K Number
K201290
Device Name
Medline DeNovo 4Pro Electrical Stimulation Device
Date Cleared
2020-09-21

(130 days)

Product Code
Regulation Number
890.5850
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
For EMG mode: - Relaxation muscle training and muscle re-education For NMES (also known as STIM) mode: - Relaxation of muscle spasms - Prevention or retardation of disuse atrophy - Increasing local blood circulation - Immediate post-surgical stimulation of calf muscles to prevent venous thrombosis - Maintaining or increasing range of motion - Muscle Re-Education For TENS mode: - Symptomatic relief and management of chronic (long-term), intractable pain - Adjunctive treatment in the management of post-surgical pain and post traumatic acute pain For EMG Triggered Stimulation (ETS) mode (nonimplanted electrical continence device only): - Acute and ongoing treatment of stress, urge or mixed urinary incontinence and where the following results may improve urinary control: Inhibition of the detruser muscles through reflexive mechanisms and strengthening of pelvic floor muscles - Incontinence treatment for assessing EMG activity of the pelvic floor and accessory muscles (abdominal or gluteal) For FES - Helps to relearn voluntary motor functions of the extremities
Device Description
The Medline DeNovo 4Pro Electrical Stimulation Device is a four-channel, hand-held, non-sterile, battery-powered, multi-patient device intended to be used by adult patients under the supervision of a trained clinical healthcare provider. The proposed device is controlled by a MCU (Microcontroller Unit) that supports device functionality, display functionality. Bluetooth, and audio. The subject device is intended to be used for muscle stimulation for the purposes of urinary incontinence treatment, pain management, muscle strengthening and training, as well as muscle relaxation and re-education. The device is a TENS (Transcutaneous Electrical Nerve Stimulator), ETS (Electrical Muscle Stimulator) and NMES (Neuromuscular Electrical Stimulator also known as STIM) including FES (Functional Electrical Stimulation) with EMG biofeedback. The Medline DeNovo 4Pro Electrical Stimulation Device features four channels for NMES (Neuromuscular Electrical Stimulator also known as STIM), with two that utilize Electromyography (EMG). Multiple stimulation protocols are pre-programed for three general categories of applications: muscle strengthening (i.e. biofeedback training), pain control, and neuromuscular re-education. Each category contains up to eight protocols to address the specific needs of the patient. The Medline DeNovo 4Pro Electrical Stimulation Device is designed to provide safe and effective electrical stimulation by sending small electrical currents to underlying nerves and muscle groups via electrodes applied on the skin or through a vaginal probe (for incontinence treatment protocols only). The parameters of the unit are controlled by the +/push buttons and touch screen (refer to Figure 1 and 2 below). The pre-programed protocols on the Medline DeNovo 4Pro Electrical Stimulation Device are all fully automatic and controlled by the device, and it is also capable of manual control in hand switch mode. The levels of intensity are adjustable to the needs of the patient and treatments prescribed by their healthcare providers. The device can be used with or without linkage to a PC and includes a color, pressure sensitive touch-screen. This unit also comes with a wireless charger that is capable of charging during NMES (Neuromuscular Electrical Stimulator also known as STIM) via inductive charging. Batteries will not need to be regularly replaced, and charging will be made so much easier. The proposed device also has Bluetooth capabilities that will allow the device to connect to a computer for screen mirror imaging.
More Information

No
The description focuses on pre-programmed protocols and manual control, with no mention of adaptive learning, pattern recognition beyond basic biofeedback, or any terms associated with AI/ML. The control is explicitly stated to be via a Microcontroller Unit (MCU) and user input.

Yes
The device description and intended use/indications for use clearly state that the device is used for various therapeutic purposes, including muscle strengthening, pain management, muscle relaxation, muscle re-education, and urinary incontinence treatment.

No

The device is described as an electrical stimulation device for therapeutic purposes (e.g., muscle relaxation, re-education, pain relief, incontinence treatment), and while it uses EMG biofeedback, it mentions assessing EMG activity rather than making a diagnosis. The primary functions listed are for treatment and management, not for diagnosing a condition.

No

The device description explicitly states it is a "four-channel, hand-held, non-sterile, battery-powered, multi-patient device" and mentions hardware components like a MCU, display, Bluetooth, audio, and a wireless charger. It is a physical electrical stimulation device controlled by software, not a software-only device.

Based on the provided information, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • IVD Definition: In Vitro Diagnostic devices are used to examine specimens taken from the human body (like blood, urine, tissue) to provide information for diagnosis, monitoring, or screening.
  • Device Function: The Medline DeNovo 4Pro Electrical Stimulation Device is an external electrical stimulation device that applies electrical currents to the body through electrodes or a probe. It is used for therapeutic purposes like muscle stimulation, pain management, and incontinence treatment.
  • Lack of Specimen Analysis: The device does not analyze any biological specimens from the patient. Its function is based on applying electrical signals to the body.

The intended uses and device description clearly indicate that this is a therapeutic device, not a diagnostic one that analyzes samples.

N/A

Intended Use / Indications for Use

For EMG mode:

  • Relaxation muscle training and muscle re-education

For NMES (also known as STIM) mode:

  • Relaxation of muscle spasms
  • Prevention or retardation of disuse atrophy
  • Increasing local blood circulation
  • Immediate post-surgical stimulation of calf muscles to prevent venous thrombosis
  • Maintaining or increasing range of motion
  • Muscle Re-Education

For TENS mode:

  • Symptomatic relief and management of chronic (long-term), intractable pain
  • Adjunctive treatment in the management of post-surgical pain and post traumatic acute pain

For EMG Triggered Stimulation (ETS) mode (nonimplanted electrical continence device only):

  • Acute and ongoing treatment of stress, urge or mixed urinary incontinence and where the following results may improve urinary control: Inhibition of the detruser muscles through reflexive mechanisms and strengthening of pelvic floor muscles
  • Incontinence treatment for assessing EMG activity of the pelvic floor and accessory muscles (abdominal or gluteal)

For FES

  • Helps to relearn voluntary motor functions of the extremities

Product codes (comma separated list FDA assigned to the subject device)

IPF, GZJ, HCC, GZI, KPI

Device Description

The Medline DeNovo 4Pro Electrical Stimulation Device is a four-channel, hand-held, non-sterile, battery-powered, multi-patient device intended to be used by adult patients under the supervision of a trained clinical healthcare provider. The proposed device is controlled by a MCU (Microcontroller Unit) that supports device functionality, display functionality. Bluetooth, and audio. The subject device is intended to be used for muscle stimulation for the purposes of urinary incontinence treatment, pain management, muscle strengthening and training, as well as muscle relaxation and re-education. The device is a TENS (Transcutaneous Electrical Nerve Stimulator), ETS (Electrical Muscle Stimulator) and NMES (Neuromuscular Electrical Stimulator also known as STIM) including FES (Functional Electrical Stimulation) with EMG biofeedback.

The Medline DeNovo 4Pro Electrical Stimulation Device features four channels for NMES (Neuromuscular Electrical Stimulator also known as STIM), with two that utilize Electromyography (EMG). Multiple stimulation protocols are pre-programed for three general categories of applications: muscle strengthening (i.e. biofeedback training), pain control, and neuromuscular re-education. Each category contains up to eight protocols to address the specific needs of the patient.

The Medline DeNovo 4Pro Electrical Stimulation Device is designed to provide safe and effective electrical stimulation by sending small electrical currents to underlying nerves and muscle groups via electrodes applied on the skin or through a vaginal probe (for incontinence treatment protocols only). The parameters of the unit are controlled by the +/- push buttons and touch screen (refer to Figure 1 and 2 below). The pre-programed protocols on the Medline DeNovo 4Pro Electrical Stimulation Device are all fully automatic and controlled by the device, and it is also capable of manual control in hand switch mode. The levels of intensity are adjustable to the needs of the patient and treatments prescribed by their healthcare providers. The device can be used with or without linkage to a PC and includes a color, pressure sensitive touch-screen. This unit also comes with a wireless charger that is capable of charging during NMES (Neuromuscular Electrical Stimulator also known as STIM) via inductive charging. Batteries will not need to be regularly replaced, and charging will be made so much easier. The proposed device also has Bluetooth capabilities that will allow the device to connect to a computer for screen mirror imaging.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Body via electrodes applied on the skin or through a vaginal probe. Pelvic floor muscles, calf muscles, extremities.

Indicated Patient Age Range

Adult

Intended User / Care Setting

Used by adult patients under the supervision of a trained clinical healthcare provider. Physician Office, physical therapy clinic, hospital, nursing home, post-acute care, Chiropractic Clinic.

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies (study type, sample size, AUC, MRMC, standalone performance, key results)

Functional Performance Testing: Non-clinical verification was conducted to evaluate the safety, performance, and functionality of the device. Results demonstrate overall safety and support substantial equivalence.
Electrical Safety and Electronic Compatibility: Compliance with IEC 60601-1:2012, IEC 60601-1-2:2014, IEC 61000-6-1, IEC 60601-2-10, IEC 60601-2-40.
FCC Radio Frequency (RF) Testing: Compliance with FCC/CFR 47: Part 15.2018, subpart B: 2008 Class B ANSI C63.4: 2003, FCC/CFR 47: Part 15: 2018, subpart C.
Wireless Coexistence Testing: Evaluated in an environment with other Medline DeNovo 4Pro Electrical Stimulation devices and 2.4 GHz wireless devices (Wi-Fi) to ensure function in presence of multiple, coexisting communication systems.
Usability Testing: Compliance with IEC 60601-1-6:2013 and IEC 62366:2007.
Software Testing: Software verification and validation activities conducted in accordance with IEC 62304:2015 and FDA guidance document "General Principles of Software Validation". Device software is classified as Class B.

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Not Found

Predicate Device(s): If the device was cleared using the 510(k) pathway, identify the Predicate Device(s) K/DEN number used to claim substantial equivalence and list them here in a comma separated list exactly as they appear in the text. List the primary predicate first in the list.

K080950, K053434

Reference Device(s): Identify the Reference Device(s) K/DEN number and list them here in a comma separated list exactly as they appear in the text.

K160138, K122194

Predetermined Change Control Plan (PCCP) - All Relevant Information for the subject device only (e.g. presence / absence, what scope was granted / cleared under the PCCP, any restrictions, etc).

Not Found

§ 890.5850 Powered muscle stimulator.

(a)
Identification. A powered muscle stimulator is an electrically powered device intended for medical purposes that repeatedly contracts muscles by passing electrical currents through electrodes contacting the affected body area.(b)
Classification. Class II (performance standards).

0

Image /page/0/Picture/0 description: The image contains the logo of the U.S. Food and Drug Administration (FDA). On the left is the Department of Health & Human Services logo. To the right of that is the FDA logo, which is a blue square with the letters "FDA" in white. To the right of the blue square is the text "U.S. FOOD & DRUG ADMINISTRATION" in blue.

September 21, 2020

Medline Industries Inc Leontyne Banks Regulatory Affairs Specialist Three Lakes Drive Northfield. Illinois 60090

Re: K201290

Trade/Device Name: Medline DeNovo 4Pro Electrical Stimulation Device Regulation Number: 21 CFR 890.5850 Regulation Name: Powered Muscle Stimulator Regulatory Class: Class II Product Code: IPF, GZJ, HCC, GZI, KPI Dated: June 14, 2020 Received: June 24, 2020

Dear Leontyne Banks:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food, Drug, and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. Although this letter refers to your product as a device, please be aware that some cleared products may instead be combination products. The 510(k) Premarket Notification Database located at https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm identifies combination product submissions. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

1

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); medical device reporting of medical device-related adverse events) (21 CFR 803) for devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see https://www.fda.gov/combination-products/guidance-regulatory-information/postmarketing-safety-reportingcombination-products); good manufacturing practice requirements as set forth in the quality systems (OS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to https://www.fda.gov/medical-device-safety/medical-device-reportingmdr-how-report-medical-device-problems.

For comprehensive regulatory information about medical devices and radiation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/medicaldevices/device-advice-comprehensive-regulatory-assistance) and CDRH Learn (https://www.fda.gov/training-and-continuing-education/cdrh-learn). Additionally, you may contact the Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See the DICE website (https://www.fda.gov/medical-device-advice-comprehensive-regulatoryassistance/contact-us-division-industry-and-consumer-education-dice) for more information or contact DICE by email (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100).

Sincerely.

Vivek Pinto, PhD Director DHT5B: Division of Neuromodulation and Physical Medicine Devices OHT5: Office of Neurological and Physical Medicine Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

Enclosure

2

Indications for Use

510(k) Number (if known) K201290

Device Name

Medline DeNovo 4Pro Electrical Stimulation Device

Indications for Use (Describe)

For EMG mode:

  • Relaxation muscle training and muscle re-education

For NMES (also known as STIM) mode:

  • Relaxation of muscle spasms

  • Prevention or retardation of disuse atrophy

  • Increasing local blood circulation

  • Immediate post-surgical stimulation of calf muscles to prevent venous thrombosis

  • Maintaining or increasing range of motion

  • Muscle Re-Education

For TENS mode:

  • Symptomatic relief and management of chronic (long-term), intractable pain

  • Adjunctive treatment in the management of post-surgical pain and post traumatic acute pain

For EMG Triggered Stimulation (ETS) mode (nonimplanted electrical continence device only):

-Acute and ongoing treatment of stress, urge or mixed urinary incontinence and where the following results may improve urinary control: Inhibition of the detruser muscles through reflexive mechanisms and strengthening of pelvic floor muscles

-Incontinence treatment for assessing EMG activity of the pelvic floor and accessory muscles (abdominal or gluteal)

For FES

  • Helps to relearn voluntary motor functions of the extremities

Type of Use (Select one or both, as applicable)

X Prescription Use (Part 21 CFR 801 Subpart D)

Over-The-Counter Use (21 CFR 801 Subpart C)

CONTINUE ON A SEPARATE PAGE IF NEEDED.

3

This section applies only to requirements of the Paperwork Reduction Act of 1995.

DO NOT SEND YOUR COMPLETED FORM TO THE PRA STAFF EMAIL ADDRESS BELOW.

The burden time for this collection of information is estimated to average 79 hours per response, including the time to review instructions, search existing data sources, gather and maintain the data needed and complete and review the collection of information. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden, to:

Department of Health and Human Services Food and Drug Administration Office of Chief Information Officer Paperwork Reduction Act (PRA) Staff PRAStaff@fda.hhs.gov

"An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB number."

4

510(k) SUMMARY [AS REQUIRED BY 21CFR807.92(c)]

Submitter / 510(k) Sponsor

Medline Industries, Inc. Three Lakes Drive Northfield, IL 60093

Registration Number: 1417592

Contact Person

Leontyne Banks Regulatory Specialist Phone: 224-931-1484 Email: 1banks(@medline.com

Summary Preparation Date

September 15, 2020

Type of 510(k) Submission

Traditional

Device Name / Classification

Proprietary Name: Medline DeNovo 4Pro Electrical Stimulation Device Classification Name: Device, Biofeedback Classification Panel: Neurology Product Code: IPF, KPI, GZJ, HCC, GZI Regulatory Class: Class II Regulation #: 21 CFR 890.5850, 876.5320, 882.5890, 882.5050, 882.5810

Predicate Device

Primary Predicate: Otto Bock Healthcare Product GmbH - STIWELL med4 - K080950

Secondary Predicate: Thought Technology Ltd. - MyoTrac Infiniti Electrical Stimulator -K053434

5

Device Description

The Medline DeNovo 4Pro Electrical Stimulation Device is a four-channel, hand-held, non-sterile, battery-powered, multi-patient device intended to be used by adult patients under the supervision of a trained clinical healthcare provider. The proposed device is controlled by a MCU (Microcontroller Unit) that supports device functionality, display functionality. Bluetooth, and audio. The subject device is intended to be used for muscle stimulation for the purposes of urinary incontinence treatment, pain management, muscle strengthening and training, as well as muscle relaxation and re-education. The device is a TENS (Transcutaneous Electrical Nerve Stimulator), ETS (Electrical Muscle Stimulator) and NMES (Neuromuscular Electrical Stimulator also known as STIM) including FES (Functional Electrical Stimulation) with EMG biofeedback.

The Medline DeNovo 4Pro Electrical Stimulation Device features four channels for NMES (Neuromuscular Electrical Stimulator also known as STIM), with two that utilize Electromyography (EMG). Multiple stimulation protocols are pre-programed for three general categories of applications: muscle strengthening (i.e. biofeedback training), pain control, and neuromuscular re-education. Each category contains up to eight protocols to address the specific needs of the patient.

The Medline DeNovo 4Pro Electrical Stimulation Device is designed to provide safe and effective electrical stimulation by sending small electrical currents to underlying nerves and muscle groups via electrodes applied on the skin or through a vaginal probe (for incontinence treatment protocols only). The parameters of the unit are controlled by the +/push buttons and touch screen (refer to Figure 1 and 2 below). The pre-programed protocols on the Medline DeNovo 4Pro Electrical Stimulation Device are all fully automatic and controlled by the device, and it is also capable of manual control in hand switch mode. The levels of intensity are adjustable to the needs of the patient and treatments prescribed by their healthcare providers. The device can be used with or without linkage to a PC and includes a color, pressure sensitive touch-screen. This unit also comes with a wireless charger that is capable of charging during NMES (Neuromuscular Electrical Stimulator also known as STIM) via inductive charging. Batteries will not need to be regularly replaced, and charging will be made so much easier. The proposed device also has Bluetooth capabilities that will allow the device to connect to a computer for screen mirror imaging.

How Device Achieves its Intended Purpose:

  • . TENS
    TENS uses the proposed battery operated unit to provide a non-invasive, low-risk nerve stimulation in order to reduce pain (both acute and chronic). In TENS, mild electrical impulses are transmitted through the skin via surface electrodes to relieve muscle pain by modifying the body's pain perception. TENS does not cure problematic physiological conditions; it only helps to control the pain perception.

  • NMES (also known as STIM) ● NMES is the elicitation of muscle contraction using electric impulses. The impulses are

6

generated by a device and delivered through the electrodes in direct proximity to the muscles to be stimulated or via the vaginal probe. The impulses mimic the action potential coming from the central nervous system, causing the muscles to contract. NMES is both a form of electrotherapy and of muscle training. Neuromuscular Stimulation has been used to stimulate muscle and nerve fibers for muscle strengthening, maintenance of muscle mass and strength during prolonged periods of immobilization, selective muscle retraining, and the control of edema.

● FES

FES is the process of combining electrical stimulation with a functional task such as walking. This is a treatment that applies small electrical charges to the leg to improve mobility in people who have difficulties with walking. As well as being a treatment for foot drop, FES can also be used in rehabilitation, complementing physiotherapy techniques, often to assist with movements in muscles that have become weak. This allows the user to build strength and range of movement.

Surface electromyography (EMG) ● EMG is a technique for evaluating and recording the electrical activity produced by skeletal muscles. Surface EMG is used for recording from superficial muscles in clinical or kinesiological protocols, where intramuscular electrodes are used for investigating deep muscles or localized muscle activity.

. ETS

ETS involves initiating a voluntary contraction for a specific movement until the muscle activity reaches a threshold level. This treatment is especially useful for stroke rehabilitation and pelvic muscle improvement. As soon as the EMG activity reaches a target threshold then an assisting electrical stimulus begins which helps to support the contracted muscle. A microprocessor connected to the surface electrodes or vaginal probe monitors the EMG activity levels as well as administers the neuromuscular stimulation. The Target threshold could be set to automated regime, when it goes up and down depending on the running muscle performance.

7

Figure 1: Medline DeNovo 4Pro Electrical Stimulation Device

The illustration below presents the Medline DeNovo 4Pro Electrical Stimulation Device.

Image /page/7/Picture/2 description: The image shows a device with a screen and several buttons. The device has a screen at the top, followed by buttons labeled "PAUSE", "STOP", a home icon, a return icon, a power icon, and "START". Below these buttons are four sets of plus and minus buttons, each associated with a number from 1 to 4, and the labels "AUTO.1" and "AUTO.2".

8

Figure 2: Buttons and Basic Operation

The illustration below presents the keypad button functions for the Medline DeNovo 4Pro Electrical Stimulation Device. Please note that many of the button options below are duplicated by the touch screen buttons.

Image /page/8/Figure/2 description: The image shows a labeled diagram of a remote control. The remote has buttons for pause, stop, home, back, start, and on/off. There are also intensity buttons for channels 1 and 2, as well as auto buttons for channels 1 and 2. The diagram provides a brief description of each button's function.

mA+ : 600ms interval between first 1 mA increase and then changes every 200ms

mA- : 400ms interval between first 1 mA decrease and then changes every 100ms

9

Figure 3: Buttons and Basic Operation

The illustration below presents the home touch screen functions of the Medline DeNovo 4Pro Electrical Stimulation Device. Please refer to DNV420P-SRS-P9 in Appendix E for additional screen settings and protocol options.

Image /page/9/Picture/2 description: The image shows a graphical user interface with 17 labeled icons. The first icon, labeled 1, displays the text "Medl.". Icons 2 through 5 show a micro SD card, a pen, a bluetooth symbol, and a battery symbol. Icons 6, 7, and 8 are labeled "Custom Protocol 1", "Custom Protocol 2", and "Custom Protocol 3", respectively. The remaining icons are labeled "Pain", "Strength", "NM Re-ed", "EMG/ETS", "Games", "Patient Records", "User Protocols", "Gate Ctrl", and "Settings".

    1. Device Name
    1. MicroSD Card
    1. Hand Switch Icon Accesses the manual hand switch treatment mode
    1. Bluetooth Icon Accesses Bluetooth ID information
    1. Battery Icon Displays battery voltage levels
  • Custom Protocol shortcut 1 Accesses most frequently used protocols (assigned by 6. user)
    1. Custom Protocol shortcut 2 Accesses most frequently used protocols (assigned by user)
  • Custom Protocol shortcut 3 Accesses most frequently used protocols (assigned by 8. user)
    1. System Pre-defined Protocols Pain
    1. System Pre-defined Protocols Strength
    1. System Pre-defined Protocols Neuromuscular Re-education (NM Re-ed)
    1. EMG/ET EMG and ETS (EMG triggered stimulation) modality (including EMG template training)
    1. Games Accesses EMG games
    1. Patient Records Accesses patient information and records stored in Micro SD card (if card with data is inserted)
    1. User Protocols Accesses list of custom protocols created and saved by the user
    1. Last Used Accesses last used program
    1. Global Settings Accesses general device settings

10

Accessories

The proposed device is intended to come with eight electrodes and a vaginal probe. The electrodes offered with this device are manufactured by GMDASZ Manufacturing Co., Ltd and are covered under a separate 510(k) (K160138). Similarly, the vaginal probe is covered by its own 510(k) (K122194) and is manufactured by Everyway Medical Instrument Co. Ltd. Table 1 and 2 below provide additional information regarding these accessories.

Device NameAdhesive Electrodes
Product CodeGXY
Regulation Number882.1320
ClassificationII
510(k) NumberK160138
Device DescriptionMulti-layer reusable, flexible structures composed of laminated materials commonly used in this application. First layer: Insulating backing material: Fabric/foam/tan fabric Second layer: Conductive film: Carbon film/Carbon film coated with silver/aluminum foil film Third layer: Biocompatible self-adhesive conductive hydrogel Protective liner: PET
Intended UseThe adhesive electrodes are intended for as a reusable, conductive adhesive interface between the patient's skin and the marketed electrical stimulators (i.e. TENS (Transcutaneous Electrical Nerve Stimulation)), EMS (Electrical Muscular Stimulation), IF (Interferential) or PGF (Pulsed Galvanic Stimulation) for transmitting electrical current.
Electrical
ConnectionLead wire
BiocompatibilityComplies with ISO 10993
Single Use vs. Single
Patient UseSingle Patient Use
Reusable vs.
DisposableReusable
Prescription vs.
OTCPrescription Use and OTC Use

Table 1: Accessory Description - Adhesive Electrodes

11

| Device Name | Everyway Incontinence Stimulation Electrode – Vaginal
Stimulation |
|--------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Product Code | HIR |
| Regulation Number | 876.5320 |
| Classification | II |
| 510(k) Number | K122194 |
| Device Description | The Life-Care Vaginal Probe models PR-02/02A, PR-03/03A,
PR-04/04A, PR-10A, PR-h1A, PR-14A are light weight
cylinders consisting of two or three independent conductive
rings or plates that are paired and isolated, physically and
electrically. The cylinder is shaped with a waist and handle for
comfort positioning in vaginal canal for incontinent treatment
as above mentioned and easy for removing after treatment. It
is watertight to allow for washing with soap and water
between uses. The electrode is designed for repeated
intermittent use in home or clinic for up to one year by a
single user. It does not require sterilization, but does required
washing for reuse according to the validated cleaning method
as recommended in user manual. |
| Intended Use | Intended to provide EMG feedback from pelvic musculature
or electrical stimulation to pelvic musculature for the purpose
of rehabilitation of weak pelvic floor muscles and restoration
of neuromuscular control during the treatment of urinary
incontinence. |
| Indications for Use | Electrical stimulation of the pelvic floor muscles for the
treatment of urinary incontinence. EMG sensing of the pelvic
floor muscles. |
| Electrical
Connection | Lead wire |
| Biocompatibility | Conformity to ISO 10993-5 and ISO 10993-10 |
| Single Use vs. Single
Patient Use | Single patient use |
| Reusable vs.
Disposable | Reusable |
| Prescription vs.
OTC | Prescription Use |

Table 2 Accessory Description: Vaginal Probe

12

Intended Use

For EMG mode:

  • . Relaxation muscle training and muscle re-education

For NMES (also known as STIM) mode:

  • Relaxation of muscle spasms ●
  • Prevention or retardation of disuse atrophy
  • Increasing local blood circulation
  • Immediate post-surgical stimulation of calf muscles to prevent venous thrombosis ●
  • Maintaining or increasing range of motion
  • Muscle Re-Education ●

For TENS mode:

  • Symptomatic relief and management of chronic (long-term), intractable pain
  • Adjunctive treatment in the management of post-surgical pain and post traumatic acute pain

For EMG Triggered Stimulation (ETS) mode (nonimplanted electrical continence device only):

  • Acute and ongoing treatment of stress, urge or mixed urinary incontinence and where the ● following results may improve urinary control: Inhibition of the detruser muscles through reflexive mechanisms and strengthening of pelvic floor muscles
  • Incontinence treatment for assessing EMG activity of the pelvic floor and accessory . muscles (abdominal or gluteal)

For FES

  • . Helps to relearn voluntary motor functions of the extremities

13

Summary of Technological Characteristics

Tables 3 and 4 provides a side-by-side comparison between the proposed device and the selected predicate devices, the STIWELL med4 (K080950) and MyoTrac Infiniti Electrical Stimulator Device (K053434).

Table 3: COMPARISON OF PROPOSED AND PRIMARY PREDICATE DEVICES - STIWELL med4

| Device Characteristic | Proposed Device
Medline DeNovo 4Pro | Predicate Device #1
STIWELL med4 – K080950 | Comparison
Analysis |
|------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------------------|
| Product Name | Medline DeNovo 4Pro
Electrical Stimulation Device | STIWELL med4 | N/A |
| MANUFACTURER | Medline (Sponsor)
Verity (Manufacturer) | Otto Bock Healthcare Product
GmbH | N/A |
| 510(k) REFERENCE | TBD | K080950 | N/A |
| PRODUCT CODE | IPF
KPI
HCC
GZJ
GZI | IPF
KPI
HCC
GZJ
GZI | Same |
| CLASSIFICATION | Class II | Class II | Same |
| REGULATION
NUMBER | 21 CFR 890.5850
21 CFR 876.5320
21 CFR 876.5050
21 CFR 882.5890
21 CFR 882.5810 | 21 CFR 890.5850
21 CFR 876.5320
21 CFR 876.5050
21 CFR 882.5890
21 CFR 882.5810 | Same |
| INDICATIONS FOR
USE | NMES (also known as STIM)
• Relaxation of muscle spasms
• Prevention or retardation of disuse atrophy
• Increasing local blood circulation
• Immediate post-surgical stimulation of calf muscles to prevent venous thrombosis
• Maintaining or increasing range of motion
• Muscle Re-Education

For EMG Triggered Stimulation (ETS) mode (nonimplanted electrical continence device only):
• Acute and ongoing treatment of stress, urge or mixed urinary incontinence and | As a powered muscle stimulator the STIWELL med4 is indicated for the following Conditions:
• Relaxation of muscle spasms
• Prevention or retardation of disuse atrophy
• Increasing local blood circulation
• Muscle Re-Education
• Maintaining or increasing range of motion
• Immediate post-surgical stimulation of calf muscles to prevent venous thrombosis

As a transcutaneous electrical nerve stimulator for pain relief the | Similar |

14

15

WAVEFORMSSymmetrical Biphasic DC zero [TENS and HAN (TENS)] Symmetrical Biphasic [NMES]Biphasic SymmetricalSimilar
CONNECTION OF
DEVICE TO
ELECTRODESWith cables including pins to
connect to electrodes pins. There is 1
cable per channel with a maximum
of 4 channels.With cables including pins to connect
to electrodes pins. There is 1 cable per
channel with a maximum of 4 channelsSame
ENVIRONMENT OF
USEPhysician Office, physical therapy
clinic, hospital, nursing home, post-
acute care, Chiropractic ClinicPhysician Office, physical therapy
clinic, hospital, nursing
home, post-acute care, Chiropractic
ClinicSame
TARGET
POPULATIONAdultAdultSame
POWER SOURCE4x AA NiMh,
4.8V Rechargeable Battery packBattery Pack Li-ion 11, 1VDifferent
ELECTRICAL TYPEType BFType BFSame
PATIENT LEAKAGE
CURRENT -
NORMAL
CONDITION (μΑ)N/A
Battery Operated Device
(