Patent Publication Number: US-9849299-B2

Title: Disposable, single-use thermal exchange component

Description:
CLAIM OF PRIORITY 
     This application is a continuation of commonly assigned Sham et al. U.S. patent application Ser. No. 12/882,878, entitled “DISPOSABLE, SINGLE-USE THERMAL EXCHANGE COMPONENT,” filed Sep. 15, 2010, which is a continuation of commonly assigned Sham et al. U.S. patent application Ser. No. 12/831,779, entitled “ELECTROMAGNETIC THERMAL THERAPY,” filed on Jul. 7, 2010, which is a continuation-in-part of commonly assigned Gill et al. U.S. Pat. No. 7,783,348, entitled “STIMULATION DEVICE FOR TREATING OSTEOARTHRITIS,” filed on Apr. 16, 2008, which claims priority to Gill et al. U.S. Patent Application Ser. No. 60/927,354, entitled “STIMULATION DEVICE FOR TREATING OSTEOARTHRITIS,” filed on May 3, 2007, and to Gill et al. U.S. Patent Application Ser. No. 60/983,653, entitled “STIMULATION DEVICE FOR TREATING OSTEOARTHRITIS,” filed on Oct. 30, 2007, the benefit of priority of each of which is claimed hereby, and each of which are incorporated by reference herein in its entirety. 
    
    
     BACKGROUND 
     Osteoarthritis, also known as degenerative joint disease, is characterized by gradual loss of hyaline cartilage and, in extreme cases, cyst formation in and deformation of the subchondral bone. The hyaline cartilage lines the articular surfaces of the knee and provides cushion and lubrication for the joint. During osteoarthritis, the extra-cellular matrix of the cartilage is worn down at a greater rate than it is being synthesized, leading to a net reduction in the overall amount of cartilage at the articular surfaces of the knee. As the cartilage breaks down, symptoms such as pain, swelling, tenderness, stiffness, and eventual muscle atrophy are manifested. Chondrocytes, the cellular component of hyaline cartilage that is responsible for matrix synthesis and turnover, are also depleted, thus resulting in an inability to naturally recover from this disease. Additionally, cells present in osteoarthritic joints release catabolic cytokines and enzymes that suppress collagen synthesis. 
     To date, conventional therapies for osteoarthritis have aimed at reducing pain and the progression of joint damage in order to minimize disability and maximize quality of life. The current algorithm for the management of osteoarthritis includes diagnosing the disease, modifying patient activity, prescribing anti-inflammatory medications, injecting steroids into the knee, and as a last resort, surgery. Although this regimen does provide some benefit, it is by no means a cure all for patients with osteoarthritis. 
     Aside from the conventional therapies, there are currently a number of alternative therapies that may be used to treat osteoarthritis. Three of the forerunners in the non-invasive alternative therapy field include electric, static magnetic, and electromagnetic stimulation. 
     Electrical stimulation, such as transcutaneous electrical nerve stimulation (TENS), delivers mild electrical impulses across the skin and into regional nerves. In patients having osteoarthritis, pain impulses are transmitted to the spinal cord through small cutaneous fibers. TENS acts to stimulate large cutaneous fibers that subsequently transmit a faster impulse via C-fibers to inhibit pain signals from the small fibers. It is in this way that TENS masks the pain normally experienced by patients having osteoarthritis. It is also thought that TENS incites the secretion of endogenous opiates, the body&#39;s natural pain killers, further reducing the pain experienced by patients with osteoarthritis. 
     Static magnetic stimulation has also been shown to provide medically relevant benefits. Various experiments designed to induce osteoporosis, fracture, and synovitis in animals have demonstrated faster bone repair, increased bone density, and decreased joint inflammation following magnetic treatments. It is thought that magnets can affect biological processes by: decreasing the firing rate of chronic pain neurons; modifying the rate of enzyme-mediated reactions; modulating intracellular signaling by affecting the functioning of calcium channels in the cell membranes; and enhancing blood flow. All of the above may provide some therapeutic benefit with respect to the symptoms of osteoarthritis. 
     Additionally, electromagnetic stimulation, a modality that generates a magnetic field by sending current through a coil, may also provide medical benefits for the treatment of osteoarthritis. It has been observed that physical stress on bone causes the appearance of tiny electric currents (piezoelectric potentials) that are thought to be the mechanism of transduction of the physical stresses into a signal that promotes bone formation. In particular, studies of electrical phenomena in cartilage have demonstrated a mechanical-electrical transduction mechanism resembling those described in bone, appearing when cartilage is mechanically compressed. Generating currents within cartilage is thought to stimulate chondrocyte activity, thus promoting the synthesis of cartilage. New cartilage synthesis may work to combat the degeneration seen in osteoarthritis and therefore alleviate the symptoms of osteoarthritis. 
     Thus, there is a need for an improved device and method to treat osteoarthritis. 
     Overview 
     In various embodiments disclosed herein, devices or methods for the treatment of osteoarthritis are disclosed. More particularly, certain embodiments relate to portable, disposable pulsed electromagnetic field (PEMF) stimulation and thermal therapy devices for treating osteoarthritis and their methods of use. 
     A portable, non-invasive device comprised of a multiple usage cuff and two single-use therapy units is designed to provide Electro-Magnetic Thermal Therapy (EMT 2 ) for treating knee osteoarthritis. The EMT 2  provides both transcutaneous pulsed electromagnetic field stimulation and thermal therapy. For purposes of this application, it is understood that “thermal therapy” means any therapy that provides for application of heat or cold for purposes of treatment. The EMT 2  is designed to alleviate pain and increase range of motion without requiring direct skin contact to the afflicted joint. The single-use therapy units offer heat or cooling and PEMF stimulation when inserted into the cuff, which provides the power and control for the coils. The cuff may contain a rechargeable power source capable of delivering a recommended amount of therapy and the coils for delivering the PEMF stimulation. The cuff may be fastened to the knee in a manner that directs the therapy to the medial and lateral areas of the joint. Furthermore, the cuff may be designed such that it is aesthetically pleasing and comfortable to wear during daily activities either over or underneath clothing, thereby increasing patient compliance. 
     The basic principle behind the concept of electromagnetic stimulation is that passing an electric current through a coil winding structure will generate an electromagnetic field. The electromagnetic field can, in turn, generate a current in any conductive material, such as nerves or other body tissues, within this field. The electromagnetically induced electric field created by properly oriented pulsed electromagnetic stimulation thus accomplishes the result of transferring charge to cells of the body. This induced current can lead to nerve firing, muscle contraction, stimulation of cell signaling pathways causing cell growth, and a number of other effects. In contrast to applications of electrical stimulation, pulsed electromagnetic stimulation does not require direct skin contact to induce nerve excitation. As a result, significantly higher levels of directed stimulation can be achieved through pulsed electromagnetic stimulation without the adverse effects of other technologies. 
     Thus, the EMT 2  devices and methods disclosed herein are designed with a powerful electromagnetic stimulating means created for the purpose of stimulating nerve, muscle, and/or other body tissues. Previous clinical studies have shown a high correlation between low-frequency PEMF and new cartilage growth for treating osteoarthritis. The inventive device provides an easy-to-use, portable system that may have applications within a host of clinical and home health applications. 
     This overview is intended to provide an overview of subject matter of the present patent application. It is not intended to provide an exclusive or exhaustive explanation of the invention. The detailed description is included to provide further information about the present patent application. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       In the drawings, which are not necessarily drawn to scale, like numerals may describe similar components in different views. Like numerals having different letter suffixes may represent different instances of similar components. The drawings illustrate generally, by way of example, but not by way of limitation, various embodiments discussed in the present document. 
         FIG. 1  is a diagram illustrating a typical human knee joint model. 
         FIG. 2  is a block diagram illustrating a stimulation device for treating osteoarthritis in the knee according to one embodiment. 
         FIG. 3  is a front view of one embodiment of a stimulation device that is securable to a patient&#39;s knee for delivery of electromagnetic and thermal therapy. 
         FIGS. 4A and 4B  illustrate the stimulation device of  FIG. 3  secured to the patient&#39;s knee. 
         FIG. 5  is an exploded perspective view of the stimulation device of  FIG. 3 . 
         FIG. 6  is an enlarged exploded view of a portion of the stimulation device of  FIG. 3 . 
         FIG. 7  is a perspective view of one embodiment of a stimulation device in the form of a patch that is securable to a patient&#39;s body for delivery of electromagnetic and thermal therapy. 
         FIG. 8  illustrates generally an exploded perspective view of an active knee system. 
         FIG. 9  illustrates generally an example of an active ankle system. 
         FIG. 10  illustrates generally an example of an active back system. 
         FIG. 11  illustrates generally an example of an active elbow system. 
         FIGS. 12 and 13  illustrate generally examples of an active wrist system. 
     
    
    
     DETAILED DESCRIPTION 
     A device for providing therapeutic treatment to a body part such as a joint to promote healing of the body part comprises a signal generator for generating a pulsed electromagnetic field based upon a selected treatment mode, a controller for storing the treatment mode and communicating the treatment mode to the signal generator, a heat source configured to provide thermal therapy to the body part, and monitoring means for monitoring the electromagnetic field generated by the electromagnetic stimulating means. The device may also include telemetry means in communication with the monitoring means for remotely accessing the controller to modify the treatment mode. The device can also be disposable. 
       FIG. 1  is a diagram illustrating a typical human knee joint model. As shown in  FIG. 1 , the typical human knee joint includes a compartment filled with synovial fluid that is bounded by articular cartilage on the ends of the femur and tibia, respectively, and fibrous capsules. In accordance with one embodiment of the devices and methods discussed herein, osteoarthritis in the knee joint may be treated by the application of heat or cold and specific and selective electromagnetic fields via coils positioned adjacent to the knee joint. As will be discussed in more detail to follow, a signal generator means may provide the appropriate signals to the coils for generating the specific and selective electromagnetic fields. The specific and selective electromagnetic field needed to treat osteoarthritis in the knee joint may be calculated, and varies depending upon, among other factors, the dimensions of the tibia and femur and the severity of the symptoms. Furthermore, a heating or cooling source may also be positioned adjacent to the knee joint to relieve pain, reduce patient discomfort, and increase range of motion. The heating or cooling source can also be referred to as a “thermal exchange component,” which, for purposes of the instant application, means any component or device that can be used to apply heat (or any temperature that is higher than the patient&#39;s body temperature or the ambient temperature) or cold (or any temperature that is lower than the patient&#39;s body temperature or the ambient temperature). 
     More particularly, the implementations discussed herein relate to devices and methods for generating both (1) heat or cold, and (2) selective pulsed electromagnetic fields for the treatment of diseased tissue in a joint, such as a knee joint. The devices, which may be designed in numerous forms such as a knee brace or a small dermal patch, preferably offer transcutaneous stimulation for treating osteoarthritis. The devices may be designed to provide stimulation directly to the afflicted joint to alleviate pain and increase range of motion. 
     As will be discussed in further detail in subsequent paragraphs, the various EMT 2  stimulation device embodiments may be designed to attach to a patient for a prolonged period of time while having little disruption to daily activities and minimal skin irritation. In addition, the stimulation devices may be designed such that it is aesthetically pleasing and comfortable to wear. As a result of these and other design characteristics, patient refusal of treatment due to discomfort (i.e., patient “non-compliance”) may be minimized. 
     Pulsed electromagnetic fields generate small, induced currents (Faraday currents) in the highly conductive extracellular fluid, which thereby mimics endogeneous electrical currents. The endogeneous electrical currents are due primarily to movement of fluid containing electrolytes in channels of the bone containing organic constituents with fixed negative charges, generating what are called “streaming potentials.” Studies of electrical phenomena in cartilage have demonstrated a mechanical-electrical transduction mechanism that resembles those described in bone, appearing when cartilage is mechanically compressed, causing movement of fluid and electrolytes over the surface of fixed negative charges in the proteoglycans and collagen in the cartilage matrix. These streaming potentials serve a purpose in cartilage similar to that in bone, and, along with mechanical strain, lead to signal transduction that is capable of stimulating chondrocyte synthesis of matrix components. 
     In contrast to direct currents, PEMFs are able to penetrate cell membranes and either stimulate them or directly affect intracellular organelles. As a result, the effect of PEMFs on extracellular matrices includes increased synthesis of cartilage molecules, thereby enabling a “remodeling” of the knee joint. 
       FIG. 2  is a block diagram illustrating EMT 2  stimulation device  10  for treating osteoarthritis in the knee according to one embodiment. This device embodiment  10  has a signal generator  12 , power source  14 , first stimulating means  16 A, and second stimulating means  16 B. First stimulating means  16 A is coupled to first output  18 A of signal generator  12  via first signal line  20 A. Similarly, second stimulating means  16 B is coupled to second output  18 B of signal generator  12  via second signal line  20 B. In various embodiments, the first stimulating means  16 A has either or both of an electromagnetic stimulating means  26 A and a thermal exchange component  28 A and the second stimulating means  16 B has either or both of an electromagnetic stimulating means  26 B and a thermal exchange component  28 B. 
     First and second signal lines  20 A and  20 B are configured to deliver the signals generated by signal generator  12  to create the appropriate therapeutic stimulation via first and second stimulating means  16 A and  16 B. First and second signal lines  20 A and  20 B may be “wired,” such as with coaxial cable. Alternatively, a “wireless” connection means, such as Bluetooth, may be used. Although stimulation device  10  is shown as having two output ports  18 A and  18 B for simultaneously and independently delivering output signals (either the same or different signals) to two stimulating means  16 A and  16 B, one skilled in the art will appreciate that the number of output ports and stimulating means may be varied without departing from the intended scope of the implementations disclosed herein. Thus, embodiments of device  10  that include any number of stimulating means are contemplated. For example, in one alternative embodiment, the device  10  can have one stimulating means. 
     Power source  14 , which may be, for example, a lithium battery pack, is provided for delivering a current input to signal generator  12 . While shown in  FIG. 2  as a remote unit, power source  14  may be incorporated as part of or housed together with signal generator  12 . Since the embodiments may be designed with low power requirements, power source  14  may be one capable of providing an average power input of less than about 300 mW per session. As a result, power source  14  is generally small and lightweight. In an alternative embodiment, the device  10  has two power sources—one to supply power to the signal generator and another to supply power to create the thermal exchange. 
     As shown in  FIG. 2 , signal generator  12  may include voltage regulator  22  and microcontroller  24 . Furthermore, first stimulating means  16 A may include first electromagnetic stimulating means  26 A and first thermal exchange component  28 A, while second stimulating means  16 B may include second electromagnetic stimulating means  26 B and second thermal exchange component  28 B. In one embodiment, the first and second electromagnetic stimulating means  26 A,  26 B are first and second coils  26 A,  26 B. Voltage regulator  22  may be used to provide various required supply voltages to first and second electromagnetic stimulating means  26 A and  26 B. First and second electromagnetic stimulating means  26 A and  26 B may be triggered by microcontroller  24 , which may be designed to generate accurate pulses at a particular triggering and switching frequency. Output signals are delivered from microcontroller  24  to first and second stimulating means  16 A and  16 B, each of which is individually responsive to the signals to create a pulsed electromagnetic field. 
     As shown in  FIG. 2 , alternative embodiments of the device  10  may further include display  30  and monitoring means  32 . Display  30  may be designed to display many different treatment parameters, including but not limited to a treatment mode, a power level, and an amount of time remaining in a treatment session. 
     Monitoring means  32  may be designed for monitoring one or more of the output conditions of stimulation device  10 . In particular, monitoring means  32  may be configured to ensure that accurate treatment dosages are delivered through first and second stimulating means  16 A and  16 B to the patient&#39;s knee. One condition that may be monitored by monitoring means  32  is the electromagnetic field generated by first and second coils  26 A and  26 B. In particular, monitoring means  32  may include circuitry to both detect the strength of the electromagnetic field and adjust the signals delivered to the coils if the sensed field is not in accordance with the desired treatment level. A second condition that may be monitored by monitoring means  32  is tissue temperature generated by first and second thermal exchange component  28 A and  28 B. If, for example, monitoring means  32  senses a tissue temperature that is out of an acceptable range and poses a danger of injuring tissue around the knee, monitoring means  32  may communicate with the patient through display  30  to instruct removal of device  10  from the patient&#39;s knee. 
     For example, in one embodiment, monitoring means  32  may include a signal detector coupled to first stimulating means  16 A and/or second stimulating means  16 B for measuring the energy emission from first and second coils  26 A and  26 B. The signal detector may be designed so as to transmit a feedback signal to signal generator  12  for controlling the energy output. The actual electromagnetic energy field, or treatment dosage, that is transmitted from first and second stimulating means  16 A and  16 B may be measured directly by embedding the signal strength detector within the stimulating means. The signal level measured by the signal detector may then be sent to signal generator  12 , where it may be used as a feedback control signal to control the output signals of the generator. If, at any time, monitoring means  32  detects a field strength outside of the desired range of the treatment mode, display  30  may display an audible, visible, tactile, or other type of alarm to inform the patient and/or physician of a malfunction in the treatment mode. Furthermore, if the measured field strength is at or above a level that poses a risk of danger, the feedback circuit of monitoring means  32  may stop the treatment to ensure that the patient is not harmed. As will be appreciated by one skilled in the art, monitoring means  32  may alternatively or additionally include a temperature sensor and associated feedback control to sense and control tissue temperature around the patient&#39;s knee. 
     As shown in  FIG. 2 , device  10  may be connected to a computer system  34  to allow the physician to program treatment modes into microcontroller  24 . In this manner, the physician retains control over the type of treatment that the patient receives since device  10  may be designed such that only the physician is able to access and modify the programmed treatment modes. Through computer system  34 , the physician may also monitor the treatment conditions to ensure that, for example, the correct field strength is being generated. 
     In order to make treatment with stimulation device  10  more convenient for both the physician and the patient, telemetry means  36  may be incorporated into the device. In general, telemetry allows for the remote measurement and reporting of information of interest to a remote system or operator. In addition, telemetry allows for the remote operation and control of a device by allowing the operator to remotely send instructions to or program the device. 
     With respect to stimulation device  10 , telemetry means  36  enables the physician to remotely monitor the treatment as well as modify the treatment modes programmed into microcontroller  24 . In this way, the physician has the ability to control and prescribe treatment modes without the requirement of a face-to-face consultation with the patient, thus making treatment of osteoarthritis more convenient for both the patient and the physician. In one embodiment, telemetry means  36  may operate using wireless communication, such as by utilizing a radio frequency (RF) system to implement the data link between the device and remote system. However, telemetry means  36  may alternatively transfer data over other media, such as a telephone line, a computer network, or via an optical link. 
     Now that certain embodiments of the EMT 2  stimulation device have been generally described in reference to the block diagram illustration of  FIG. 2 , one exemplary embodiment of a stimulation device that may be worn by a patient for the treatment of osteoarthritis will be described. In particular,  FIG. 3  illustrates a stimulation device  110 , which generally includes a knee cuff  111 , a housing  131  in which a signal generator and a power source are positioned, a first stimulating means  116 A, a second stimulating means  116 B, and a fastening means  117 . The housing  131  can be positioned anywhere on the cuff  111 . The device  110  alternatively also has a display  130  that can display one or more treatment parameters, such as the treatment mode or the amount of treatment time remaining in a therapy session. In the embodiment depicted in  FIG. 3 , the display  130  is located on the housing  131 . Alternatively, the display  130  can be positioned in any location from which the display is visible to the user during use. Stimulation device  110  is a device for providing electromagnetic field stimulation and thermal therapy to a patient&#39;s body to promote healing. In particular, stimulation device  110  may provide pulsed electromagnetic field stimulation and thermal therapy (via first and second stimulating means  116 A and  116 B) to a knee joint suffering from the effects of osteoarthritis to promote healing of the knee. However, one skilled in the art will appreciate that various device embodiments disclosed herein may be useful to provide electromagnetic field stimulation and thermal therapy (EMT 2 ) to various other locations on a patient&#39;s body to promote healing or provide a therapeutic effect. 
     Knee cuff  111  includes main body portion  113 , first set of strap members  115 A, and second set of strap members  115 B. First set of strap members  115 A include first fastening members  117 A, while second set of strap members  115 B include second fastening members  117 B. As will be discussed in the following paragraphs, first fastening members  117 A are configured to mate with second fastening members  117 B in order to removably couple first set of strap members  115 A to second set of strap members  115 B and thus, to secure knee cuff  111  to the patient&#39;s knee. 
       FIGS. 4A and 4B  illustrate stimulation device  110  secured to the patient&#39;s knee, according to one embodiment. In particular,  FIG. 4A  illustrates a front side of the patient&#39;s knee, while  FIG. 4B  illustrates a back side of the knee. Knee cuff  111  of stimulation device  110  is wrapped around the knee such that first set of strap members  115 A having first fastening members  117 A overlap with second set of strap members  115 B having second fastening members  117 B to secure the cuff at the desired location on the knee. When properly secured to the knee, first stimulation means  116 A is positioned at a lateral knee location, while second stimulating means  116 B is positioned at a medial knee location. In one embodiment, first fastening members  117 A and second fastening members  117 B form a hook-and-loop fastening means, such as that commonly known as VELCRO®, wherein first fastening members  117 A are the “hook” portions and second fastening members  117 B are the “loop” portions. However, other means of fastening may be used including, but not limited to, buckles, snaps, and zippers. In alternate embodiments of knee cuff  111 , no fastening means is used. Instead, the fabric forming the wrap is capable of being stretched and is able to hold itself in place due to the elasticity of the wrap. 
       FIG. 5  is an exploded perspective view of stimulation device  110  according to a further embodiment. As shown in  FIG. 5 , first stimulating means  116 A includes first coil  126 A, first stimulating means holder  125 A, first stimulating means holder base plate  121 A, first thermal exchange component  128 A, and first stimulating means housing  119 A. First coil  126 A of first stimulating means  116 A is designed to be contained within the first stimulating means holder  125 A. The first stimulating means holder base plate  121 A provides a base for the first stimulating means holder  125 A to attach to in order to be joined to the knee cuff by means of any one of such exemplary attachment mechanisms as, but not limited to, an irreversible snap-fit hook mechanism, ultrasonic welding, or glue. In one embodiment, the first stimulating means holder base plate  121 A may be permanently attached to the knee cuff  111  by sewing, glue, or any known attachment means. First thermal exchange component  128 A is designed to be contained within first thermal stimulating means housing  119 A. Housing  119 A may then be enclosed on a back side by a thin plastic barrier  123 A formed from a material such as Tyvek®. The thin barrier  123 A can be attached to the housing  119 A by glue, heat seal, or a plastic snap-fit cover  118 A. First thermal exchange component  119 A is insertable into first stimulating means holder  125 A, which is coupled to knee cuff  111  as shown in the embodiment depicted in  FIG. 3 . 
     Although not shown in an exploded view like first stimulating means  116 A, second stimulating means  116 B includes similar components in a similar configuration. Thus, the discussion focuses on first stimulating means  116 A for purposes of example only, but applies equally to second stimulating means  116 B. As a result, second stimulating means  116 B includes similar components having similar reference numerals. 
     The signal generator  112  depicted schematically in  FIG. 5  includes a voltage regulator  122  and a microcontroller  124 , which control the signals transmitted through the wire harness  132  to first and second coils  126 A and  126 B to provide the pulsed electromagnetic field to the knee. The wire harness  132  is hidden within the different fabric layers of the knee cuff  111 . Power source  114 , which provides power to voltage regulator  122 , is positioned in the same housing that contains the signal generator means  112 . However, as discussed above, power source  114  may alternatively be positioned remotely from the signal generator means  112 . In a further alternative embodiment, two power sources are provided: one for the signal generator and one for the thermal exchange component. In yet another embodiment, three power sources are provided: one for the signal generator and one for each of the thermal exchange components. In one embodiment, the power sources for the thermal exchange components are single-use heating mixtures that provide energy when exposed to air. 
     First and second coils  126 A and  126 B are either unipolar or bipolar electromagnets that generate a magnetic field when electrical current flows through them. The magnetic field is created by passing an electric current through first and second coils  126 A and  126 B, which are preferably formed from a long wire strand coiled around a core. The “pulsed” electromagnetic field may be created by programming microcontroller  124  to turn the electromagnetic field on and off at a rapid rate. 
     Although first and second thermal exchange components  128 A and  128 B are not required components, incorporating them into first and second stimulating means  116 A and  116 B, respectively, may provide beneficial treatment results. In particular, when used in combination with electromagnetic therapy, thermal therapy is helpful in treating the effects of osteoarthritis and improving patient compliance. However, one skilled in the art will appreciate that embodiments of stimulation device  110  that apply only thermal therapy, only electromagnetic therapy, or a combination of both therapies are possible. As a result, the stimulation devices described herein may be tailored to the particular needs of different patients. 
     Heat is a natural remedy that may be used to both relieve pain and reduce discomfort. This is accomplished by stimulating the patient&#39;s thermoreceptors which, in turn, aid in blocking the pain sensation from reaching the brain by relaxing deep muscles to reduce tenderness and pain. In order to attain a therapeutic heat transfer effect including increases in tissue temperature, blood flow, muscle lengthening, and metabolism, an intramuscular temperature of about 104 degrees F. (40 degrees Celsius) must be reached. 
     Numerous types of heat sources may be utilized to provide beneficial heat therapy in accordance with various implementations. For example, first and second thermal exchange components  128 A and  128 B may be multi-use cartridges that require the patient to ‘re-heat’ the cartridges before every use, such as by placing the cartridges in the microwave. Alternatively, first and second thermal exchange components  128 A and  128 B may be one-time use cartridges that are designed to provide an irreversible exothermic reaction to provide a source of heat for a specified amount of time. In one embodiment, first and second thermal exchange components  128 A and  128 B are cartridges that contain iron, carbon, sodium chloride, sodium thiosulfate, and water. When the CLLHW compound is exposed to air, it undergoes an exothermic reaction that produces heat. In other embodiments, heat may be provided through: a resistive based heating source; selective insulation; or “warmth” radiated from the battery during operation. As will be appreciated by one skilled in the art, first and second thermal exchange components  128 A and  128 B may be heat sources designed such that they deliver heat therapy for any designated period of time ranging from a few minutes to the entire day. This designated period may or may not coincide with the electromagnetic field duration. In addition, first and second thermal exchange components  128 A and  128 B may be pulsed such that the heat therapy is not constant. 
     In one embodiment, power source  114  is a lithium-polymer battery, which may be either a single-use battery or a rechargeable, multi-use battery. If power source  114  is a rechargeable type battery, stimulation device  110  may be configured for attachment to a docking station for recharging the device. Alternatively, the docking station may be designed to receive only power source  114 , which may be made removable from stimulation device  110 . As one skilled in the art will appreciate, numerous other types of power sources may be used to provide the requisite power to stimulation device  110 . For example, stimulation device  110  may be designed to create power from the patient&#39;s body movements. Alternatively, stimulation device  110  may be powered through a chemical reaction with heat being the by-product. In this case, the heat by-product may provide the heat therapy to the knee joint. 
     As shown in  FIG. 5 , stimulation device  110  further includes display  130  for displaying one or more treatment parameters, such as the treatment mode or the amount of treatment time remaining in a therapy session. Display  130  may utilize many different types of indicator means such as, for example, a light source, a heat-sensitive material that changes color (as a function of elapsed time), a digital timer, or sound repetition. In addition, display  130  may function together with a monitoring means in order to transmit an audio, visual, or tactile-type message to the patient in response to the monitoring means sensing, for example, an electromagnetic field strength that is outside of that defined by the treatment mode. In this instance, display  130  is useful to instruct the patient to remove the stimulation device or to call his or her physician. 
       FIG. 6  is an enlarged illustration of the exploded perspective view of  FIG. 5 , according to one embodiment. In this embodiment, the stimulating means housings  119 A,  119 B as depicted in  FIG. 5  are insertable, replaceable units that can be easily and quickly inserted into and removed from the means holders  125 A,  125 B. In one embodiment, the stimulating means housings  119 A,  119 B have connections that, upon insertion into the holders  125 A,  125 B, couple with connections in the holders  125 A,  125 B to supply power to the housings  119 A,  119 B. 
       FIG. 6  depicts one embodiment of a stimulation device  110  with insertable stimulating means housings  119 A,  119 B. As shown in  FIG. 6 , the stimulation device  110  has a metal plate  140 A in the stimulating means housing  119 A and a first pair of stimulating means holder spring-loaded metal contacts  142 A. When the stimulation device  110  is assembled as shown in the embodiment of  FIG. 3 , the metal plate  140 A on the stimulating means housing  119 A is used to make an electrical connection with a pair of spring-loaded metal contacts  142 A in the first stimulating means holder  125 A. The protrusions  133 A on the stimulating means housing  119 A can slide in and out of the grooves  134 A on the stimulating means holder  125 A and engage in the notches  135 A to create a reversible mechanical snap-in feature that allows for secure insertion and removal of the housing  119 A to the stimulating means holder  125 A. In an alternative implementation, the metal plate  140 A in the stimulating means housing  119 A makes contact with the first pair of stimulating means holder magnets that are inserted into a first pair of magnet notches in first stimulating means holder  125 A for securing the housing  119 A to the first stimulating means holder  125 A. In a further alternative, instead of a metal plate, the stimulation device  110  can have a pair of stimulating means magnets and a corresponding pair of stimulating means holder magnets. 
     The first pair of stimulating means holder spring-loaded metal contacts  142 A are coupled to a corresponding pair of signal lines (not shown) in communication with signal generator  112 . When first stimulating means housing  119 A is positioned within first stimulating means holder  125 A, the electrical connection between the metal plate  140 A and the corresponding first pair of stimulating means holder spring-loaded metal contacts  142 A creates a closed circuit that electrically couples first stimulating means  116 A to signal generator  112 . As a result, signal generator  112  is able to communicate with first stimulating means  116 A to deliver the prescribed treatment signals defined by the treatment mode programmed into microcontroller  124 . 
     The embodiment of stimulation device  110  illustrated in  FIGS. 3-6  is a two coil arrangement with one coil on either side of the knee for generating the PEMF therapy. In general, voltage regulator  122  is used to provide a constant supply voltage to signal generator  112 , and first and second stimulating means  116 A and  116 B. Microcontroller  124  triggers first and second coils  126 A and  126 B, thereby generating accurate pulses at a particular triggering and switching frequency defined by the designated treatment mode stored in the microcontroller. The triggering frequency is defined as the rate at which a set number of pulses occur. The switching frequency is the fundamental frequency of the individual pulses. Another parameter called the switching duty cycle is defined as the ratio of the pulse width over the switching period. The voltage of the pulses is equivalent to the amplitude of the PEMF therapy. 
     The required penetration depth of the pulsed electromagnetic field generated by signal generator  112  and first and second stimulating means  116 A and  116 B may vary depending upon, for example, the size of the patient&#39;s knee region. However, for an adult patient, the penetration depth is generally in the range of about 1 cm to about 5 cm. Alternatively, the penetration depth is in the range of about 2 cm to about 4 cm. In a further alternative, the penetration depth ranges from about 2 cm to about 2.5 cm. This “penetration depth” parameter is necessary in order to estimate the magnetic field intensity needed to provide the therapy, which ultimately determines the power requirement of power source  114 . 
     In general, the magnetic field intensity generated by a coil is measured in terms of Tesla (T) and has the following approximate relationship with current flowing through the coil: 
             B   =             μ   0     ⁢     nIR   2         2   ⁢       (       R   2     +     x   2       )       3   /   2           ⟹   I     ⁢       2   ⁢           ⁢       B   ⁡     (       R   2     +     x   2       )         3   /   2             μ   0     ⁢     nR   2                 
where “B” is the magnetic field produced by the coil, “I” is the current through the coil, “R” is the radius of the coil, and “x” is the penetration depth of the PEMF.
 
     According to one embodiment, the magnetic field strength B applied to the target body part of the patient ranges from about 10 μT to about 2,000 μT. Alternatively, the magnetic field strength B ranges from about 20 μT to about 100 μT. In a further alternative, the magnetic field strength B ranges from about 30 μT to about 50 μT. In yet another alternative, the magnetic field strength B is about 40 μT. According to one embodiment, the magnetic field produced by the coil is applied perpendicular to the coil. 
     In one implementation, the magnetic field is applied into the knee for a distance ranging from about 1 cm to about 5 cm into the knee. Alternatively, the magnetic field is applied for a distance ranging from about 2 cm to about 4 cm into the knee. In a further alternative, the magnetic field is applied to a distance ranging from about 2 cm to about 2.5 cm into the knee. 
     The coil, in accordance with one embodiment, has 20 turns of a 24 AWG wire around a core with a radius of about 2 centimeters with a pulsed current 712 mA. Alternatively, the coil has 65 turns of a 28 AWG wire around a core with a radius of 1.5 cm with a pulsed current of 339 mA. 
     While a single-coil configuration is possible and within the intended scope of this application, the two-coil configuration uses about 20 times less power than the single-coil configuration because it requires a significantly smaller amount of energy to penetrate both the lateral and medial side of the knee. Furthermore, embodiments having more than two coils are also contemplated. 
     In one embodiment, the PEMF therapy is applied for period ranging from about 30 minutes to about 4 hours. Alternatively, the PEMF therapy is applied for a period ranging from about 1 hour to about 3 hours. In a further alternative, the therapy is applied from about 1.5 to about 2.5 hours. In yet another alternative, the therapy is applied for about 2 hours. Further, the optimal treatment window may vary depending upon many factors, including, but not limited to, the field intensity provided to the knee, the severity of the osteoarthritis in the knee, and the physical dimensions of the knee. 
     According to one implementation, the triggering frequency ranges from about 1 Hz to about 100 Hz. Alternatively, the triggering frequency ranges from about 5 Hz to about 50 Hz. In a further alternative, the triggering frequency ranges from about 10 Hz to about 20 Hz. In yet another alternative, the triggering frequency is about 15 Hz. 
     In accordance with one embodiment, the switching frequency ranges from about 50 Hz to about 100 kHz. Alternatively, the switching frequency ranges from about 300 Hz to about 70 kHz. In a further alternative, the switching frequency ranges from about 2 kHz to about 4 kHz. In yet another alternative, the switching frequency is about 3 kHz. 
     In general, in order to achieve the optimal therapeutic effect with the PEMF, a triggering frequency in the range of about 15 Hz and a switching frequency in the range of about 3 kHz are desirable, although other triggering and switching frequencies are also contemplated. 
     As one skilled in the art will appreciate based upon the above disclosure, stimulation device  110  does not require connection to any external hardware while delivering the prescribed therapy. Thus, stimulation device  110  is portable, and is designed such that it may be worn by the patient during their normal daily activities without discomfort. Knee cuff  111  may be both ergonomically designed and cosmetically appealing to increase patient compliance with wearing the device. 
     First and second stimulating means  116 A and  116 B may be designed as complete or partial disposable units that may be discarded and replaced after a predetermined number of treatments. For example, stimulating means housing  119 A, which may include first thermal exchange component  128 A and/or first coil  126 A, may be removed from stimulation means holder  125 A and disposed of by the patient upon expiration. Optionally, display  130  may instruct the patient when the units have expired and require replacement. The disposability feature of first and second stimulating means  116 A and  116 B may be advantageous because if one or more of the stimulating means stops functioning properly, it is only necessary to replace those components and not the entire stimulation device. 
     Another exemplary embodiment of an EMT 2  stimulation device is depicted in  FIG. 7 . The device  200  shown in  FIG. 7  has a PEMF generation component  202  and a thermal exchange component  204 . The PEMF generation component  202  is positioned between a first exterior layer  206  and a second exterior layer  208 . According to one embodiment, the first layer  206  has an adhesive component  210  on at least a portion of the side of the layer external to the device  200 . The adhesive component  210  is any known adhesive that allows for attaching the device  200  to the patient&#39;s skin. 
     In accordance with one implementation, the device  200  also has a power source (not shown) positioned in an external casing  212  positioned on the second layer  208 . In a further embodiment, certain electronic components can be positioned in the casing  212 . 
     Alternatively, the device  200  has two power sources (not shown)—one for the PEMF generation component  202  and one for the thermal exchange component  204 . Two different power sources can help to maximize battery life. Alternatively, one power source is provided for both the PEMF generation component  202  and the thermal exchange component  204 . In a further embodiment, one power source is provided for the PEMF generation component  202 , and the thermal exchange component  204  in this embodiment requires no power source, as explained in further detail below. According to one implementation, the single power source or both power sources are positioned in the external casing  212 . Alternatively, the single power source or both power sources are positioned between the first layer  206  and the second layer  208 . In a further alternative, one power source is positioned in the external casing  212  and one power source is positioned in between the first  206  and second  208  layers. 
     In one embodiment, one or both of the power sources are a single-use or disposable power source. Alternatively, the one or more power sources can be reusable or permanent power sources. In a further alternative, the power source is any known power source for use with a PEMF stimulation device and/or a thermal exchange component. 
     In one embodiment, the device  200  is a single-use patch-like device. Alternatively, the device  200  is a reusable device. As shown, the device  200  has a square shape. Alternatively, the device  200  can have a circular or round shape or any other known shape. For example, in one embodiment, the device  200  may have any shape that maximizes attachment to the patient&#39;s skin and patient comfort. 
     In this embodiment, the PEMF generation component  202  is a coil configured to generate the pulsed electromagnetic field. Alternatively, the PEMF generation component  202  can be any known component for generating a PEMF. 
     According to one implementation, the thermal exchange component  204  is a heat source such as, for example, a component having an exothermic chemical mixture. For example, the heat source in one embodiment is a mixture containing iron powder, water, activated charcoal, and salt that oxidizes in air to generate heat. One commercial example of such a mixture can be found in hand warming products sold by HeatMax®, which is located in Dalton, Ga. Another example of a heat source that can be used with the present embodiment is a mixture containing super-cooled sodium acetate. Yet another example is a mixture containing calcium chloride or magnesium sulfate and water. In a further alternative, the thermal exchange component can be any known component or device for generating heat. 
     In accordance with one implementation in which the thermal exchange component  204  is a heat source utilizing an exothermic chemical mixture, the component  204  does not require a power source. That is, the chemical mixture generates the exothermic reaction without the need for any battery or any other kind of power source. 
     Alternatively, the thermal exchange component  204  is a cooling source such as, for example, a component having an endothermic chemical mixture. For example, the cooling source can be a mixture containing ammonium nitrate and water. In a further alternative, the thermal exchange component  204  can be any known component for providing a temperature reduction. 
     In one implementation, the first and second exterior layers  206 ,  208  are flexible or pliable layers. The layer pliability or flexibility can, according to one embodiment, facilitate attachment of the device  200  to the patient&#39;s skin. In one alternative embodiment, one or both of the exterior layers can be gas permeable. In a further alternative, one or both of the exterior layers are permeable to oxygen. The layers  206 ,  208  can consist of a biocompatible membrane such as, for example, the Tegaderm™ and Medipore™ products available from 3M™ Company, located in St. Paul, Minn. 
     According to one embodiment, the adhesive component  210  is a hypoallergenic adhesive. In a further alternative implementation in which one or both of the exterior layers  206 ,  208  are gas permeable, the adhesive component  210  is a porous adhesive that allows gas to pass through the adhesive and the gas permeable layer. 
     It is understood that this device  200  can be used to treat any joint or any other body part that might benefit from treatment with PEMF and thermal exchange. In one embodiment, the target area is the knee. It is further understood that more than one device  200  could be used to treat a target area. The device  200  can be used to relieve osteoarthritis pain and increase range of motion. 
     One skilled in the art will appreciate that although the devices and methods have been described in reference to only a few embodiments of a stimulation device, these embodiments are provided for purposes of example and not limitation. Accordingly, numerous other embodiments are possible and within the intended scope. 
     Other Examples 
       FIG. 8  illustrates generally an example of an active knee system including a stimulation device  110 , the stimulation device  110  including a knee cuff  111  having a first layer  111 A and a second layer  111 B. In the example of  FIG. 8 , the active knee system includes a portable, battery operated, non-invasive shortwave diathermy medical device that applies electromagnetic energy for the treatment of medical conditions using means other than the generation of deep heat within body tissues (e.g., using athermal means). 
     In an example, the active knee system can be configured to deliver a pulsed RF signal to a target tissue via inductive coupling with applicator coils (e.g., a first coil  126 A and a second coil  126 B). In this example, the applicator coils are placed on either side of a knee (e.g., the medial and lateral areas of the knee joint) within the knee cuff  111  (e.g., between the first layer  111 A and the second layer  111 B). In other examples, the applicator coils can be placed in other locations about the knee cuff (e.g., depending on the desired target tissue) or one or more applicator coils can be placed in one or more locations within one or more other cuffs configured to be placed about one or more other parts of the body. 
     In an example, separate RF signal generators can be located proximate each applicator coil (e.g., within a stimulation means holder, proximate an applicator coil, or in certain examples, within the same sub-assembly as the applicator coil) to significantly reduce potential RF signal degradation in comparison to a system having multiple applicator coils separately routed, in some examples, substantially large distances, to a single RF signal generator. In other examples, separate RF signal generators can be assigned to a first group of applicator coils located in closer proximity than a second group of applicator coils. 
     In certain examples, one or more of the RF signal generators or the applicator coils can be controlled by a single microcontroller contained within a separate housing (e.g., a housing  131 ) removable from the knee cuff  111  (or one or more other cuff). The microcontroller can control the RF signal generators (e.g., on-state, off-state, etc.) using a low-speed power line. The combination of the RF signal generators located proximate the applicator coils and the separate microcontroller can allow complete modularization of the system (e.g., the one or more RF signal generators or applicator coils can be placed independently from the microcontroller). 
     The stimulation device  110  can include one or more disposable, single-use, air activated pods that provide heat or cold to a target tissue. In an example, the one or more pods can be snapped or otherwise attached into medial and lateral slots or holders on the knee cuff  111 . In various examples, treatment (e.g., PEMF therapy, or one or more of thermal therapy or electromagnetic therapy) can occur through dressings, clothing, casts, compression garments, supports, or one or more other barrier between the knee cuff  111  and the target tissue. Further, in certain examples, the pods (separately or in combination) can act as an activator switch that enables or turns on one or more portion of the PEMF therapy. 
     In an example, the PEMF therapy can include one or more of the following parameters: 1 W peak generator power; 4 mW average generator power; 3 V generator voltage; a voltage standing wave ration of approximately 1; 10 mA current; 27.12 MHz carrier frequency; 2 msec burst duration (e.g., 2 msec burst on, and 498 msec burst off); 2 Hz burst frequency; 50 Ohm standard load; etc. In other examples, the PEMF therapy can include one or more other parameters. 
     Although the example of  FIG. 8  illustrates generally an active knee system, one or more other systems configured to provide therapy to one or more other target areas are consistent with the teachings herein, such as an active ankle system, an active wrist system, etc. 
     Active Ankle System 
       FIG. 9  illustrates generally an example of an active ankle system including a stimulation device  110 , the stimulation device  110  including an ankle cuff  151  configured to be worn around an ankle, first and second stimulating means  116 A,  116 B configured to provide therapy to the ankle, and a housing  131  configured to store a microcontroller to control at least a portion of at least one of the first or second stimulating means  116 A,  116 B. In an example, the ankle cuff  151  can include fasteners, in this example, first and second straps  152 ,  153  configured to cross over the front of the ankle and securely fasten the ankle cuff  151  to the ankle. In an example, the fasteners can include hook and loop fasteners, or one or more other type of fastener. 
     The active ankle system can be configured to deliver PEMF therapy (e.g., a pulsed RF signal) to a target tissue using one or more applicator coils (e.g., first and second coils), as well as thermal therapy (e.g., heat therapy) using one or more disposable, single-use air activated pods, to a target area of the ankle. In an example, the first or second stimulating means  116 A,  116 B can include at least one of an applicator coil or a thermal pod. In an example, the PEMF or thermal therapies can be provided near the tibiotalar and talocalcaneal joints of the ankle, which are generally the most common places for arthritis in the ankle to occur. By positioning the applicator coils or the thermal pods at or near the tibiotalar and talocalcaneal joints of the ankle, treatment of both the commonly injured (e.g., when an ankle is rolled or sprained) posterior and anterior talo-fibular ligaments is possible. 
     In other examples, the PEMF or thermal therapies can be used to reduce post-surgical pain and edema in the ankle, as well as provide one or more other therapeutic benefits. Using the unique wrap design illustrated in  FIG. 9 , the ankle cuff  151  can be worn on either the left or right ankle and still provide therapy to the target locations of the ankle without producing different active ankle systems for each side. Further, the applicator coils or the thermal pods can be placed in one or more other locations about the ankle cuff  151  due to the modular design of the system, such as described above. 
     Active Back System 
       FIG. 10  illustrates generally an example of an active back system including a stimulation device  110 , the stimulation device  110  including a back wrap  161  configured to be worn around a back, stimulating means (e.g., first, second, third, and fourth stimulating means  116 A,  116 B,  116 C,  116 D, respectively) configured to provide therapy to the back, and a housing  131  configured to store a microcontroller configured to control at least a portion of at least one of the first, second, third, or fourth stimulating means  116 A,  116 B,  116 C,  116 D. In an example, the back wrap  161  can be positioned in place securely about the back using fasteners, such as hook and loop fasteners located at opposite ends of the back wrap  161 . 
     In an example, the active back system can be configured to deliver PEMF therapy (e.g., a pulsed RF signal) to a target tissue using one or more applicator coils (e.g., first and second applicator coils, or any other number of applicator coils), as well as thermal therapy (e.g., heat therapy) using one or more disposable, single-use air activated pods, to a target area of the back. In certain examples, the first through fourth stimulating means  116 A,  116 B,  116 C,  116 D, can include at least one of an applicator coil or a thermal pod. In an example, the PEMF or thermal therapies can be provided on one or more sides of the spine, in one or more areas of pain due to various reasons (e.g., surgery, arthritis, poor posture, etc.), such as the lumbar region of the back. 
     In an example, to reduce cost, but still provide therapy to the subject, a sub-set of stimulating means can include both the applicator coil and the thermal pod, while others include only a thermal pod (e.g., the lower stimulating means including applicator coils and thermal pods, and the upper stimulating means including only thermal pods, etc.). Further, the applicator coils or the thermal pods can be placed in one or more other locations about the back wrap  161  due to the modular design of the system, such as described above. 
     Active Elbow System 
       FIG. 11  illustrates generally an example of an active elbow system including a stimulation device  110 , the stimulation device  110  including an elbow cuff  171  configured to be worn around an elbow, first and second stimulating means  116 A,  116 B configured to provide therapy to the elbow, and a housing  131  configured to store a microcontroller configured to control at least a portion of at least one of the first or second stimulating means  116 A,  116 B. In an example, the elbow cuff  171  can be worn around the elbow, secured in place by fasteners (e.g., hook and loop fasteners located at ends of the elbow cuff  171 ) in a similar fashion as the active knee system is secured around the knee. 
     In an example, the first or second stimulating means  116 A,  116 B can include at least one of an applicator coil or a thermal pod. In an example, the PEMF and thermal therapies can be provided near the medial and lateral sides of the elbow, in certain examples, providing treatment over the lateral epicondyle to treat one or more injuries or condition, such as tennis elbow, etc. 
     In other examples, the PEMF and thermal therapies can be used to reduce post-surgical pain and edema in the elbow, as well as provide one or more other therapeutic benefits. Using the unique wrap design illustrated in  FIG. 11 , the elbow cuff  171  can be worn on either the left or right elbow and still provide therapy to the target locations of the elbow without producing different active elbow systems for each side. Further, the applicator coils or the thermal pods can be placed in one or more other locations about the elbow cuff  171  due to the modular design of the system, such as described above. 
     Active Wrist System 
       FIG. 12  illustrates generally an example of an active wrist system including a stimulation device  110 , the stimulation device  110  including a wrist cuff  181  configured to be worn around a wrist, first and second stimulating means  116 A,  116 B configured to provide therapy to the wrist, and a housing  131  configured to store a microcontroller configured to control at least a portion of at least one of the first or second stimulating means  116 A,  116 B. In an example, the wrist cuff  181  can be worn by placing the thumb through the hole in the wrist cuff  181  and wrapping the wrist cuff  181  around the wrist. In an example, the wrist cuff  181  can include fasteners, in this example, first and second straps  182 ,  183 . In an example, the fasteners can include hook and loop fasteners, or one or more other type of fastener. 
     In an example, the first or second stimulating means  116 A,  116 B can include at least one of an applicator coil or a thermal pod. In an example, the PEMF and thermal therapies can be provided near the medial and lateral areas of the wrist, in certain examples, providing treatment at or near the basal joint, a common location of arthritis. Further, by positioning the applicator coils or the thermal pods at or near the basal joint, treatment over the two collateral ligaments in the wrist is possible. 
     In other examples, the PEMF or thermal therapies can be used to reduce post-surgical pain and edema in the wrist, as well as provide one or more other therapeutic benefits. Using the unique wrap design illustrated in  FIG. 12 , the wrist cuff  181  can be worn on either the left or right wrist and still provide therapy to the target locations of the wrist without producing different active wrist systems for each side. Further, the applicator coils or the thermal pods can be placed in one or more other locations about the wrist cuff  181  due to the modular design of the system, such as described above. 
       FIG. 13  illustrates generally an example of an active wrist system including a stimulation device  110 , the stimulation device  110  including a wrist cuff  191  configured to be worn around a wrist, first and second stimulating means  116 A,  116 B configured to provide therapy to the wrist, and a housing  131  configured to store a microcontroller configured to control at least a portion of at least one of the first or second stimulating means  116 A,  116 B. In this example, the thumb can be pushed through the appropriate thumb hole and first and second straps  192 ,  193  can be adjusted to secure the wrist cuff  191  in place using fasteners, such as hook and loop fasteners, or one or more other fasteners. In an example, the wrist cuff  191  can secure the stimulation first and second stimulating means  116 A,  116 B over the center of the wrist, allowing the therapy to penetrate deep within the wrist. 
     In other examples, the PEMF or thermal therapies can be used to reduce post-surgical pain and edema in the wrist, as well as provide one or more other therapeutic benefits. Using the unique wrap design illustrated in  FIG. 13 , the wrist cuff  191  can be worn on either the left or right wrist and still provide therapy to the target locations of the wrist without producing different active wrist systems for each side. Further, the applicator coils or the thermal pods can be placed in one or more other locations about the wrist cuff  191  due to the modular design of the system, such as described above. 
     Additional Notes 
     The above detailed description includes references to the accompanying drawings, which form a part of the detailed description. The drawings show, by way of illustration, specific embodiments in which the invention can be practiced. These embodiments are also referred to herein as “examples.” Such examples can include elements in addition to those shown or described. However, the present inventors also contemplate examples in which only those elements shown or described are provided. Moreover, the present inventors also contemplate examples using any combination or permutation of those elements shown or described (or one or more aspects thereof), either with respect to a particular example (or one or more aspects thereof), or with respect to other examples (or one or more aspects thereof) shown or described herein. 
     All publications, patents, and patent documents referred to in this document are incorporated by reference herein in their entirety, as though individually incorporated by reference. In the event of inconsistent usages between this document and those documents so incorporated by reference, the usage in the incorporated reference(s) should be considered supplementary to that of this document; for irreconcilable inconsistencies, the usage in this document controls. 
     In this document, the terms “a” or “an” are used, as is common in patent documents, to include one or more than one, independent of any other instances or usages of “at least one” or “one or more.” In this document, the term “or” is used to refer to a nonexclusive or, such that “A or B” includes “A but not B,” “B but not A,” and “A and B,” unless otherwise indicated. In the appended claims, the terms “including” and “in which” are used as the plain-English equivalents of the respective terms “comprising” and “wherein.” Also, in the following claims, the terms “including” and “comprising” are open-ended, that is, a system, device, article, or process that includes elements in addition to those listed after such a term in a claim are still deemed to fall within the scope of that claim. Moreover, in the following claims, the terms “first,” “second,” and “third,” etc. are used merely as labels, and are not intended to impose numerical requirements on their objects. 
     Method examples described herein can be machine or computer-implemented at least in part. Some examples can include a computer-readable medium or machine-readable medium encoded with instructions operable to configure an electronic device to perform methods as described in the above examples. An implementation of such methods can include code, such as microcode, assembly language code, a higher-level language code, or the like. Such code can include computer readable instructions for performing various methods. The code may form portions of computer program products. Further, the code can be tangibly stored on one or more volatile or non-volatile tangible computer-readable media, such as during execution or at other times. Examples of these tangible computer-readable media can include, but are not limited to, hard disks, removable magnetic disks, removable optical disks (e.g., compact disks and digital video disks), magnetic cassettes, memory cards or sticks, random access memories (RAMs), read only memories (ROMs), and the like. 
     The above description is intended to be illustrative, and not restrictive. For example, the above-described examples (or one or more aspects thereof) may be used in combination with each other. Other embodiments can be used, such as by one of ordinary skill in the art upon reviewing the above description. The Abstract is provided to comply with 37 C.F.R. §1.72(b), to allow the reader to quickly ascertain the nature of the technical disclosure. It is submitted with the understanding that it will not be used to interpret or limit the scope or meaning of the claims. Also, in the above Detailed Description, various features may be grouped together to streamline the disclosure. This should not be interpreted as intending that an unclaimed disclosed feature is essential to any claim. Rather, inventive subject matter may lie in less than all features of a particular disclosed embodiment. Thus, the following claims are hereby incorporated into the Detailed Description, with each claim standing on its own as a separate embodiment, and it is contemplated that such embodiments can be combined with each other in various combinations or permutations. The scope of the invention should be determined with reference to the appended claims, along with the full scope of equivalents to which such claims are entitled.