SYSTEM 3 PRO Application - Operation Manual March 2006

SYSTEM 3 PRO

This manual covers installation and operation procedures for the following System 3 PRO products: #835-000 #835-002

115 VAC System 3 PRO 230 VAC System 3 PRO

NOTE: All or some of the following symbols, cautions, warnings and notes may apply to your System 3 PRO and correspond to this operation manual: Symbol

Meaning

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Attention, consult accompanying documents.

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Symbol signification: Attention, se référer à la notice.

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

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

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

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TABLE OF CONTENTS INTRODUCTION ...IV BEFORE PROCEEDING ...V 1. CONTROLS AND ADJUSTMENTS ...1-1 Dynamometer...1-1 Positioning Chair ...1-4 Seat Back Brace...1-6 The Control Panel ...1-7 Controller ...1-11 Dynamometer Attachments ...1-12 The Combination Ankle Attachment (for All Ankle Patterns and Knee: Tibial Internal/External Rotation) ...1-14 2. OPERATION ...2-1 Considerations for Safe Operation of Your Biodex System...2-1 General Operating Instructions (Mechanical) ...2-3 The Setup Mode (Sample Procedure) ...2-4 The Isokinetic Mode (Sample Procedure) ...2-6 The Passive Mode (Sample Procedure) ...2-8 The Isometric Mode (Sample Procedure)...2-10 The Isotonic Mode (Sample Procedure) ...2-11 The Reactive Eccentric Mode (Sample Procedure) ...2-13 Additional Considerations ...2-15 Proper Testing Technique ...2-16 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 Parts & Components ...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 6. APPENDICES ...6-1 EMG/Analog Signal Access Interface ...6-1 Maintenance ...6-3 System Specifications ...6-4 General Product Warranty ...6-6 - III -

TABLE OF CONTENTS

INTRODUCTION Congratulations, you’ve made an excellent choice! By selecting the Biodex 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. If you add the Back, Lift and Work Simulation options, your Biodex System is transformed into a comprehensive clinic. You’ll also appreciate the Windows-based Biodex Advantage Software 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. Biofeedback is provided by the high resolution color graphics monitor to encourage patient compliance with exercise protocols. The versatility of the Biodex System facilitates effective treatment of a broad range of patients and pathologies. 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 System you have purchased may differ slightly from the system depicted in the photographs and illustrations used in this manual.

NOTE: LEvELINg PAD INSTALLATION INSTRUCTIONS Shipped with each unit are six leveling pads. These can be used to eliminate any excessive rocking of the Biodex T-bases. Once the T-bases have been assembled and all bolts have been tightened, slide the dynamometer to one side and note if there is any rocking of the T-bases. If noted, move dynamometer to other side of the T-base and repeat. Place the necessary amount of leveling pads under the ends of the T-base to eliminate any excessive motion. Use caution when lifting the T-base to place the pads underneath. If you have any questions, contact Biodex service at (800) 224-6339, in NY and Int’l, (631) 924-9000.

INTRODUCTION

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BEFORE PROCEEDINGTABLE OF CONTENTS

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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 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 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.

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CAUTION: Placing your hands or fingers between the dynamometer input shaft (or 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 Ramsay 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

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BEFORE PROCEEDING

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Figure 1.1. The Biodex System 3 Pro positioning configuration.

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BEFORE PROCEEDING

1. CONTROLS AND ADJUSTMENTS

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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 Stops 10. Dynamometer Locking Knob Storage 11. Dynamometer Position Color Codes 12. Dynamometer Yoke

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

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SYSTEM SPECIFICATIONS 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. 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.

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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.

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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.

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.

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CONTROLS AND ADJUSTMENTS

ASSEMBLY AND INSTALLATION

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Comfort Stops (Dynamometer, Remote): These buttons provide the subject with the ability to instantaneously terminate 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.)

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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.

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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.

Dynamometer Position Color Code: Located on the Dynamometer Yoke Pivot Plate, the Dynamometer Position Color Code 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.

CONTROLS AND ADJUSTMENTS

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X 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, press the Up or Down Seat Height Pedals, 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. 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.

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CONTROLS AND ADJUSTMENTS

X 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 5 push the chair fore or aft on the T-base.

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Figure 1.3. Positioning Chair adjustments.

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

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

CONTROLS AND ADJUSTMENTS

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CONTENTS SEAT BACK BRACE (See Figure 1.5 - 1.7) INTRODUCTION 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, 2 and 3.) 1. Ensure the seat back is in the up position. Rotate the seat to 0 degrees to either side on 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 on the System 3. Insert the clevis pin.

Figure 1.5. Attaching the Seat Back Brace to the System 3 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. Figure 1.6. Attaching the Seat Back Brace 6. To rotate the seat to the opposite 0 degreed position, disconnect the lower end of the back only. Repeat steps four and five.

to the System 3 trolley mount clevis

Figure 1.7. System 3 Seat Back Brace installed and ready for use. CONTROLS AND ADJUSTMENTS

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CLINICAL CONSIDERATIONS ThE CONTROL PANEL (See Figure 1.8.)

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Figure 1.8. The Biodex System 3 Control Panel. 1. System Status Window 2. Modes of Operation 3. Range of Motion 4. Percent ROM (Away and Toward) 5. Speed 6. Contraction 7. Torque 8. Start/Stop 9. Computer/Panel Control 10. End Stop Cushion 11. Applied Torque 12. Hold/Resume

System Status Window Displays the mode of operation currently selected, along with the dynamometer status and simple prompts or instructions (i.e., Setup Mode, Hold Dynamometer, Press Start...). Also displays system status codes in the case of malfunction. Modes of Operation There are six operating modes from which to choose: Setup, Isokinetic, Passive, Isometric, Isotonic, Reactive Eccentric. When the system is first turned ON the Setup mode is automatically selected, as indicated by the Setup LED. To change modes, press any mode button. The LED for the mode selected will come ON and remain illuminated until another mode is selected.

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CONTROLS AND ADJUSTMENTS

CONTENTS Attachment Selection The Attachment Selection button, located immediately to the right of the mode buttons, is used to select the appropriate sensistivity for the attachment to be used. The system status window will display the currently selected dynamometer attachment (knee is the default attachment). To change the selected attachment value, cycle through the available attachments by pressing the Attachment Select button until the desired choice is selected and remains the currently selected attachment until you change it again. NOTE: You need not select an attachment every time you use the system. For example, when using the knee attachment with the knee currently selected, the selection stays valid unless you use the Attachment Selection button to change it. Attachment selection can also be made with computer control. Range of Motion Set Limit Away/Toward: The Set Limit buttons on the control panel allow the clinician to set or adjust patient ROM. These buttons are used in Setup mode, per patient protocol, to set the final safe or “target” maximum range of motion for the specific test or exercise to be performed. If a Set Limit LED (Away or Toward) is flashing, there are currently no end ROM limits set for that direction of dynamometer shaft rotation. As a safety precaution, no mode other than Setup can be activated when either Set Limit LED is flashing. To set patient ROM limits via panel control: 1. Select the Setup Mode. Both Set Limit LEDs on the control panel should be flashing. 2. Assist or have the patient move through the appropriate range of motion for the initial direction (away or toward). When the patient has reached max ROM, press the Set Limit button to lock in the maximum ROM for that direction. The LED on the control panel for the direction selected should stop flashing. 3. Move the patient through full ROM in the opposite direction. Press the appropriate Set Limit button once the patient has reached the desired limit. The LED on the control panel for the second direction should now stop flashing. End limits are now set for both directions of movement. Total ROM in degrees is displayed in the Total ROM-Degrees window. To clear patient ROM limits press <Setup>. NOTE: The ROM settings are not “locked in” until ROM is set for both directions.

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

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

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CONTENTS Clinical Applications

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NOTE: Range limits must always be set after the subject is positioned and prior to switching to a test or exercise mode. Limits should not be set at points that are beyond the safe maximum allowable range of motion for the individual subject. The system will not allow selection of mode until ROM end points are set.

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NOTE: Always assume that previously set ROM limits are inappropriate for successive subjects and for successive joints on the same subject. Always set new limits when testing a new subject or moving from one joint to the next.

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NOTA: Les amplitudes réglées antérieurement doivent être considerée inappropiées a priori. Régler les limites aprés chaque nouveau positionnement, changement d'accessoire, ou changement de côte. Au cours de la séance on peut augmenter l'amplitude, mais sans pour autant, passer audelà des limites r´glées lors du montage. Avant tout mouvement d'examen ou d'entraînement, s'assurer que l'amplitude est confortable.

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NOTA: Les limites d'amplitude doivent être réglées après le positionnement du patient et avant de passer à un mode d'entraînement. Ces limites doivent être placées à des angles de sécurité pour le sujet concerné.

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As the available range of motion decreases for a particular joint, as in short arc exercise, the speed of movement should decrease also. Limited range of motion will not always provide sufficient time for the joint to reach higher speeds.

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Joints that have a greater range of motion, such as shoulders, can generally achieve higher speeds of exercise. Conversely, joints that have less range of motion, such as ankles, cannot attain the higher speeds.

Percent ROM (Away and Toward) The Percent ROM buttons are used to selectively reduce the total range of motion established during patient setup. When the Set Limit Away LED is illuminated the Percent ROM -/+ Away button can be used to decrease the percent ROM allowed in the away direction (movement away from the body such as knee extension). Likewise, the Percent ROM -/+ Toward button can be use to decrease the percent ROM allowed in the toward direction. NOTE: During exercise, limits can be moved within, but never beyond, the ROM established in the Setup mode. Before proceeding with a test or exercise bout, always ensure a comfortable range of motion for the subject. Pause (0 to 30 seconds) The Pause buttons, (Away and Toward toggles) allow the introduction of time delays between reciprocating patterns of motion during exercise in the Passive mode. The Pause function is inactive when set to zero seconds. Use the Pause Away button to increase or decrease the time length of the pause in the away direction (movement away from the body such as knee extension,) as indicated in the Seconds window. Use the Pause Toward to increase or decrease the time length of the pause in the toward direction.

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CONTROLS AND ADJUSTMENTS

CLINICAL CONSIDERATIONS Clinical Applications Among other things, the Pause feature may be used to: 1. 2. 3. 4. 5.

give commands, especially when patients are working non-reciprocally (concentric/eccentric, eccentric/concentric) Provide neurologically impaired individuals with enough time to prepare for a contraction. Allow the subject time for a brief passive stretch which can be combined with ultrasound or an ice/friction massage. Apply stimulation at terminal points in the ROM. Align the subject to perform multi-angle isometrics.

Speed Use the Speed (Away and Toward) buttons to set the maximum velocity for each direction of movement in the Isokinetic, Passive or Reactive Eccentric mode. The velocities selected are shown in degrees-per-second in the Degs/Sec. window for each direction, (Concentric max speed: 500-deg./sec., eccentric max speed: 300 degrees per second.) Contraction The Contraction buttons are active for isokinetic and isotonic modes only. In both modes, the contraction setting defaults to concentric/concentric movement. Use the Away or Toward button to change the contraction type for the desired direction (i.e., concentric/concentric, concentric/eccentric or eccentric/concentric). Contraction type is indicated by the LEDs for each direction of movement. The direction the attachment is moving will determine the contraction (for quadriceps, choose concentric away and eccentric towards.) Torque The Torque buttons, Away and Toward, provide a means of keeping a subject’s torque level either at or below an operator-specified level of torque production while performing eccentric contractions in the Passive or Reactive Eccentric and Isokinetic mode. In Passive Mode, when a subject exerts an eccentric torque in excess of the torque limit selected, the dynamometer shaft stops rotating until the force output is reduced to a value below the set limit. The subject must therefore work below the limit threshold to continue through the ROM. The Torque buttons are also used to select the desired torque control value in Isotonic mode. In Eccentric mode, the torque value represents the minimum force required to initiate motion (10% of torque limit), and the maximum force the patient can produce prior to stopping the attachment. The patient must work between the 10% minimum and torque limit to keep the attachment moving. The numerical values displayed in the Torque Windows represent foot-pounds of torqued (Newton Meters for International Systems.) Under panel control, torque can be adjusted at anytime during the exercise or test session to accomodate the patient’s gains. Start/Stop Press the Start button to allow dynamometer shaft rotation. Press the Stop button to stop dynamometer shaft rotation (cut off power). Computer/Panel Control On power-up, the Biodex System automatically defaults to Panel Control operation as indicated by the Panel Control LED. To access computer control for automated protocols, press the Computer Control button. The Computer Control LED will illuminate, indicating that automated protocols may now be selected. End Stop Cushion The End Stop Cushion button provides a means of varying the point at which the deceleration starts (1=hard, 9=soft). Deceleration occurs earlier in the ROM with a softer cushion.

CONTROLS AND ADJUSTMENTS

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COMPUTER PRELIMINARIES Clinical Applications As a general rule, “hard” cushions (short range of deceleration) are used for testing while “soft” cushions are selected for rehabilitation applications. This is especially true in a small range of motion or at high isokinetic speeds. The higher the cushion the shorter the amount of time spent at isokinetic speed. Applied Torque Illumination of any of the three Applied Torque LED’s indicates the dynamometer’s torque sensing assembly is generating a signal. The center LED indicates the sensor is active but is not sensing any torque. The left LED indicates torque is being applied in the away direction while the right LED indicates torque is being applied in the toward direction. Clinical Applications Many clinicians use the Applied Torque indicators for biofeedback during the rehabilitation process.

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CONTROLS AND ADJUSTMENTS

X ThE CONTROLLER (Located at bottom of Computer Data Station) Main Power Switch (Rear of Unit) 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. Status/Diagnostics Panel (LEDs) Located to the left of the Dynamometer and Computer Power Switch, 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.

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Figure 1.9. The Biodex 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)

CONTROLS AND ADJUSTMENTS

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APPLICATIONS DYNAMOMETER ATTAChMENTS

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

Shoulder/Elbow Adapter

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

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

Knee Adapter

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:

Wrist Attachment

Ex/Flex Radial/Ulnar Deviation Pro/Supination

Wrist Adapter

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CONTROLS AND ADJUSTMENTS

APPLICATIONS 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: Knee:

Ex/Flex

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

Ex/Flex

CONTROLS AND ADJUSTMENTS

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