Rebox Currents

INTRODUCTION

• Rebox electrotherapeutic method is based on non-invasive transcutaneous application of specific electric currents to a living tissue.

• Main indications for using the Rebox include treatment of acute and chronic pain, immobility, musculoskeletal and neurological disorders and oedema.

• Rebox was invented by Ing. Petr Slovak, Ph.D., a lecturer at Czech Technical University in Prague, CZ.

• The name Rebox is derived from the "Rehabilitation Box".

• Specific impulses (frequency 2–4 kHz, pulse width 100-300 μs) of weak electric currents (100-200 μA) are introduced transcutaneously to the affected region.

CLASSIC HARD TIP GOLDEN FLEXI TIP

Physiological Effects• Within several seconds, local acidosis in the

treated tissue will be corrected, lymphatic fluid and blood circulation will be increased, and effective myorelaxation will take place at the same time.

• It restores the microcirculation in living tissue, reduces inflammation, improves blood and lymph circulation, decreases pain, and provides tissue relaxation.

• This speeds up recovery time.

FORM OF THE PULSES UNIPOLAR RECTANGULAR

AMPLITUDE 0-20V

PULSE FREQUENCY 2-4 kHz

PULSE WIDTH 100 – 300 MICROSECONDS

• Treatment Modes • 1. GENTLE - Recommended for a new patient

(first few sessions).2. STANDARD - The most frequent mode when patient is used to the treatment.3. STRONG - For patients who do not respond to normal stimulation amplitude.

• small non-invasive treatment electrode (cathode) AND a second reference electrode (anode) hand held to complete electric circuit.

ELECTRODE TIPS2 TYPES - classic hard tip- Golden flexi tip

• The treatment electrode (active surface 1,5 mm2) is applied for 2–3 seconds in one spot, then proceeding approx. 1,5 cm to another point.

• About 20 points are treated per one session. Frequency of treatment sessions is individual for each patient.

• Procedure: • The small, pencil-probe is placed over the treated area lightly

touching the skin.The other probe is held by the hand of the person receiving treatment.The therapist monitors the treatment reading the meter.Treatment should be repeated for stable results.

Rebox therapy is more effective in acute cases, than in chronic cases.

• One application of Rebox probe produces healing effect within a radius of about an inch�

TCLA Method

• The treatment method of the Rebox is based on Transcutaneous Correction of Local Acidosis (TCLA). This therapy method is being clinically used since 1985.

• Acute injuries and chronic diseases are accompanied by local acidosis in living tissue. The changes in tissue microenvironment often result in pain, oedema and myocontraction.

• Battery powered pulse generator provides pulsating DC current with rectangular waveform.

• Microamp meter is measuring the average value of the current.

• All positive ions (mainly K+, Ca++ and Na+) are attracted from the extra cellular fluid to the cathode leads to local changes in tissue microenvironment resulting in positive treatment effects.

• After a short time, myorelaxation in the tissue occurs - especially thanks to calcium ions.

• Due to the electrolysis effect, water molecules in extra cellular fluid dissociate to hydrogen positive ions and OH hydroxide negative ions according to the chemical equation in the picture.

• Since hydrogen ions leave the tissue and enter the surrounding air, and hydroxide ions together with K+ and Na+ ions create hydroxides NaOH and KOH, local alkalization occurs.

• This results in dramatic pain decrease. Because the effective radius, which was experimentally found, is about 1.5cm (approx. 1/2 inch), we can imagine the treated area for one needle probe application point as a hemisphere with a 1.5cm radius.

• After 2-3 seconds of needle probe application balance occurs and the current remains constant, but only if we treat normal tissue without pathologies.

• At this moment, application can be finished at this point and the therapist can move 1-2cm further.

• The average current vs. time characteristics for normal tissue can be seen in the picture. The cross shows the optimal time for finishing the treatment at this point.

• If there is any pathology in the tissue, we will obtain another characteristic.

• the TCLA treatment method has three basic effects:

• AnalgeSic: Pain decrease due to local alkalizationMyorelaxation: Due to calcium ionsImproved blood and lymphatic fluid circulation: Due to increased ion migration

• These effects appear during a few minutes following the application. The treatment can be then repeated the next day if needed.

• The number of treatment sessions and the length of one session depend on the type of disease.

TREATMENT DURATION

• A typical session length is between 5-10 minutes and a sufficient number of sessions OF 4-5 during a week for acute injuries.

Indications• Rebox current is used by physiotherapists,

rehabilitation providers, general practitioners, neurologists and sport-medicine providers.

• The devices are also used by patients themselves in homecare treatment.

• The most frequent applications include back pain, epicondylitis, sprained ankle, torticollis, knee ligament damage and others

CONTRAINDICATIONS

• The Rebox should not be used in these cases:

A. LOCAL CONTRAINDICATIONS- disruption in continuity of the skin (open wound, etc.)- skin ulcer - acute inflammation of the skin or subcutaneous tissue- thrombosis

• B. GENERAL CONTRAINDICATIONS- cardiostimulator- pregnancy- epilepsy- tumour (diagnosed or suspected)- shock

• Special care should be taken if the REBOX is used in the neck area of the carotid sinus, to avoid stimulation of the vagus nerve (n.X).

• The Rebox is not recommended for use in the vicinity of a high frequency power supply.

• The change of Rebox current in time has diagnostic value.

• The therapist receives information from the patient's tissues during treatment, giving him the great advantage of continuous monitoring and control of the dosage applied.

• Every type of tissue pathology shows its own specific course of changes in the electric current during treatment, the type of needle movement acts as a diagnostic aid as well as a treatment monitor.

Torticollis

• Treatment: Use two parallel rows of points on either side of the spine, with points spaced 2 cm apart. Treat distally from C1. Then treat in a spiral around the focus of the spasm (may be determined by palpation).

• Cautions: In the first and second session preferably use GENTLE mode, especially in sensitive patients. Keep strictly to the dorsal paravertebral muscles

• Recommended Timetable: First week 3x, then according to patient need. If possible immediately after the symptoms appear.

• Recommended Supplementary Therapy: We recommend gentle manual massage immediately after Rebox therapy, then gentle exercises.

Mandibular Muscular Spasm

• Treatment: Treat in a spiral line around the mandibulo-maxillar joint beginning approx. 3 cm from the joint (with distance approx. 15 mm between points) and ending in the center of the joint (with a distance 4 - 5 mm between points).

• Cautions: Maximum of 30 points treated in the above described spiral are enough. At the first session also treat the three branches of the trigeminus. Use GENTLE mode if necessary.

• Recommended Timetable: For the first three days treat twice a day, then once a day for four days, second week 4x - 5x, third week 2x, then check after two weeks.

Sprained Ankle

• Treatment: Treat distally in four parallel rows of points with distance of points spaced 15 - 20 mm apart. Then treat in a large spiral around the ankle with points spaced approx. 5 mm apart. Treat both the lateral and the medial side.

• Cautions: In first session use GENTLE mode because the treatment is rather painful.

• Recommended Timetable: First week 3x, second week 2x - 3x, third week 2x.

Lateral Epicondylitis (Tennis Elbow)

• Treatment: 3 - 4 rows of points distally, with points spaced 2 - 3 cm apart. Then in a spiral around the epicondyle with points 0.5 - 1 cm apart.

• Cautions: Check tension of elbow muscles. If in a state of tension treat in 5 - 10 points along the lines of tension.

• Recommended Timetable: Acute cases: First week 3x, second week 2x, third week 2x, fourth week 1x. Chronic cases: first week 2x, second week 2x, then four sessions once a week, then according to patient need (usually up to six months).

• Comments: In patients previously treated by mesocaine injections a long - term treatment is usually necessary.

Lumbago

• Treatment: Three rows of points (distance between points 2 - 3 cm) on either side of the spine from the chest to the sacrum. Then follow plexus lumbalis and gluteal muscles in four or five rows of points, with 4 - 5 cm between points. Apply treatment in spirals around the centers of pain as indicated by patient.

• Recommended Timetable: First week 3x - 4x, second week 3x, third week 3x, fourth week 2x.

• Recommended Supplementary Therapy: exercises.

Lateral Ligament Damage (Knee)

• Treatment: 3 - 4 rows of points from proximal to distal, with points spaced 2 - 3 cm apart. Then in a spiral around the problem area with distance of points 0.5 - 1 cm.

• Cautions: Do not apply Rebox in states with acute hyperemia (e.g. immediately after surgery).

• Recommended Timetable: First week 2x - 3x, second week 2x, third week 2x, fourth week 2x.