EMG indications-  INCONTINENCE :Retraining of pelvic floor muscles using intra vaginal or anal probes

    but also surface electrodes

     SOFT TISSUES INJURIES : Mostly due to hyper tonus Biofeedback goal is to modify postural behavior decreasing and/or balancing muscle activity. the information is more qualitative as long as Signal variability is a major issue with Surface EMG.

     GENERAL REHAB: Improving the outcomes of problems affecting voluntary muscle contraction ( post surgery, Nerve transplant, Muscle and Tendon trauma

     PAIN : Chronic pain produce reductions in joint movements and associated muscle tightness. EMG Biofeedback is used to promote relaxation

     SPASTICITY: Use to reduce and control spasticity

     STROKE retraining the voluntary activation of the wrist extensors, Shoulder abductors, and ankle dorsiflexors

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    EMG contraindications-

    •There are no contraindications to EMG Biofeedback but limits to the actual method.

    •Applicable to superficial muscles only.

    •Practitioner expertise important.

    •Patient must actively be able to participate.

    .

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    Stimulation module

    Galvanic current- Direct current that flows 1 second or more continuously.

    Clinical usage- Iontophoresis use of current flow between two electrodes to push ions through the skin barrier.

    Allows adding another 2 channels

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    Waveforms continued-

    Russian current (KOTZ current)

    Russian Current name derives from muscle stimulation works conducted by Russian scientist KOTZ in the late 1970’s It is a 2,5kHz sinusoidal wave form deliver in bursts ( series of pulse) with a 50% duty cycle.

    Clinical usage- • Innervated muscle stimulation •Strengthening

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    Waveforms continued-  TENS  Trancutaneous nerve stimulation.  TENS is the popularized name for electrical stimulations to treat pain. It is rectangular biphasic ( symmetrical or

    asymmetrical wave form at frequencies in a range 1 to 120Hz and pulse duration from 50 to 200µs  Physiological effects- • Nerve excitability: Selective excitability of A Beta and  A Delta fibers (sensory nerves) for Gate control and Alpha Moto neurons ( producing muscles twitches at low

    frequency) for Endorphin release. Short duration and rectangular pulse shape provide very comfortable stimulation.

    • Clinical usages- • Acute and Chronic Pain • Nocioceptive or neurogenic pain • Dysmenorhea • Angina pectoris • Labor pain but not during actual partum.

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    Waveforms continued-  NMES  Description  The current use for Neuro Muscular Electrical stimulation is basically a TENS current as rectangular biphasic

    (symmetrical wave form at frequencies in a range of 1 to 120Hz and pulse duration from 150 to 500µs  Physiological effects • Nerve excitability: Excitability of Alpha motor neurons producing normally innervated muscles contractions.

    Short duration and rectangular pulse shape can provide very strong contractions but very comfortable stimulation.

    • Clinical usages- • Normally innervated muscle stimulation • Prevention of Atrophy • Mobilization • Muscle reinforcement • Functional Electrical Stimulation

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    Waveforms continued-  INTERFERENTIAL (IFC)

     Description  Interferential currents IFC are two Alternating currents applied in a continuous mode  Frequencies are in the range of 1-10kHz. The currents have a slightly different frequency. The total current

    amplitude is the sum of the two currents at any point in the tissue where they interfere.

     Physiological effects • Deep efficiency of stimulation ( maximum stimulus is produced at depth ) • High frequency currents are more comfortable in case of High impedance ( resistive skin and fat tissues) • Nerve excitability • Gate control • Endorphins & encephalin release.

    • Clinical usages- • Pain ( same as TENS )

    time

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    Waveforms continued- INTERFERENTIAL 4 pole Vector

    Vector rotation •This is achieved by rhythmically increase or decrease the amount of current applied on each pair of electrode over a period of several seconds ( when one current goes up the other goes down and vice versa). Vector rotation will change the pattern of stimulation in the tissue volume. Increasing the current in one direction between one pair of electrode will stimulate more fibers lying parallel to the current path.

    Clinical usage-

    Greater stimulation is produced at deeper depth. Mainly use for pain ( gate control) . Whirlpool effect.

    I2I1

    Itotal

    I1

    I1

    I2

    I2

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    Waveforms continued-

    PREMODULATED INTERFERENTIAL 2 poles

    Description The 2 frequencies are combined within the stimulator producing one current claimed as having similar parameters to the expected outcome of current mixing in tissues producing better comfort.

    Clinical usage- Easier to apply Maybe be more effective and comfortable in muscle stimulation Greater stimulation remains superficially to treatment.

    I1

    I1

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    High Voltage pulsed currents-

    Description The High Voltage Pulsed Current (HVPC) has a very brief pulse duration ( 7µs) characterized by two distinct peaks delivered at high (100-500V) voltage. The waveform is monophasic (current flows in one direction only).

    Clinical use Pain Wound healing Better tissue pen