Compex Vitality User Manual [en, de, es, fr, it]
User and applications manual
Art no. 885516 v8
DJO France S.A.S.
Centre Européen de Frêt
3 rue de Bethar
64990 Mouguerre, France
© 12/2011 DJO, LLC
Compex® is a registered trademark of DJO, LLC
Manuale d’uso e di applicazioni
Manuel d’utilisation et d’applications
Gebrauchs- und Anwendungshandbuch
Gebruiksaanwijzing en specifieke toepassingen
Manual de utilización y aplicaciones
English
Directions for use 11
Programs and specific applications 20
Table with placements of electrodes and
stimulation positions 49
Italiano
Istruzioni per l’uso 61
Programmi e applicazioni specifiche 70
Tabella di posizionamento degli elettrodi
e posizioni del corpo 99
Français
Mode d’emploi 111
Programmes et applications spécifiques 120
Tableau de placements des électrodes
et positions du corps 149
Deutsch
Gebrauchsanweisung 161
Programme und spezifische Anwendungen 170
Tabelle zur Elektrodenplatzierung und
Körperposition für die Stimulation 199
Nederlands
Gebruiksaanwijzing 211
Programma’s en specifieke toepassingen 220
Tabel voor de plaatsing van de elektroden
en de stimulatieposities 249
Español
Modo de empleo 261
Programas y aplicaciones específicas 270
Tabla de colocación de los electrodos y
de posición del cuerpo para la estimulación 299
3
English
TABLE OF CONTENT
I. WARNINGS 5
1. Counter-indications 5
2. Safety measures 5
II. PRESENTATION 7
1. Reception of equipment and accessories 7
2. Presentation of the device 8
3. Guarantee 8
4. Maintenance 9
5. Storage and transportation conditions 9
6. Use conditions 9
7. Elimination 9
8. Standards 9
9. Patent 10
10. Normalised symbols 10
11. Technical information 10
III. DIRECTIONS FOR USE 11
1. Connections 11
2. Preliminary settings: language, light intensity and sound volume 11
3. Selecting a program category 12
4. Selecting a program 12
5. Personalising a program 13
6. During the stimulation session 14
7. Electricity consumption and recharging 15
8. Problems and solutions 16
IV. HOW DOES ELECTROSTIMULATION WORK? 17
V. USE PRINCIPLES 18
1. Placement of electrodes 18
2. Stimulation position 19
3. Setting the stimulation energy level 19
4. Progression in the levels 19
VI. PROGRAMS AND SPECIFIC APPLICATIONS 20
Pain relief category 21
Massage category 28
Vascular category 31
Rehabilitation category 35
Aesthetic category 39
Fitness category 44
VII. TABLE WITH PLACEMENTS OF ELECTRODES
AND STIMULATION POSITIONS 49
4
I. WARNINGS
1. Counter-indications
Important counter-indications
■ Cardiac stimulator (pacemaker)
■ Epilepsy
■ Pregnancy (no positioning in the
abdominal area)
■ Serious arterial circulatory problems
in the lower limbs
■ Abdominal or inguinal hernia
Precautions when using
the Compex
■ After trauma or a recent operation
(less than 6 months)
■ Muscular atrophy
■ Persistent pains
■ Need for muscular rehabilitation
Osteosynthesis equipment
The presence of osteosynthesis
equipment (metallic equipment in
contact with the bone: pins, screws,
plates, prostheses, etc.) is not a contraindication for the use of Compex programs.
The electrical current of the Compex is
specially designed to have no harmful
effect with regard to osteosynthesis
equipment.
In all of the above cases, you are
advised to:
■ never use the Compex for prolonged
periods without medical advice;
■ consult your doctor if you are in
any doubt whatsoever;
■ read this manual carefully, in
particular chapter VI, which provides
information concerning the effects
and indications of each stimulation
program.
2. Safety measures
What you should not do with
the Compex
■ Do not use the Compex in water
or in a humid atmosphere (sauna,
hydrotherapy, etc.).
■ Never carry out an initial stimulation
session on a person who is standing.
The first five minutes of stimulation
must always be performed on a
person who is sitting or lying down.
In rare instances, very highly strung
people may have a vagal reaction.
This is of psychological origin and is
connected with a fear of the muscle
stimulation as well as surprise at
seeing one of their muscles contract
without having intentionally contracted
it themselves. This vagal reaction
produces a feeling of weakness with
a fainting tendency, slowing down
of the heartrate and a reduction in
arterial blood pressure. If this does
occur, all that is required is to stop
the stimulation and lie down with the
legs raised for the time it takes for
the feeling of weakness to disappear
(5 to 10 minutes).
■ Never allow movement resulting
from muscular contraction during a
stimulation session. You should
always stimulate isometrically; this
means that the extremities of the limb
in which a muscle is being stimulated
must be firmly fixed, so as to prevent
the movement that results from
contraction.
■ Do not use the device at less than
1.5 metres from a short-wave device,
a micro-wave device or high
frequency (H.F.) surgical equipment
to avoid the risk of causing skin
irritations or burns under the electrodes.
If you are in any doubt about using
the Compex in close proximity to any
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5
English
other medical device, please consult
its manufacturer or your doctor.
■ Only use the electrode cables
supplied by Compex.
■ Do not disconnect the stimulator
electrode cables during the session
without first switching off the
stimulator.
■ Never connect stimulation cables to
an external electric power supply
because of risk of electric shock.
■ No not use rechargeable batteries
other than the one supplied by
Compex.
■ Never recharge the stimulator when
cables and electrodes are still
connected onto the user.
■ Never recharge the batteries with
another charger than the one
supplied with the Compex.
■ Never use the Compex or the
charger if it is damaged (case, cables,
etc.) or if the compartment for the
rechargeable battery is open. There is
a risk of electric discharge.
■ Disconnect immediately the charger
if the Compex “bleeps” continuously,
in case of abnormal heating or smell,
or if smoke comes from the charger
or the Compex. Do not recharge the
batteries in a confined area (case,
etc.) because of risk of fire or electric
discharge.
■ Keep the Compex and its accesso-
ries out of the reach of children.
■ Do not allow any foreign items
(soil, water, metal, etc.) to enter into
the Compex, the compartment for the
rechargeable battery and the charger.
■ Sudden temperature variations can
create droplets in the device due to
condensation. Use the device only
once it reached ambient temperature.
■ Do not use the Compex while
driving or operating machinery.
■ Do not use the stimulator in the
mountains at an altitude higher than
3.000 metres.
6
Where you should never apply
electrodes…
■ To the head.
■ Counter-laterally: Do not use the
two poles of the same channel
(one electrode connected to the
positive/red pole and one electrode
connected to the negative/black
pole) on either side of the body centreline (eg: right arm and left arm).
■ To or in the vicinity of skin
lesions of any kind (wounds,
inflammations, burns, irritations,
eczema, etc.).
Precautions when using the
electrodes
■ Only use the electrodes supplied
by Compex. Other electrodes may
have electrical properties that are
unsuitable for the Compex stimulator.
■ Do not remove or move the
electrodes during a stimulation
session without first switching off
the instrument.
■ Do not plunge the electrodes into
water.
■ Do not apply a solvent of any
kind to the electrodes.
■ Before applying the electrodes, it
is recommended to wash and
degrease the skin, and then dry it.
■ Apply the whole surface of the
electrodes to the skin.
■ For very important reasons of
hygiene, each user must have his
own electrode set. Do not use the
same electrodes on different people.
■ Do not use a set of electrodes for
more than fifteen sessions, as the
quality of the contact between the
electrode and the skin, which is
important for the comfort and
effectiveness of stimulation,
progressively degrades.
■ In certain people with very
sensitive skin, redness may be
observed under the electrodes after a
stimulation session. Generally, this
redness is completely harmless and
disappears after 10 to 20 minutes.
However, avoid starting a stimulation
session on the same area until the
redness is no longer evident.
II. PRESENTATION
1. Reception of equipment and accessories
Your stimulator is supplied with:
– The stimulator
– A battery charger
– One set of electrode cables with colour indicators (blue, green, yellow, red)
– Bags containing the electrodes (small (5 x 5 cm) and large (5 x 10 cm) electrodes)
– A user and applications manual
– A poster with the pictures for the placements of electrodes and the stimulation positions
– A belt clip
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7
English
2. Presentation of the device
A – “On/Off” switch
B – “i” button. To increase the energy level
of several channels simultaneously
C – Sockets for the 4 electrode cables
A
B
C
3
3
2
D
2
1
1
3. Guarantee
D – Electrode cables
channel 1 = blue channel 2 = green
channel 3 = yellow channel 4 = red
E – “+”/“–” keys of the 4 stimulation channels
F – Compartment for the rechargeable battery
G – Belt clip socket
E
F
G
4
4
Refer to the flyer attached.
8
4. Maintenance
6. Use conditions
To clean your unit, use a soft duster
and an alcohol-based cleaning product,
which does not contain any solvents.
The user must not attempt any repairs
to the device or any of its accessories.
Never dismantle the Compex or the
charger containing high-voltage parts
because of risk of electric discharge.
Compex Médical SA declines all
responsibility for damages and
consequences resulting from any
attempt to open, modify or repair
the device or any of its components
by a person or a service centre not
officially approved by Compex
Médical SA.
Compex stimulators do not require
calibration or verification of performance parameters. The characteristics are systematically verified and
validated for each device manufactured. These characteristics are stable
and do not vary when used under
normal conditions.
If your device seems to not function
as expected, regardless of the
situation, contact an official Compex
service centre for assistance.
Medical and health professionals must
refer to local legislation for information related to maintenance. Normally, these laws require verification
of certain criteria at regular intervals.
5. Storage and
transportation conditions
The Compex contains rechargeable
batteries and so the storage and
transportation conditions must not
exceed the following figures:
Storage and transportation temperature:
from -20°C to 45°
Max. relative humidity: 75%
Atmospheric pressure: from 700 hPa to 1060 hPa
Temperature of use: from 0°C to 40°C
Max. relative humidity: from 30% to 75%
Atmospheric pressure: from 700 hPa to1060 hPa
Do not use in an explosion risk area.
7. Elimination
The Directive 2002/96/CEE (WEEE)
has a first priority, the prevention of
waste electrical and electronic equipment, and in addition, the re-use,
recycling and other forms of recovery
of such wastes so as to reduce the
disposal of waste.
The pictogram wheeled bin barred
means that the equipment can not be
thrown with the household refuse,
but that it makes the object of a
selective collection.
The equipment has to be given to a
suitable collection point for the
treatment.
By this way, you contribute to the
safeguarding of the natural resources
and the human health protection.
Batteries must be disposed of in
accordance with your country’s
national laws governing the disposal
of such items.
8. Standards
The Compex is based directly on
medical technology.
To guarantee your safety, the design,
manufacturing and distribution of
Compex are in conformity with the
requirements of the European
Directive 93/42/CEE.
The device is in conformity with the
standard for general safety rules for
electromedical devices IEC 60601-1,
the standard for electromagnetic
compatibility IEC 60601-1-2 and the
standard for special safety rules for
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9
English
nerve and muscle stimulators IEC
60601-2-10.
Current international standards (IEC
60601-2-10 AM1 2001) require that a
warning be given concerning the
application of electrodes to the thorax
(increased risk of cardiac fibrillation).
Directive 2002/96/CEE Waste electrical
and electronic equipment (WEEE).
9. Patent
Snap electrode: patent pending.
10. Normalised symbols
Important: Under some
conditions, the effective figure
for the stimulation pulses can exceed
10 mA and 10 V. The information
given in this handbook must be
strictly observed.
The Compex is a class II device
unit with its own internal electric
power, with type BF applied sections.
Waste electrical and electronic
equipment (WEEE).
The “On/Off” switch is a
multi-function key:
Functions Symbol N°(according to CEI 878)
On/Off (2 positions, stable) 01-03
Waiting or preparation for part of the unit 01-06
Stop (switching off) 01-10
11. Technical information
General points
Power supply: NIMH rechargeable
battery (NIMH) (4,8 V ª 1200 mA/h).
Chargers: The only chargers used
for recharging the battery bear the
following information:
Type TR503-02-E-133A03
Input 90-264 VAC / 47-63Hz / 0.5A max.
EUROPE
Output 9V / 400mA / 6W
Type TR1509-06-E-133A03
Input 90-264 VAC / 47-63Hz / 0.5A max.
Output 9V / 1.4A / 15W
USA
Type TR503-02-E-133A03
Input 90-264 VAC / 47-63Hz / 0.5A max.
Output 9V / 400mA / 6W
Type TR1509-06-E-133A03
Input 90-264 VAC / 47-63Hz / 0.5A max.
Output 9V / 1.4A / 15W
UK
Type TR503-02-E-133A03
Input 90-264 VAC / 47-63Hz / 0.5A max.
Output 9V / 400mA / 6W
Type TR1509-06-E-133A03
Input 90-264 VAC / 47-63Hz / 0.5A max.
Output 9V / 1.4A / 15W
Neurostimulation
All electrical specifications are given
for a charge between 500 and 1000
ohms per channel.
Channels: four independent and individually
adjustable channels electrically insulated from
each other and from ground
Impulse shape: constant rectangular current
compensated to eliminate any direct current
component to avoid any residual skin
polarisation
Maximum current of an impulse: 80 milliamperes
Intensity increase interval:
– Manual stimulation intensity adjustment:
0-444 (energy units)
– Impulse duration: 0.5 mA
Impulse duration: from 50 to 400 microseconds
Maximum quantity of electricity per impulse:
80 microcoulombs (2 x 40 µC compensated)
Typical rise time for an impulse:
3 microseconds (between 20% and 80% of
maximum current)
Impulse frequency:
from 1 to 150 Hertz
10
III. DIRECTIONS FOR USE
Before using the unit for the first time, you are strongly advised to take careful note of
the counter-indications and safety measures detailed at the beginning of this manual
(chapter I: “Warnings”), as this powerful equipment is neither a toy nor a gadget!
blue = channel 1 yellow = channel 3
1. Connections
The electrical impulses generated by
the Compex are transmitted to the
nerves by self-adhesive electrodes. The
choice of the size, the connection and the
correct positioning of the electrodes are
essential factors for ensuring effective and
comfortable stimulation. So they require
particular care. To do all this – and for
information on the recommended
stimulation positions – refer to the pictures
and pictograms in the poster, and to the
“Table with placements of electrodes and
stimulation positions” in chapter VII. The
specific applications contained in chapter
VI also provide useful relevant information.
1a 1a1b1a
1a
green = channel 2 red = channel 4
It is important to place the electrodes
correctly to the cable connectors; in order
to do so, press strongly the connector to
the electrode until you hear a double click.
Connecting the charger
The Compex has considerable opera-
ting autonomy, as it uses rechargeable
batteries. To recharge them, use the
charger supplied with your device and
connect it to the base of the device,
then plug the charger in a socket.
To recharge the Compex, first
disconnect the electrode cables from
the device.
Before using your stimulator for the
first time, it is always strongly
recommended that you completely
charge the battery to improve its
autonomy and extend its working life.
English
Fig.1 – Base of device
1a Sockets for the four electrode cables
1b Socket for the battery charger
Connecting the electrodes and
cables
The electrode cables are connected
to the stimulator through sockets on
the base of the device.
Four cables can be connected
simultaneously to the four channels
of the device.
For easier use and better identifica-
tion of the four channels, we advise
you to follow the colour of the
electrode cables and the stimulator
sockets:
2. Preliminary settings:
language, light intensity
and sound volume
Before using the unit for the first
time, you should select the working
language of the device which is
displayed on the options screen.
Proceed as per the instructions
described below.
Afterwards, for the greatest comfort,
Compex offers you a number of
setting options (operating language
selection, display contrast setting
and sound volume setting).
To do this, display the options
screen by pressing the “On/Off”
switch on the left of the Compex
and hold it down for a few seconds.
11
English
2d
Fig.2
2a To select the language of your choice, press
the “+”/“–” key of channel 1 (to go up or down),
until the desired language is displayed in white
characters on a black background.
2b To set the contrast of the display, press the
“+”/“–” key of channel 2 (“+” to increase the
preferred percentage and “–” to reduce it).
2c To set the sound volume, press the “+”/“–” of
channel 3 (“+” to increase the preferred percentage and “–” to reduce it).
2d To confirm the parameters selected, press
the “On/Off” switch. Your stimulator saves your
options. It is now ready for use with the settings
you selected.
3. Selecting a program
category
To switch on your stimulator, briefly
press the “On/Off” switch on the left
of the Compex. A musical signal can
be heard and a screen showing the
different program categories is
displayed.
Before choosing a program, you
should select the desired category.
2a 2b 2c
3b To confirm your choice and to move on to
the program selection screen (see the next
section: “Selecting a program”), press the
“+”/“–” key of channel 4.
3c Press the “On/Off” key to switch off the
stimulator.
4. Selecting a program
To choose a program, it is particularly
useful to consult chapter VI of this
manual (“Programs and specific applications”).
Regardless of the category you selected
in the previous step, a list containing
a select number of programs appears
on the screen.
4a To select the desired program, press
the “+”/“–” key of channel 1 (to go up or down),
until the desired program is displayed in
white characters on a black background.
4b Press the “On/Off” key to return to the
previous screen.
4c After selecting the desired program,
press the “+”/“–” key of channel 4 which,
depending on the program selected, displays
the symbol or .
a) = the stimulation session starts
immediately;
b) = a parameter setting screen displays.
START
START
3c
Fig.3
3a To select the desired category, press the
“+”/“–” key of channel 1 (to go to the left) or
channel 3 (to go to the right), until the desired
category is displayed in a frame.
3a
12
3b
4b
Fig.4
4a
4c
5. Personalising a program
The program personalisation screen
is not available for all programs.
5d
5e
Fig.5
5a Certain programs require manual selection
of the muscular group that you want to stimulate and a figurine is displayed above
channel 1.
To select your desired group, press the “+”/“–”
key of channel 1 (to go up or down). The seven
muscular groups are displayed in succession in
black on the figurine:
Abdomen and Lower back
5a 5b 5c 5f
vb
c
Thighs
5b The warming-up sequence suggested for
some programs is active by default (an animated rising convection symbol above the
heater). If you prefer to skip this sequence,
press the “+”/“–” key of channel 2.
Warming-up
No warming-up
Current international standards
require that a warning be given
concerning the application of
electrodes to the thorax (increased risk
of cardiac fibrillation).
m
Forearms and Hands
td
Thorax and Back
English
f
Buttocks
5c Certain programs allow you to adjust the level of work. To do this, press the “+”/“–” key of
channel 3 (to go up or down), until the desired level of work is displayed.
Level 1 Level 2 Level 3 Level 4 Level 5
5d Total program time in minutes.
5e By pressing the “On/Off” key, you can
return to the previous screen.
j
Legs and Feet
e
Shoulders and Arms
5f To confirm your selection and start the
program, press the “+”/“–” key of channel 4.
13
English
6. During the stimulation session
Setting stimulation energy
When the program starts, the Compex
prompts you to increase the stimulation energy, a key factor for the effectiveness of the stimulation.
6d
6b
6c
6e
Fig.6
6a The Compex “bleeps” and the symbols of the
four channels flash, changing from “+” to “000”:
the four channels are at 0 energy. You must
increase the stimulation energy so that the
stimulation can start. To do this, press the “+”
of the keys of the relevant channels, until the
desired setting is reached.
If you want to increase the energy level of all
four channels simultaneously, press the “i”
button, located below the “On/Off” key. You can
also increase the energy level of three first
channels, by pressing the “i” button twice, or
the energy level of two first channels only, by
pressing three times this button.
Once you activate the “i” button, the associated
channels are highlighted in white on a black
background.
6b Remaining time in minutes and seconds.
6c The animated rising convection symbol
represented the warming-up sequence.
6d Session progression scale. For details on how
it works, see the following section (“Program
progression”).
6e By pressing the “On/Off” key, you can return
to the previous screen.
6a
Program progression
Stimulation does really start when the
stimulation energy has been increased.
The screens that are displayed during
stimulation allow you to observe the
progression of the session. These
screens may differ from one program
to another. The examples reproduced
14
below are sufficient for you to
understand the general rules.
7a
Fig.7
8a
8b
Fig.8
7a-8a Remaining time (in minutes and
seconds) before the end of the program.
7b-8b A small animated symbol indicating
category to which the program belongs.
7c-8c Session progression scale:
The progression scale is composed of three
distinct parts: the program consists of three
stimulation sequences, i.e., warming up (light
hatching /left), the actual work (black
area/centre) and relaxation at the end of the
program (heavier hatching/right).
The progression scale can be also entirely
hatched: the program then consists of a single
stimulation sequence.
The small cursor located just below the scale
moves horizontally and indicates precisely the
state of progression of the program (here:
start of the first sequence, i.e., the work
sequence).
7d-8d Contraction and active rest time bar:
This bar is displayed at the right of the progression scale, but only during the work
sequence. It indicates the duration of the
contraction and active rest times.
7d The cursor is located under the black (left)
part of the bar: you are in a muscular contraction phase.
7c
7e
7b
7f
8c
8e
8f
7d
8d
8d The cursor is located under the hatched
(right) part of the bar: you are in an active rest
phase.
The stimulation energy during the
active rest phase is automatically
set at 50% of the stimulation energy during
the muscular contraction.
7e-8e Bar charts:
7e The muscular contraction phase is repre-
sented by the bar charts of the stimulation
channels used (which become black during the
contraction phase).
8e The active rest phase is represented by
the bar charts of the stimulation channels
used (which become hatched during the active
rest phase).
7f-8f You can interrupt the program momen-
STOP
tarily ( = “PAUSE”) ”) by pressing the
“On/Off” key. If you wish to restart the session,
simply press the “+”/“–” key of channel 4.
After an interruption, stimulation
restarts at 80% of the stimulation
energy set before the .
STOP
Adjusting stimulation energy
9a
End of program
10a
10b
Fig.10
10a At the end of the session, you hear a
musical signal and a small flag is displayed.
10b It is then only necessary to switch off
the stimulator by pressing the “On/Off” key ( ).
OFF
7. Electricity consumption
and recharging
Never recharge the stimulator with
cables still connected to it.
Never recharge the batteries with
a charger different from the one supplied
by Compex.
The Compex runs on rechargeable
batteries. The discharge time depends
on the programs and stimulation
energy used.
Before using your stimulator for
the first time, it is always strongly
recommended that you completely
charge the battery to improve its autonomy and extend its working life.
If you do not use your device for a
long period of time, please regularly
recharge the battery.
English
Fig.9
9a During the session, the Compex “bleeps”
and some symbols start to flash above
the active channels (over the energy indications):
the Compex is prompting you to increase the
stimulation energy level. If you cannot support
an increase of the energy, just ignore this
message.
+
Electricity consumption
The symbol of a small battery indicates
the charge level of the batteries.
11a
11b
Fig.11
15
English
11a The small battery symbol has only two
reference marks: The batteries are losing their
charge. Interrupt the session and recharge the
device (see the following section).
11b The , symbol normally displayed
above the “+”/“–” key of channel 4 has disappeared ( ) and the small battery flashes: The
batteries are completely flat. It is no longer
possible to use the device. Recharge it
immediately (see the following section).
START
13a
Fig.13
Recharging
To recharge the Compex, first
disconnect the electrode cables from
the device, then plug the charger in a
socket and lastly connect the stimulator to the charger (see in section I:
“Connecting the charger”). The
charge menu illustrated below appears
automatically.
12a
Fig.12
12a The Compex has been charging for 3 mi-
nutes and 8 seconds (a full charge may take
from 1h30 to 2 hours with the rapid charger
delivered with your device).
12b Charging is in progress and the small
battery symbol is not completely full.
When charging is completed, total charge
duration flashes and the small battery is
completely full. The Compex switches off
automatically as soon as you disconnect the
charger.
.
12b
8. Problems and solutions
Electrode fault
13a-14a The Compex “bleeps” and alterna-
tively displays the symbol of a couple of electrodes and an arrow pointing to the channel
where a problem has been detected. Below,
the stimulator has detected an electrode
16
fault on channel 2.
14a
Fig.14
This message may mean that:
1) there is no electrode connected to this
channel;
2) the electrodes are old, worn out and/or the
contact is poor: try using new electrodes;
3) the electrode cable is defective: try it using
another channel. If cable shows a default again,
please replace.
Recharging error
A recharging error may happen
during charging. The Compex
“bleeps” continuously and the
following screen is displayed:
Fig.15
If this message appears, disconnect
the charger and the device switches
off automatically. Please contact the
hotline, noting this error code.
If, for any reason, you experience
any other trouble with your device,
please contact the hotline mentioned
and approved by Compex Médical SA.
IV. HOW DOES ELECTROSTIMULATION
WORK?
The principle of electrostimulation is
to stimulate nerve fibres by means of
electrical impulses transmitted by
electrodes.
The electrical impulses generated by
Compex stimulators are high-quality
impulses – ensuring safety, comfort
and efficiency – that stimulate
different types of nerve fibres:
1. the motor nerves to stimulate a muscular
response. The quantity of work and the benefits
obtained depend on the stimulation parameters.
This is known as electromuscularstimulation (EMS).
2. certain types of sensitive nerve fibres to
obtain analgesic or pain-relieving effects.
1. Motor nerve
stimulation (EMS)
In voluntary activity, the order for
muscular work comes from the brain,
which sends a command to the nerve
fibres in the form of an electrical
signal. This signal is then transmitted
to the muscular fibres, which contract.
The principle of electrostimulation
accurately reproduces the process
observed during a voluntary contraction. The stimulator sends an electrical
current impulse to the nerve fibres,
exciting them. This excitation is then
transmitted to the muscular fibres
causing a basic mechanical response
(= muscular twitch). The latter
constitutes the basic requirement
for muscular contraction.
This muscular response is completely
identical to muscular work controlled
by the brain. In other words, the
muscle cannot distinguish whether
the command comes from the brain
or from the stimulator.
The parameters of the Compex
programs (number of impulses per
second, contraction time, rest time,
total program time) subject the
Electrical
impulse
Excitation
Motor
nerve
Stimulated
muscle
Basic mechanical response = muscular twitch
Excitation
transmission
muscles to different types of work,
according to muscular fibres. In fact,
different types of muscular fibres may
be distinguished according to their
respective contraction speed: slow,
intermediate and fast fibres. The fast
fibres will obviously predominate in a
sprinter, while a marathon runner will
have more slow fibres.
With a good knowledge of human
physiology and a perfect mastery of
the stimulation parameters of the
various programs, the muscular work
can be directed very precisely towards
the desired goal (muscular reinforcement, increased blood flow, firming
up, etc.).
2. Stimulation of the
sensitive nerves
The electrical impulses can also excite
the sensitive nerve fibres to obtain an
analgesic or pain-relieving effect.
The stimulation of the tactile sensitive
nerve fibres blocks the transmission
of pain by the nervous system.
The stimulation of another type of
sensitive fibres creates an increase in
the production of endorphins and,
therefore, a reduction of pain.
With pain relief programs, electrosti-
mulation can be used to treat localized
sharp or chronic pains as well as
muscular pains.
English
17
English
Do not use the pain relief programs for
a long period without medical advice.
Benefits of electrostimulation
Electrostimulation is a very effective way to make
your muscles work:
■ with significant improvement of different
muscular qualities,
■ without cardio-vascular or mental fatigue,
■ with limited stress on the joints and tendons.
Electrostimulation thus allows a greater quantity
of work by the muscles compared with voluntary
activity.
To be effective, this work must involve the greatest
possible number of muscular fibres. The number
of fibres working depends on the stimulation
energy. It will therefore be necessary to use the
maximum tolerable energy. The user controls this
aspect of stimulation. The higher the stimulation energy, the greater the number of muscular fibres that are working and, therefore, the
more significant the progress achieved.
To maximize your results, Compex recommends
that you complement your electrostimulation
sessions with other efforts, like:
■ regular exercise,
■ proper and healthy nutrition,
■ balanced lifestyle.
V. USE PRINCIPLES
The use principles presented in this section should be considered general
rules. For all programs, it is recommended that you read carefully the
information and advice on use presented in chapter VI of this manual
(“Programs and specific applications”).
1.Placement of electrodes
It is recommended that you comply
with the suggested placements. To do
this, refer to the pictures and pictograms
shown on the poster and to the “Table with
placements of electrodes and stimulation
positions” in chapter VII.
A stimulation cable consists of two
poles:
a positive pole (+) = red connection
a negative pole (–) = black connection
A different electrode must be connec-
ted to each of the two poles.
18
Note: It is possible and normal to
have an electrode arrangement that
leads one electrode connection free
from a cable.
Depending on the characteristics of
the current used for each program,
the electrode connected to the
positive pole (red connection) is
more effective when placed in a
“strategic” position.
For all muscle electrostimulation
programs, i.e., programs involving
muscle contractions, it is important to
place the positive polarity electrode
on the muscle motor point.
The choice of electrodes size (large or
small) and the correct positioning of
the electrodes on the muscular group
to be stimulated are determinant and
essential factors for the effectiveness
of the stimulation. Therefore, always
use the size of electrodes shown in
the pictures. Unless you have other
specific medical instructions, always
follow the placement directions in the
pictures. If necessary, find the best
position by slightly moving the
positive polarity electrode, so as to
obtain the best muscle contraction
or the position that seems most
comfortable.
Compex Group disclaims all
responsibility for electrodes positioned
in any other manner.
2.Stimulation positions
To determine the stimulation position
to adopt depending on the placement
of the electrodes and the chosen program,
refer to the pictures and pictograms on the
poster and to the “Table with placements of
electrodes and stimulation positions” in
chapter VII.
The stimulation position depends on
the muscular group to be stimulated
and the program chosen.
For the programs involving powerful
muscular contractions, the muscle
should always be stimulated in an
isometric fashion. Consequently, you
should fix the extremity of the stimulated limb(s) firmly. In this way, you
provide maximum resistance to the
movement and prevent any shortening
of the muscle during the contraction,
which could create cramp pains and
serious stiffness after the session. For
example, when stimulating the
quadriceps, the user should be in a
seated position with the ankles fixed
with straps to prevent extension of the
knees.
For the other types of programs (for
example, the
Active recovery
Pain
programs and the
program), which do
not involve powerful muscular
contractions, position yourself as
comfortably as possible.
3.Setting the stimulation
energy level
In a stimulated muscle, the number
of recruited fibres depends on the
stimulation energy. For the programs
involving powerful muscular contractions, it is therefore absolutely necessary to use maximum stimulation
energy, always at the limit of what you
can support, so as to involve the
greatest possible number of fibres.
The “Table with placements of
electrodes and stimulation positions”
in chapter VII provides information
on the energy to use, depending on
the selected program.
4.Progression in the levels
In general, it is not advisable to go
through the different levels quickly
with the intention of reaching level 5
as fast as possible. In fact, the
different levels correspond to progress
with electrostimulation.
The simplest and most usual procedure
is to start with level 1 and raise the
level when changing to a new stimulation cycle.
At the end of a cycle, you may either
start a new cycle at the next level up
or do some maintenance at the rate
of 1 session a week at the last level
reached.
English
19
English
VI. PROGRAMS
AND SPECIFIC APPLICATIONS
The applications that follow are given by way of example. They provide a
better understanding of how electrostimulation sessions can be combined with
voluntary activity. These protocols will help you to determine the best procedure to follow depending on your needs (choice of the program, muscular
group, duration, placement of the electrodes, body position).
You can of course choose a muscular
group different from the one indicated,
depending on the activities you practice or the body area you wish to
stimulate.
The specific applications provide you
information on the placement of electrodes and the stimulation position to
adopt. This information is represented
by numbers (placement of electrodes)
and letters (stimulation position).
They refer to the “Table with placements of electrodes and stimulation
positions” in chapter VII and to the
poster with the pictures for the
placements of electrodes and the
pictograms for the body positions.
The table also indicates the stimulation
energy to use, according to the
program.
You must select in the device the
muscular group indicated on the
figurine. When no figurine appears
(–), it is not necessary to choose the
muscular group: the selection is
automatic.
20
Pain relief category
Physical pain is an abnormal and unpleasant sen-
sation caused by an injury, a disorder or incorrect
functioning of a part of our organism. It is always
a signal sent to us by our bodies, one that should
not be ignored, and that in all cases requires us to
consult a doctor if it does not disappear quickly.
he approach to pain adopted by the medical
T
profession has changed considerably in recent years.
Treatment of the cause is always fundamental,
however the pain as such must be otherwise
removed or at least considerably reduced and
made bearable for the patient. The means to
combat pain have developed greatly, and there is
no longer any hesitation today in using powerful
analgesics to improve the quality of life of patients.
It is within this context that recourse to electrothe-
rapy has developed. Excitation of the nerve fibres
of sensation by means of electrical micro-impulses
is often the preferred method of combatting pain.
Today, such analgesic electrotherapy is widely
used, particularly in rehabilitation medicine and in
specialist pain treatment centres.
The precision of electrical currents allows the anal-
gesic action to be accurately targeted according to
the type of pain. It is up to the user to choose the
most appropriate program for the type of pain
and to follow practical recommendations in order
to obtain maximum effect.
English
If the pain is great and/or persistent, you are advised to consult a doctor. Only a
doctor can make an accurate diagnosis and put in place therapeutic actions
designed to encourage disappearance of the disorder.
21
English
Table of the pathologies
Pain relief
Pathologies
Neuralgia of the upper
limb (brachial neuralgia)
Chronic muscular pain
(polymyalgia)
Contracture (eg: localized
contracture in external side of the calf)
Chronic muscular pain in
the back of the neck
(cervical pain)
Muscular pain in the thoracic
region (thoracic back pain)
Muscular pain in the low
region (low back pain)
Muscular pain in the low back
region associated with pain in
the buttocks and at the back of
the thights (lumbosciatica)
Programs
Modulated
TENS
Endorphinic
Decontracture
Cervical pain
Thoracic back
pain
Low back pain
Lumbosciatica
References
See application
page 24
See application
page 24
See application
page 24
See application
page 24
See application
page 25
See application
page 25
See application
page 25
22
Sharp and recent muscular
pains affecting a muscle
in the low back (lumbago)
Chronic elbow pain
(epicondylitis = tennis elbow)
Recent and acute back of the
neck muscle pains
(torticollis)
Chronic pain in the joints
(eg: arthrosis of the knee = gonarthrosis)
Lumbago
Epicondylitis
Torticollis
Arthralgia
See application
page 26
See application
page 26
See application
page 26
See application
page 27
Pain relief
Table of the Pain relief programs
Programs Effects
English
Uses
Modulated
TENS
Endorphinic
Decontracture
Cervical
pain
Thoracic
back pain
Low
back pain
Lumbosciatica
Lumbago
Blocks transmission of pain
by the nervous system
Analgesic action through
the release of endorphinis
Increased blood flow
Reduced muscular tension
Relaxing effect
Analgesic action through
the release of endorphinis
Increased blood flow
Analgesic action through
the release of endorphinis
Increased blood flow
Analgesic action through
the release of endorphinis
Increased blood flow
Analgesic action through
the release of endorphinis
Increased blood flow
Reduced muscular tension
Relaxing effect
All acute or chronic
localized pain
To combat chronic
muscular pain
To combat recent and
localized muscular pain
Analgesic current specifically
adapted to pains in the back
of the neck
Analgesic current specifically
adapted to low back pain
(lumbar region)
Analgesic current specifically
adapted to low back pain
(lumbar region)
Analgesic current specifically
adapted to low back pain
(lumbar region) combined with
pain in the buttocks running
down the rear of the thigh and
sometimes into the leg and foot
Analgesic current specifically
adapted to sharp and sudden
low back pain (lumar region)
Epicondylitis
Torticollis
Arthralgia
The use of pain relief programs should not be prolonged without medical advice
Blocks transmission of pain
by the nervous system
Reduced muscular tension
Relaxing effect
Blocks transmission of pain
by the nervous system
Analgesic current specifically
adapted to persistent pain
int he elbow
Analgesic current specifically
adapted to acute and sharp
pains int he back of the neck
Analgesic current specifically
adapted to persistent pain in a
joint, as in osteoarthritis and rheumatsim (all joints in the limbs
except the elbow: see the Epi-
condylitis program above)
23
English
Specific applications
Pain relief
Neuralgia of the upper limb
(brachial neuralgia)
Some people suffer from arthritis in the
joints of the vertebrae at the back of the
neck, or from arthritis or periarthritis of
the shoulder. These situations often give
rise to pain that runs down one arm and
is known as “brachial neuralgia”. These
arm pains that start in the shoulder or the
back of the neck can be reduced with the
Compex Modulated TENS program by
following the practical recommendations
outlined below.
Cycle duration: 1 week, 1 x/day minimum, then
adapt according to how the pain develops
According to requirements, the Modulated
TENS program can be repeated a number of
times during the same day
Program: Modulated TENS
Chronic muscular pain (polymyalgia)
Some people suffer from muscular pain
that affects several muscles or parts of
different muscles at the same time. The
localization of this chronic pain can vary
over time. These continual and diffuse
muscle pains are the result of chronic
contractures in which acids and toxins
accumulate, irritating the nerves and
causing pain. The
particularly effective against such pain
since, in addition to its pain-reducing
effect, it increases the blood flow to the
contractured muscular groups and removes
from them accumulations of acids and
toxins.
Example: localized pain in the biceps.
However, the pain may affect other
muscular groups. The practical application
illustrated below remains valid, but it is
then necessary to place the electrodes on
the muscular group concerned.
Cycle duration: 4 weeks, 2 x/day, with a 10
minute break between the 2 sessions
You are advised to consult your doctor if no
improvement is observed after the first
week of use
Program: Endorphinic
Endorphinic program is
20
◊
24
35
Contracture (eg: localized contracture in
external side of the calf)
After tiring muscle work, intense training
or a sporting competition, certain muscles
or certain parts of muscles often remain
tense and slightly painful. These are
known as muscular contractures which
should disappear after a few days with
rest, good rehydration, a balanced food
intake with mineral salts and application
of the Decontracture program. The
phenomenon of contracture frequently
affects the calf muscles, but can also occur
with other muscles. In this case, simply
follow the same practical recommendations
as below, but place the electrodes on the
muscular group concerned.
Cycle duration: 1 week, 1 x/day
◊
You are advised to consult your doctor if no
improvement is observed after the first
week of use
Program: Decontracture
24
◊
Chronic muscular pain in the back of the
neck (cervical pain)
Positions in which the muscles of the
back of the neck remain tense for long
periods of time, for example working
in front of a computer screen, may be
responsible for the onset of pain in the
back of the neck or on either side of the
base of the neck, in the upper back.
These pains are due to a contracture of
the muscles, of which the prolonged
tension crushes the blood vessels and
prevents the blood from supplying and
oxygenating the muscle fibres. If this
phenomenon is prolonged, there is an
accumulation of acid and the blood
vessels atrophy. The pain then becomes
continuous or appears after only a few
minutes spent working in an unfavourable
position.
These chronic pains in the back of the
neck can be treated effectively with the
Cervical pain program, which reactivates
the circulation, drains accumulations of
acid, oxygenates the muscles, develops
the capillaries and relaxes the contractured muscles.
Pain relief
Cycle duration: 4 weeks, 2 x/day, with a 10
minute break between the 2 sessions
You are advised to consult your doctor if no
improvement is observed after the first
week of use
Program: Cervical pain
15
◊
Muscular pain in the thoracic region
(thoracic back pain)
Vertebral arthritis and positions in which
the muscles of the spinal column remain
under tension for long periods of time
are often responsible for the onset of pain
in the middle of the back, which is accentuated with fatigue. Pressure of the fingers
on the muscles on either side of the spinal
column can often trigger a sharp pain.
These pains are due to a contracture of
the muscles, of which the prolonged
tension crushes the blood vessels and
prevents the blood from supplying and
oxygenating the muscle fibres. If the
phenomenon is prolonged, there is an
accumulation of acid and the blood vessels
atrophy. The pain then becomes continuous
or can appear after only a few minutes
spent working in an unfavourable position.
These chronic back pains can be effectively
treated with the Thoracic back pain
program which reactivates the circulation,
drains accumulations of acid, oxygenates
the muscles, develops the capillaries and
relaxes the contractured muscles.
Cycle duration: 4 weeks, 2 x/week with a 10
minute break between the 2 sessions
You are advised to consult your doctor if no
improvement is observed after the first
week of use
Program: Thoracic back pain
13
◊
Muscular pain in the low back region
(low back pain)
Low-back pain is the most frequently
encountered pain. In a standing position,
the entire weight of the trunk is concentrated on the joints between the last
vertebrae and the sacrum. The low back
region is therefore under particular strain.
The discs between the vertebrae are crushed
and the low back muscles contractured
and painful.
There are very many treatments for the
relief of low back pain sufferers; among
these, the specific currents of the Compex
Low back pain program provide an
appreciable improvement and can even
resolve the problem if it is essentially
muscular in origin.
Cycle duration: 4 weeks, 2 x/day, with a 10
minute break between the 2 sessions
You are advised to consult your doctor if no
improvement is observed after the first
week of use
Program: Low back pain
12
◊
Muscular pain in the low back region
associated with pain in the buttocks and
at the back of the thighs (lumbosciatica)
Low back pain is the most frequent pain.
When standing, the entire weight of the
trunk is concentrated on the joints between
the last vertebrae and the sacrum. The
low back region is therefore placed under
particular strain. The discs between the
vertebrae are crushed and the low back
muscles are contracted and painful.
The discs between the last two vertebrae
or between the last vertebra and the sacrum
frequently become damaged as a result of
the pressure of the vertebrae. This damage
can give rise to an irritation, or compression, of the nerve roots which exit the
spinal column and continue down the
buttocks and legs. The pain not only affects
the low back, but also runs down the side
of one buttock, the back of the thigh and
sometimes into the leg. In this case the
condition is known as lumbosciatica, for
which it is always necessary to consult a
doctor, so that the degree of compression
of the nerve roots can be assessed and a
suitable treatment prescribed.
The specific currents of the Compex
Lumbosciatica program provide an
effective treatment against pain, but must
always be used as a supplement to other
treatments prescribed by your doctor.
Cycle duration: 4 weeks, 3 x/week
You are advised to consult your doctor if no
improvement is observed after the first
week of use
Program: Lumbosciatica
32
◊
English
25
English
Pain relief
Sharp and recent muscular pains
affecting a muscle in the low back
(lumbago)
During back movement, for example
when lifting something, when turning or
when standing up straight after bending
down, a sudden pain can be triggered in
the low back. Those who suffer from this
problem present a contracture of the low
back muscles and feel a sharp pain in
this region; because they cannot stand
completely straight, they remain bent over
on one side. All of these symptoms indicate
what is known as lumbago, which is principally the result of a sharp and intense
contracture of the low back muscles
(lumbar region).
In a situation such as this, it is always
necessary to consult a doctor to receive
appropriate treatment.
In addition to such treatment, the specific
Compex
effectively to relax the muscles and
remove the pain.
Cycle duration: 4 weeks, 3 x/week
Program: Lumbago
Lumbago program can help
You are advised to consult your doctor if no
improvement is observed after the first
week of use
33
◊
Chronic elbow pain
(epicondylitis = tennis elbow)
All tendons of the muscles that allow us
to stretch our hand, wrist and fingers end
at the small external bone mass of the
elbow (epicondyle). Hand and finger
movements therefore transmit tensions
that are concentrated in the tendon endings
at this bone mass.
When hand movements are repetitive, as
is the case for painters, tennis players or
even those who constantly use the mouse
of a computer system, small injuries,
accompanied by inflammation and pain,
develop in the region of the epicondyle.
This is known as "epicondylitis", which is
characterised by pain around the external
bone mass of the elbow when pressure is
applied or when the forearm muscles are
contracted.
The Compex Epicondylitis program
supplies specific current to combat this
type of pain. It acts effectively as a
supplement to rest.
However, it is neccary to consult your
doctor if the pain gets worse or does not
disappear quickly after a few sessions.
Cycle duration: 1 week, 2 x/week minimum, then
adapt according to how the pain develops
According to requirements, the Epicondylitis
program can be repeated several times
during the same day
Program: Epicondylitis
36
◊
26
Pain relief
Torticollis (recent and acute back of the
neck muscle pains)
As a consequence of various circumstances,
such as, for example, a rather sudden
movement of the neck, an incorrect sleeping
position or exposure to a cold environment,
a sharp pain may be felt in the back of the
neck often accompanied by a considerable
reduction of the mobility of the cervical
region. A person affected by this problem
has contracted muscles in the back of the
neck and feels a sharp pain there. Together
these symptoms represent what is known
as “torticollis”, which is mainly the result
of a sharp and intense contracture of the
muscles in the back of the neck.
In this kind of situation, it is always neces-
sary to consult a doctor in order to receive
appropriate treatment.
In addition, Compex' specific Torticollis
program can effectively help to relax the
muscles and eliminate the pain.
Cycle duration: 1 week, 1 x/day
You are advised to consult your doctor if no
improvement is observed after the first
week of use
Program: Torticollis
15
◊
Chronic pain in the joints
(eg: gonarthrosis = arthrosis of the knee)
Various factors, such as an overweight
condition, age, shock, incorrect body
positions, compressions, etc., are bad for
the joints. Under the action of these
unfavourable factors, the joints deteriorate,
and become inflamed and painful. This is
known as arthritis, mostly affecting the
large joints, such as the hip, the knee or
the shoulder. The pain in these joints is
called “arthralgia”.
The Compex Arthralgia program supplies
specific currents to combat this type of
pain.
The Arthralgia program does not lead to
regeneration of the joint but can be used to
supplement treatment prescribed by the
doctor, who must always be consulted for
this type of pain.
Cycle duration: 1 week, 1 x/day minimum, then
adapt according to how the pain develops
According to requirements, the Arthralgia
program can be repeated several times
during the same day
Program: Arthralgia
26
◊
English
27
English
Massage category
he programs of the Compex ≥category subject
T
the muscles of the stimulated region to moderate
activity, which produces beneficial
effects that help to improve physical comfort and
well-being.
emaining in the same working position for a long
R
time (for example, sitting in front of a computer
screen), conditions of stress, repeated jostling,
insufficient muscular conditioning before physical
activity are all very frequent situations that are
often responsible for uncomfortable bodily
sensations.
The automatic progression of the various stimula-
tion sequences, specific to each program of the
Massage
effects of stimulation to his own needs and objectives.
category, allows each user to adapt the
28
If strong pain persists, the programs of the Massage category should never be used
for long periods without first seeking medical advice.
Massage
Programs
Relaxing
massage
Reviving
massage
Toning
massage
Effects Uses
Decreased muscular tension
Drainage of the toxins
responsible for the exaggerated
increase of muscular tone
Effect of well-being and
relaxation
Considerable increase of blood
flow in the stimulated region
Improvement of tissue
oxygenation
Elimination of free radicals
Activation of blood circulation
Recovery of muscular
contractile properties
Invigorating effect
English
To eliminate uncomfortable
or painful sensations,
following an exaggerated
increase of muscular tone
To contrast effectively
sensations of fatigue and
localised heaviness
To prepare the muscles in
an ideal manner before an
unusual/one-time physical
activity
29
English
Specific applications
Massage
Treatment of uncomfortable muscular
tensions in the back of the neck
Remaining in a seated position for long
periods, associated with repetitive
movements of the upper limbs (as is
frequently the case in front of a computer
screen), is often responsible for an
uncomfortable – or even painful – increase
of muscle tension of the back of the neck
muscles.
Any other condition of stress may also
create situations leading to a state of
excessive muscular tension, which is often
responsible for painful or uncomfortable
sensations.
The in-depth effects produced by the
Relaxing massage
contrast effectively such painful sensations,
with a particularly significant result in
terms of relaxation.
Cycle duration: To be used on the back of the neck
muscles, whenever an occasional sensation of
painful muscular tension is felt; to be repeated, if
necessary, in cases of particularly strong
muscular tension
Program:
Relaxing massage
program enable to
Treatment of a localised sensation of
heaviness or an occasional state of
fatigue
The many stresses of everyday life are
often responsible for uncomfortable, or
even painful, physical sensations. A
circulation slowdown is often the result of
insufficient physical activity, frequently
aggravated by the need in one’s working
life to remain in the same position for
many hours (in a seated position, for
example).
Although not serious, this simple “vascular
slowdown” is, however, frequently the
cause of unpleasant sensations (for
example: a sensation of heaviness, often
localised in the lower limbs, but also, at
times, in another region of the body).
The program produces, in the greatest
comfort, a reactivation of the blood
circulation that allows an acceleration of
tissue oxygenation and the elimination
of painful sensations, due to insufficient
physical effort.
30
15◊
Cycle duration: To be used on the calf muscles,
whenever an occasional sensation of heaviness is
felt; to be repeated, if necessary, in cases of
persistent discomfort
Program:
Reviving massage
25◊
j
Muscular and circulation conditioning
before physical activity
People who regularly practise sports are
well aware of the transition, which is
often painful, between a rest activity and
an occasional physical effort.
The objective of the usual warming-up
techniques is to respond to this need to
activate progressively the physiological
functions involved in one-time physical
activity. This physiological need is also
very desirable for moderate but unusual
physical efforts, as is frequently the case
for most of us (treks, biking, jogging,
etc.).
The
Toning massage
ideal benefit in the form of optimal
muscular and circulation conditioning
d
before any type of physical effort. It allows
us to avoid the uncomfortable sensations
– usually experienced during the first few
minutes of unusual physical efforts – and
to limit the secondary consequences of
insufficient preparation (aches, etc.).
Cycle duration: To be used on the muscles most
subject to stress in the physical activity involved
(in this example: the quadriceps), in the last
thirty minutes preceding physical activity
Program:
Toning massage
program offers an
8◊
c
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