MULTI-JOINT SYSTEM PRO Setup and Operation Manual Rev B Aug 2014

BIODEX SYSTEM PRO

This manual contains installation and operation procedures for the following Biodex products: #850-000 #850-000-10 #850-000-30

Biodex Multi-Joint System, PRo Biodex Multi-Joint System, JPN Biodex Multi-Joint System, w/o CMP

NOTE: All or some of the following symbols, cautions, warnings and notes may apply to your Biodex PRO and correspond to this operation manual: Symbol

Meaning

!

Attention, consult accompanying documents.

!

Symbol signification: Attention, se référer à la notice.

!

Warning: Injuries to health may result from incorrect or excessive training.

!

Attention, incorrect ou extrême entrainement peut aboutir des lesíons au santé.

NOTE: Circuit diagrams for this product are available upon request.

- II -

TABLE OF CONTENTS INTRODUCTION ...IV BEFORE PROCEEDING ...V 1. CONTROLS AND ADJUSTMENTS ...1-1 Dynamometer...1-4 Positioning Chair ...1-7 Seat Back Brace...1-7 Controller ...1-8 Dynamometer Attachments ...1-9 Using the Combination Ankle Attachment (for All Ankle Patterns and Knee: Tibial Internal/External Rotation) ...1-11 2. OPERATION ...2-1 Considerations for Safe Operation of Your Biodex Multi-Joint System ...2-1 Readying the System for Use ...2-3 Modes of Operation...2-3 Additonal Considerations ...2-8 Proper Testing Technique...2-8 3. SETUP AND POSITIONING FOR STANDARD TEST AND EXERCISE PATTERNS ...3-1 Knee Extension/Flexion ...3-2 Ankle Plantar/Dorsiflexion (Seated) ...3-6 Ankle Inversion/Eversion ...3-10 Hip Abduction/Adduction (Lying on Side) ...3-13 Hip Extension/Flexion (Supine) ...3-16 Shoulder Extension/Flexion (Seated)...3-19 Shoulder Abduction/Adduction (Seated) ...3-22 Shoulder Internal/External Rot. in Modified Neutral Position ...3-25 Shoulder Internal/External Rot. in 90-Degrees of Abduction ...3-28 Shoulder Diagonal (Seated) ...3-31 Shoulder Diagonal (Standing) ...3-34 Elbow Extension/Flexion ...3-37 Forearm Pronation/Supination ...3-40 Wrist Extension/Flexion...3-43 Wrist Radial/Ulnar Deviation ...3-46 4. USING ThE OPTIONAL CLOSED ChAIN ATTAChMENT ...4-1 Introduction ...4-1 Setup Procedure ...4-2 Upper Extremity Exercise...4-4 Lower Extremity Exercise...4-4 Applications ...4-5 Technical Information ...4-8 5. REFERENCE MATERIALS ...5-1 Suggested Test Speeds ...5-1 Legal Precedents ...5-2 Biodex Data Admitted as Medical Evidence in Court ...5-2 Patient Progress Chart ...5-3 Current Recorded Normative Goals (English Units) ...5-4 Current Recorded Normative Goals (Metric Units) ...5-5 6. APPENDICES ...6-1 EMG/Analog Signal Access Interface ...6-1 Maintenance ...6-4 System Specifications ...6-5 Conformance to Standards...6-7 Declaration of Conformity ...6-8 Recommended Separation Distance ...6-10 General Product Warranty ...6-11 - III -

TABLE OF CONTENTS

INTRODUCTION Congratulations, you’ve made an excellent choice! By selecting the Biodex Multi-Joint System you have acquired the most advanced, versatile and reliable technology ever developed for testing and rehabilitation of the human musculoskeletal system. You’ve also joined the Biodex team of satisfied customers who benefit from unsurpassed product education, customer service, promotional and clinical support. With your new system, you can offer testing and rehabilitation services for the knee, ankle and hip plus the shoulder, elbow, forearm and wrist. Modes of operation for exercise and testing include Isokinetic, Passive, Isometric, Isotonic and Reactive Eccentric. What’s more, you’ll be able to test and exercise over the broadest range of speeds available today. Biofeedback is provided by the high resolution color graphics monitor to encourage patient compliance with exercise protocols. You’ll also appreciate the Windows-based Biodex Advantage Software touch screen package that comes with your system. Our patient database prompts quick and easy retrieval of patient information while Windows flexibility makes protocol selection and patient setups a snap. The wide variety of output reports allows numeric and graphic information to be printed in a number of different formats. Third party payers and referring physicians receive information that is complete but not overwhelming. The versatility of the Biodex Multi-Joint System facilitates effective treatment of a broad range of patients and pathologies. If you add the Back, Lift and Work Simulation options, your Biodex Multi-Joint System is transformed into a comprehensive clinic. The future certainly looks bright for you and your patients! Thank you for allowing Biodex Medical Systems, Inc., to be a part of it.

NOTE: PRODUCT ENHANCEMENTS AND MODIFICATIONS Due to on-going product enhancements and modifications, the Biodex Multi-Joint System you have purchased may differ slightly from the system depicted in the photographs and illustrations used in this manual.

INTRODUCTION

- IV -

BEFORE PROCEEDINGTABLE OF CONTENTS

!

Before you get started with any of the setups described in this manual, there are a few preliminary points to consider which will help ensure safe and smooth operation of your Biodex Multi-Joint System. • This system should be operated only by qualified personnel. • Ensure that all system wiring and cables are routed away from any area where they might be stepped on or rolled over by wheeled equipment. • For testing and exercise patterns in which the positioning chair will be used, we suggest the chair be set to its minimum height before allowing a subject to mount or dismount. It may also help to have a fixed location from which all subjects approach and leave the chair. • Be aware that use of Biodex technology requires professional expertise for discerning appropriate treatment techniques. Each subject’s unique situation should be taken into account before beginning any type of testing or rehabilitation program. Be sure you fully comprehend the operating instructions, as well as the considerations, both physical and clinical, discussed throughout the manual before attempting to set up a subject for testing or exercise. Practice setups and positioning with a healthy subject before attempting to set up an injured patient. • Instructions for each of the patient setups provided later in this manual assume that the clinician is starting with the system in its neutral position, as illustrated in Figure 1.1. • To assist our users and stimulate interest in developing protocols, this manual contains a ”Clinical Applications” section where appropriate. These comments come from the clinical experience of our users as well as from published journals. • The setups presented in this manual are intended to cover most patient protocols. However, because the Biodex Multi-Joint System is so versatile and adaptable, you may find additional setups possible. It is suggested that the clinician try the setups presented herein before attempting any setup improvisations (especially for testing applications). If you do use a pattern that deviates from the manual, be sure to fully document it in your “Patient File” notes. Placing your hands or fingers between the dynamometer input shaft (or ! CAUTION: attachment) and the mechanical ROM stops may result in serious injury.

NOTE: Service should be provided by qualified personnel only. Please do not attempt installation or repair on your own. Call Biodex Customer Service first, they’ll be glad to help. For additional technical advice, service or educational information, contact Biodex personnel at the following address: Biodex Medical Systems, 20 Ramsey Road, Shirley, New York 11967-4704. In New York and Int’l, (631) 924-9000, 1 (800) 224-6339 (Customer Service), FAX: (631) 924-8355

-V-

BEFORE PROCEEDING

X

Figure 1.1. The Biodex Multi-Joint System - PRO positioning configuration.

- VII -

BEFORE PROCEEDING

1. CONTROLS AND ADJUSTMENTS

2 13 14 12

10 5

BIODEX

1

HOLD / RESUME

9

COMFORT STOP

11 3

6

7

8

4 Figure 1.2. Dynamometer positioning controls and adjustments. 1. Dynamometer Rotation Knob 2. Dynamometer Tilt Knob 3. Dynamometer Height Lever 4. Dynamometer Foot Pedals (travel) 5. Shaft Red Dot (on dynamometer shaft) 6. Rotate Counterclockwise Button 7. Rotate Clockwise Button 8. Hold/Resume Button 9. Comfort Stop 10. Dynamometer Locking Knob Storage 11. Dynamometer Position Color Code Label 12. Dynamometer Yoke 13. Dynamometer Tilt Scale 14. Dynamometer Tilt Key DYNAMOMETER (Refer to Figure 1.2.) Dynamometer Rotation: To rotate the dynamometer in a horizontal plane, loosen the Dynamometer Rotation Knob by turning it counterclockwise. You may now rotate the dynamometer in either direction. To secure the dynamometer rotation position, tighten the knob in a clockwise direction and ensure that the dynamometer teeth are engaged. Use the Dynamometer Rotation Scale, located on the base of the dynamometer directly beneath the yoke, to note the new position.

CONTROLS AND ADJUSTMENTS

- 1-1 -

9

SYSTEM SPECIFICATIONS

0 0 50 50 5

(Dynamometer Tilt Degrees)

Dynamometer Tilt: Permits rotation of the dynamometer on a vertical plane allowing the shaft axis to tilt upward or downward from the horizontal position. To tilt the dynamometer, support the dynamometer with one hand. With the other hand, loosen the Dynamometer Tilt Knob in a counterclockwise direction. You can now gently push or pull the dynamometer to the desired position. Tighten the knob firmly in a clockwise direction, and ensure that the dynamometer teeth are engaged, to secure the dynamometer in place. Use the Dynamometer Tilt Scale (located on the yoke) to note the new dynamometer tilt position. Use the Dynamometer Tilt Key (located on directly beneath the Dynamometer Tilt Scale for a quick reference during patient set-up.

Dynamometer height: The dynamometer can be raised or lowered over a range of 14”. Loosen the Dynamometer Height Handle by turning it counterclockwise and simply apply hand pressure to the top or underside of the dynamometer to respectively raise or lower it. Retighten the handle to lock the dynamometer in position. Use the Dynamometer Height Scale, located on the dynamometer mounting post, to note the new dynamometer height. NOTE: The weight of the dynamometer is counterbalanced by a pneumatic assembly in the mounting post. When the locking handle is loosened, the dynamometer may tend to gently rise or fall, depending on the weight of attachments affixed to the dynamometer shaft. After proper height is established, always secure the locking handle. Dynamometer Travel: The dynamometer Foot Pedals allow the dynamometer to move along the travel in a horizontal plane left or right of the positioning chair. To move the dynamometer, press down on either foot pedal and slide the dynamometer to the desired location. Release the foot pedal to lock the dynamometer in place. To ensure stability, check that the dynamometer is fully locked in a detent (i.e., try to shake the dynamometer). Use the Dynamometer Position Scale on the travel to note position.

!

Shaft Red Dot (dynamometer shaft): The small red dot on the end of the dynamometer shaft provides an index for proper alignment of attachments on the dynamometer setup. When affixing any attachment to the dynamometer shaft, position the attachment so that its dot for the side to be exercised aligns with the dynamometer shaft red dot. Failure to properly align the dots may result in a reduced range of motion.

!

Point Rouge Sur L'Axe Du Dynamometre. Le point rouge situé sur l'axe du dynamomètre fournit une indication pour l'alignement correct de l'accessoire pendant le montage. Positionner l'accessoire de telle sorte que le point rouge de l'accessoire s'aligne avec le point rouge du dynamomètre. Un mauvais alignement peut entraîner une r´duction de l'amplitude.

- 1-2 -

CONTROLS AND ADJUSTMENTS

ASSEMBLY AND INSTALLATION Rotate Clockwise/Counterclockwise: The Rotate buttons atop the dynamometer allow the dynamometer shaft to be moved by pressing (and holding) the Rotate button corresponding to the direction the shaft must turn. This function of the Rotate buttons has no effect on the range of motion limits previously established in Setup Mode. hold/Resume: Stops shaft rotation. Press this button a second time to resume the test or exercise session. One Hold/Resume button is located atop the dynamometer next to the Comfort Stop. A second Hold/Resume button is activated by a hand-held remote located to the right of the control panel on the Clinical Data Station (CDS) cart.

!

Comfort Stops (Dynamometer, Remote): These buttons provide the subject with the ability to instantaneously terCOMFORT STOP minate exercise in any mode. Depressing either the large red button atop the dynamometer or the hand-held remote button causes immediate cessation of dynamometer shaft rotation. The principal purpose of this control is to guard against moving the subject into a portion of the range of motion that, for any reason, is contraindicated. It should be noted that activating a comfort stop after the onset of discomfort will result in a stoppage of movement while the subject is still in the undesirable portion of the range. Should this occur in Isokinetic or Isotonic mode, with concentric contractions selected, the operator should immediately press the Stop button on the control panel, then press Start to free the shaft and allow rotation toward a more comfortable point in the subject’s ROM. (With the shaft free, the operator should manually place the subject in a position such that the limb will not move in the direction of gravity.)

! !

CAUTION: Extra consideration is required for resuming dynamometer shaft rotation in the Passive or Reactive Eccentric mode as the patient may be assisted further into a painful portion of the ROM. In this case, remove the patient immediately from the attachment by releasing the Velcro® cuff. ATTENTION: Redoubler de précautions pour reprendre la rotation de l’arbre du dynamomètre en mode Passif ou Réactif Excentrique. Le patient pourrait se retrouver assisté encore plus loin dans la partie douloureuse de l’amplitude du mouvement. En pareil cas, retirer le patient de l’accessoire en détachant la manchette en Velcro®. L'objectif principal des ces commutateurs est d'éviter au sujet d'entrer dans une amplitude de mouvement contre-indiquée quelle qu'en soit la raison. L'utilisation de l'arrêt d'urgence peut laisser le sujet à l'intérieur d'une amplitude inconfortable: dans ce cas, il faut des uite passer en mode isocinétique ou isotonique; appuyer sur les boutons stop et start dans l'ordre sur le panneau du contrôleur pour libérer l'axe de rotation et placer le membre dans une position confortable; il faut tenir le membre pour cette manipulation pour contrôler les effets de gravité.

!

ATTENTION: Une attention particuliére doit être appliquéc avant de remettre en marche le dynamomètre dans le mode passif ou excentrique puisque le patient peut être porté à nouveau dans une amplitude douloureuse. Educating the subject about the use of the Comfort Stops (prior to exercise) also serves to improve confidence and motivation by reducing apprehension regarding the equipment. NOTE: As a safety precaution, the system will not function in any mode if the Remote Comfort Stop is not connected to the dynamometer.

CONTROLS AND ADJUSTMENTS

- 1-3 -

X Dynamometer Position Color Code 1 2 3 3 4 4 5 Label: Located on the Dynamometer Yoke Pivot Plate, the Dynamometer Position Color Code Label helps the user to quickly position the dynamometer according to the pattern selected. Rotate the dynamometer to the yellow color code positions when setting up to test or exercise the patient’s left side. Rotate the dynamometer to the blue color code positions for right side testing or exercise. Patterns that use the same positioning for both sides utilize the green color code areas. ▲

▲

▲

▲

▲

▲

▲

POSITIONING ChAIR (See Figure 1.3.) Seat Rotation: The positioning chair offers 360 degrees of rotation in the horizontal plane with detente settings at 15-degree intervals. To rotate the seat in either direction, turn the Seat Rotation Handle toward the rear of the seat. The Seat Rotation Handle is located beneath the seat between the forward receiving tube and forward buckle. While holding the Seat Rotation Handle, swivel the seat to the desired position. Release the handle to lock the seat in place, making sure the seat sets in the appropriate detente. Note the seat rotation position on the Seat Rotation Scale, located beneath the seat on the seat post. Chair Foot Pedals: The Chair Foot Pedals allow fore/aft adjustment of the positioning chair in relation to the dynamometer. To move the chair along the travel, press down on either foot pedal and slide the chair to the desired location. Release the foot pedal to lock the chair in place. To ensure stability, check that the chair is fully locked in a detente. Use the Chair Position Scale, located on the travel, to note the new position. Seatback Tilt: This adjustment allows the user to select any of five seatback angle settings: 85, 70, 55, 40 and 25 degrees. To adjust the seatback tilt, pull up on one of the Seatback Tilt Handles, located on either side of the lower seatback frame. You may now adjust the seatback to the desired angle. Release the handle and ensure that it locks into the selected detente. Record the new seatback tilt angle from the Seatback Tilt Indicator, located at the bottom on either side of the seatback frame.

➡

➡

Seat height: The motorized seat may be automatically raised or lowered over a range of 14 inches. To adjust the seat height, step down on the or Seat Height Foot Switches, located at the rear base of the chair. NOTE: The seat may be raised or lowered with the subject seated. Ensure, however, that all wires are clear and the patient is not strapped to any attachment before you begin to raise or lower it.

- 1-4 -

CONTROLS AND ADJUSTMENTS

X Seatback Fore/Aft: Crank the Seatback Fore/Aft Handle, located at the back of the seatbase, in a counterclockwise direction to move the seatback forward on the seat. Crank the handle in a clockwise direction to move the seatback toward the rear of the seat. Record the new fore/aft position from the Seatback Fore/Aft Scale, located along each side of the seat frame near the back belt buckle. Cervical Support: To reposition the Cervical Support, use one hand to hold the support so it will not slip down. With your free hand, turn the Cervical Support Locking Knob in a counterclockwise direction until loose. Lift up or push down on the support until the desired position is achieved. Turn the locking knob in a clockwise direction until tight to secure the support in place. NOTE: Be sure to support the Cervical Support with one hand before loosening the locking knob. If you do not support the Cervical Support, it may slide down and pinch your hand as you loosen the knob. Stabilization Straps: The Positioning Chair is fitted with a Thigh Strap and buckle (secured toward the front on each side of the seat frame), a Pelvic Strap and buckle (secured directly beneath the Seatback Tilt handle on the seat back frame,) and a pair of Shoulder Straps and buckles (secured toward the back on each side of the seat base) To secure any strap, lift the buckle handle, insert the strap into the buckle and pull until tight but not uncomfortable for the patient. Press the buckle handle all the way down to secure. Receiving Tubes: There are four receiving tubes located on the seat. Two are positioned at the front of the seat, left and right of center. The remaining two tubes are located one on each side of the seat. These tubes receive the T-Bar, Limb Support Pad and Footrest. Each receiving tube has a locking knob. To loosen the knobs, turn them counterclockwise. To tighten the knobs, turn them clockwise. Stabilization handles: Located on the side receiving tubes, these handles can be used by the patient for added support, stabilization, and consistent hand positioning during exercise and rehabilitation sessions. They should not be used during test session. These stabilization handles are also convenient for the clinician as a means to pull or push the chair fore or aft on the T-base.

CONTROLS AND ADJUSTMENTS

- 1-5 -

CONTENTS

5 8 6 Figure 1.3. Positioning Chair adjustments: 1. 2. 3. 4. 5. 6. 7. 8.

Seat Rotation Handle Receiving Tubes Chair Foot Pedals Seat Height Foot Switches Cervical Support Adjustment Knob Seatback Tilt Handle Seatback Fore/Aft Handle Stabilization Handles

7 2 1

4

3

3 Figure 1.4. Positioning Chair attachments: 1. T-Bar Adapter 2. Footrest 3. Limb-Support Pad

CONTROLS AND ADJUSTMENTS

2 1

- 1-6 -

CLINICAL CONSIDERATIONS SEAT BACK BRACE The Seat Back Brace is designed to provide added stability when the seat back is used in a lowered position at zero degrees seat rotation for side lying, supine and prone patterns (particularly of the hip). The Seat Back Brace is adjustable and simple to use. Once installed, set-up takes only seconds.

INSTALLATION (See Figures 1.5 - 1.7.) 1. Ensure the seat back is in the up position. Rotate the seat to 0 degrees on either side of the seat rotation scale. 2. Line up one rod-end swivel of the Seat Back Brace with the clevis on the seat back and insert the clevis pin. 3. Release the seat back handle and lower the seat back to “10” on the seat back tilt scale. 4. Loosen the seat back brace locking knob. Extend the lower part of the brace and insert the rod-end swivel into the trolley mount clevis. Insert the clevis pin.

Figure 1.5. Attaching the Seat Back Brace to the Multi-Joint System seat back clevis.

5. Position the patient per protocol, then lock the Seat Back Brace locking knob to secure. Be sure to loosen the seat locking knob when adjusting the height of the seat or the position of the seat back. 6. To rotate the seat to the opposite 0 degree position, disconnect the lower end of the back only. Repeat steps four and five.

Figure 1.6. Attaching the Seat Back Brace to the Multi-Joint System trolley mount clevis

Figure 1.7. Seat Back Brace installed and ready for use. - 1-7 -

CONTROLS AND ADJUSTMENTS

CONTENTS ThE CONTROLLER (Located at the bottom, rear, of Computer Data Station) (See Figure 1.8 - 1.9) Main Power Switch Controls main power supply to controller, computer and dynamometer. Contains a circuit breaker to protect against extreme power surges. Breaker is reset by turning the Power Switch OFF (0) and then ON (l). NOTE: It is not necessary to turn the system OFF each day. Use the Dynamometer and Computer Power Switches described below for daily shut-down. Use the Main Power Switch only if you intend to shut the system down for an extended period of time. Dynamometer Power Switch This switch controls power to the dynamometer. In the ON position, power to the dynamometer is enabled. In the OFF position, the dynamometer is on Standby. Computer Power Switch Controls power to the computer and peripherals (including printer and monitor). In the ON position, power to computer, monitor and printer are ON. In the OFF position, power to the computer, monitor and printer are OFF. NOTE: Be sure to properly exit and close down the Biodex Advantage Software application and Windows Programs before turning off the computer. CPU ON/OFF Switch Use this switch to turn the CPU ON/OFF. Status/Diagnostics Panel (LEDs) This panel provides information to assist in troubleshooting of dynamometer/control panel problems. In the event of a system malfunction, always be sure to record which LEDs light before attempting to correct a problem or restart the system. Contact a Biodex Service Representative whenever the status panel indicates a malfunction.

5 4 1

2 3

Figure 1.8.

Figure 1.9.

Figures 1.8 and 1.9. The Biodex Multi-Joint System Controller front panel (left) and rear of unit (right). 1. Main Power Switch 2. Dynamometer Power Switch 3. Controller Power Switch 4. Status/Diagnostics Panel (LED’s) 5 CPU ON/OFF Switch CONTROLS AND ADJUSTMENTS

- 1-8 -

CONTENTS DYNAMOMETER ATTAChMENTS

Shoulder/Elbow Adapter

Figure 1.10. Shoulder Attachment (Insert in Shoulder/Elbow Adapter) Patterns: Shoulder:

Ex/Flex Ab/Ad Diagonals

Shoulder Attachment

Figure 1.11. Shoulder/Elbow Attachment (Insert in Shoulder/Elbow Adapter) Patterns: Shoulder: Elbow:

In/Ex Rotation Ex/Flex (remove cuff)

NOTE: Only one Shoulder/Elbow Adapter is supplied. The same adapter is used with the Shoulder Attachment and Shoulder/Elbow Attachment.

Shoulder/Elbow Shoulder/Elbow Adapter Attachment

Figure 1.12. Knee Attachments (Left and Right) Patterns: Knee: Ankle:

Tibial In/Ex Rotation Plantar/Dorsiflexion Inversion/Eversion

Knee Attachment

!

NOTE: Ensure finger guard is in place when using this attachment. See Figure 1.16.

!

NOTA: S’assurer que le doigtier est bien en place lorsqu’on utilise cet accessoire. Voir figure 1.16.

Figure 1.13. Wrist Attachment Patterns: Wrist: Forearm:

Knee Adapter

Wrist Attachment

Ex/Flex Radial/Ulnar Deviation Pro/Supination

Wrist Adapter

- 1-9 -

CONTROLS AND ADJUSTMENTS

CLINICAL CONSIDERATIONS Figure 1.14. Hip Attachments (Left and Right) Patterns: Hip:

Ab/Ad Ex/Flex

!

NOTE: Ensure finger guard is in place when using this attachment. See Figure 1.16.

!

NOTA: S’assurer que le doigtier est bien en place lorsqu’on utilise cet accessoire. Voir figure 1.16.

Figure 1.15. Combination Ankle Attachment Patterns: Ankle:

Plantar/Dorsi Flexion Inversion/Eversion

NOTE: See "Using The Combination Ankle Attachment (next section).

Figure 1.16. Finger Guard positioned correctly on dynamometer for Knee and Hip attachments. Patterns: Knee:

Ex/Flex

!

CAUTION: Placing your hands or fingers between the dynamometer input shaft (or attachment) and the mechanical ROM stops may result in serious injury.

!

ATTENTION: Placer vos mains ou doigts entre le dynamometer données (ou attachement) et le mécanique ROM arrêts peut résulter dans sérieux blessure.

CONTROLS AND ADJUSTMENTS

- 1-10 -

COMPUTER PRELIMINARIES USING ThE COMBINATION ANKLE ATTAChMENT (See Figure 1.17.) G D A

h

B

E

C

F

A. Footplate Rotation Lever B. Footplate Tilt Lever C. Heelcup Release Buttons D. Footplate E. Adapter Locking Knob F. Ankle Attachment Adapter G. Toe Strap H. Ankle Strap Figure 1.17 The Combination Ankle Attachment adjustment mechanisms.

The Combination Ankle Attachment (#830-331) is color-coded to facilitate set ups for all ankle patterns. To prepare the attachment for use, simply line up the appropriate color coded position tags for footplate tilt and rotation with the red dots on the attachment shaft and Footplate Rotation Lever. The footplate color codes are as follows: White “P” to Red Dot: Plantar/Dorsiflexion Green “I” to Red Dot: Inversion/Eversion

- 1-11 -

CONTROLS AND ADJUSTMENTS

X Adjusting The Footplate Footplate Rotation: The Footplate Rotation Lever is located on the underside of the footplate at the toe end. Pull the lever and hold it back while you rotate the footplate until the desired colorcoded position tag aligns with the lever. Release the lever and ensure that the appropriate footplate peg is secured in the lever’s notch. Footplate Tilt: The Footplate Tilt Lever is located on the underside of the footplate just above the color-coded position tags. Loosen the lever and tilt the footplate to align the color-coded tags per test or exercise protocol by aligning the white “P” with the red dot for plantardorsiflexion or the green “I” to the red dot for InversionEversion. Tighten the lever to secure the footplate in place. heel Cup Position: To facilitate alignment of the subject’s axis of rotation with the dynamometer shaft, it may be necessary to raise or lower the patient’s foot on the footplate by adjusting the heel cup position. The Heel Cup Release Buttons are located on the top side of the footplate at the heel end. Squeeze the Heel Cup Release Buttons together and slide the support cup to the desired position. Release the buttons to lock the heel cup in place. Toe and Ankle Straps: Once all adjustments to the footplate have been completed, secure the patient’s foot using both the foot and ankle straps. To secure the toe and ankle straps, thread each strap through its respective buckle. Pull up on the narrow end of each buckle to ratchet the strap tight. Pull up on the wide end of each buckle to loosen the strap.

CONTROLS AND ADJUSTMENTS

- 1-12 -

2. OPERATIONAPPLICATIONS

!

CONSIDERATIONS FOR SAFE OPERATION OF YOUR BIODEX MULTI-JOINT SYSTEM

1.

The clinician should always be present during testing or exercise sessions. Do not allow subjects to test or exercise by themselves.

2.

Range limits should always be set after the subject is positioned according to protocol and before switching to a test or exercise mode. Limits should never be set at points that are beyond the safe maximum allowable range of motion for the individual subject. Always assume that previously set limits are inappropriate for successive subjects, or for successive joints on the same subject. Limits should be canceled by pressing Set-up, Start and Setup again at the completion of each test or exercise session.

3.

Range of motion limits should be set so that the mechanical stop on the attachment or fixture will not contact the mechanical stop on the dynamometer. Metal-to-metal contact of these parts during operation will override the system’s normal deceleration function (cushion), causing harsh impacts at ends of ROM.

4.

Always educate subject as to function and use of the Comfort Stop buttons. Always place the hand-held remote Comfort Stop (on black coiled cord) in the subject’s free hand before the start of any test, exercise or biofeedback session.

5.

During setup, check subject positioning and ability to complete range of motion (slowly) prior to securing stabilization straps. Ensure that both the positioning chair and dynamometer are securely locked in detentes before allowing subject to move through ROM.

6.

Before beginning any test or exercise session, always inform the subject that the input arm will now be able to move.

7.

Always keep the surrounding area free of equipment and other personnel, especially when the passive mode is to be used. Check for clear, unobstructed path of movement pattern (through complete ROM).

8.

Do not operate equipment that has malfunctioned until it has been serviced by a qualified technician or use has been approved by a Biodex Service Representative.

9.

Use equipment only with recommended power supplies, grounding, and surge suppression. (Refer to Biodex site survey or contact Biodex Service Department for specifications).

!

CAUTION: Placing your hands or fingers between the dynamometer input shaft (or attachment) and the mechanical ROM stops may result in serious injury.

- 2-1 -

OPERATION

COMPUTER PRELIMINARIES READYING ThE SYSTEM FOR USE 1. Turn the main power switch on the back of the controller to the ON (1) position. 2.

Ensure that the dynamometer and computer power switches are set to the ON (I) position.

3.

Upon power up, a message will be displayed on the monitor that the system needs to be initialized. Initialization consists of a self-test during which the firmware checks to ensure that the dynamometer and associated hardware are working properly. Initialization must be performed any time the system is turned ON following system shut-down or an interruption in power supply.

4.

Remove any attachments from the dynamometer input shaft and select <OK> to proceed with initialization. The dynamometer input shaft will turn fully clockwise and then counterclockwise. If any problems are encountered, the system will display an error message. If all circuits and phases of the Biodex Multi-Joint System dynamometer and hardware are working properly, no error message will be presented and the display advances to the Dynamometer Operation screen. The message “Set ROM Limits” should now be displayed in the System Status window at the top of the screen. The system is now ready for use. NOTE: Should a coded initialization error message be displayed, contact Biodex Customer Service.

Shutting Down the System at the End of the Day At the end of your day, switch the computer and dynamometer power switches, located on the back of the controller, to the OFF position. If the Biodex Multi-Joint System will not be used for an extended period of time, you may also want to switch the controller OFF via the Main Power switch on its rear panel. NOTE: You must exit both the Biodex Advantage Software and the Windows program prior to shutting down the system. Failure to do so may result in lost or damaged files. To quit Windows and shut down your computer: 1. Close the Biodex Advantage Software application by selecting the <X> in the top right corner of the screen. 2. Select the <Start> button at the lower left side of the screen to access the Start menu. 3. Select the <Shut Down> to bring up the Shut Down window. 4. Select <Yes> to shut down the computer. A screen message will be displayed when it is safe to turn the computer OFF. Following is a general guideline for use of the Biodex in each of its operating modes. These guidelines are of a mechanical nature and do not reflect use of the computer software. They are presented only as an example to help familiarize you with the mechanical aspects of equipment setup and each of the various modes of operation.

MODES OF OPERATION The Biodex Pro offers several modes of operation. These are selected via the Advantage Software package. A brief review of each mode follows. Biofeedback Operation Biofeedback Operation incorporates all the functions that, in earlier versions of Biodex MultiJoint Systems, were controlled by the front panel. In this mode, clinicians can set up and begin patient exercise without entering patient-specific data such as name, address, weight, etc. When Biofeedback Mode is selected, all settings default to match the last biofeedback session. Patient exercise data is displayed on the graph in real-time but cannot be printed or saved. - 2-3 -

OPERATION