Manual, System 4 Quick

Manual, System 4 Quick
BIODEX MULTI-JOINT SYSTEM –
QUICK-SET
SETUP/OPERATION MANUAL
840-000
840-000-10
840-000-20
840-000-30
840-000-40
840-000-50
BIODEX
Biodex Medical Systems, Inc.
20 Ramsey Road, Shirley, New York, 11967-4704, Tel: 800-224-6339 (Int’l 631-924-9000), Fax: 631-924-9338, Email: info@biodex.com, www.biodex.com
FN: 07-058 Rev B 6/14
BIODEX MULTI-JOINT SYSTEM – QUICK-SET
This manual contains installation and operation procedures for the following
Biodex products:
840-000
840-000-10
840-000-20
840-000-30
840-000-40
840-000-50
Biodex
Biodex
Biodex
Biodex
Biodex
Biodex
Multi-Joint
Multi-Joint
Multi-Joint
Multi-Joint
Multi-Joint
Multi-Joint
System,
System,
System,
System,
System,
System,
Quick
Quick
Quick
Quick
Quick
Quick
Set
Set,
Set,
Set,
Set,
Set,
JPN
Knee Only
w/o CMP
IND MED Config
Knee Only, JPN
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....................................................................................................................................1-1
Positioning Chair ..............................................................................................................................1-4
Controller ..........................................................................................................................................1-7
Dynamometer Attachments ............................................................................................................1-8
Using the Combination Ankle Attachment (for All Ankle Patterns and
Knee: Tibial Internal/External Rotation) ....................................................................................1-10
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
Shoulder: Flexion/Extension (Seated) ........................................................................................3-13
Shoulder: Abduction/Adduction (Seated) ................................................................................3-16
Shoulder: Internal/External Rot. in Modified Neutral Position ............................................3-19
Shoulder: Internal/External Rot. in 90-Degrees of Abduction................................................3-23
Shoulder: Diagonal (Seated)..........................................................................................................3-27
Shoulder: Diagonal (Standing) ....................................................................................................3-30
Elbow: Extension/Flexion ............................................................................................................3-32
Forearm: Supination/Pronation ..................................................................................................3-36
Wrist: Extension/Flexion ..............................................................................................................3-39
Wrist: Radial/Ulnar Deviation ....................................................................................................3-42
4. REFERENCE MATERIALS ..............................................................................................................4-1
Suggested Test Speeds ....................................................................................................................4-1
Legal Precedents ..............................................................................................................................4-2
Biodex Data Admitted as Medical Evidence in Court ................................................................4-2
Patient Progress Chart ....................................................................................................................4-3
Current Recorded Normative Goals (English Units) ..................................................................4-4
Current Recorded Normative Goals (Metric Units) ....................................................................4-5
5. APPENDICES ......................................................................................................................................5-1
EMG/Analog Signal Access Interface ..........................................................................................5-1
Maintenance ......................................................................................................................................5-4
System Specifications ......................................................................................................................5-5
Conformance to Standards..............................................................................................................5-6
Declaration of Conformity ..............................................................................................................5-7
Recommended Separation Distance ..............................................................................................5-9
General Product Warranty ............................................................................................................5-10
— 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.
• 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 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.
!
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 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
AVANT TOUTE APPLICATION
!
Avant d'appliquer les montages décrits dans cette notice, plusieurs consignes aideront à
obtenir une utilisation sûre et facile de votre système BIODEX.
• Utilisation de ce système doit être limité au personnel qui a les qualités requises.
• Vérifier que tous les câbles et cordons suivent un trajet qui ne traverse ni un zone de
travail ni une zone de déplacement des pièces mobiles.
• Pour les mouvements d'examen ou d'entraînement nécessitant une chaise accessoire,
régler la chaise accessorie à sa position la plus basse avant de faire monter ou descen
dre le patient. Dans certains cas un accèss fixe à la chiase peut être utile.
• La technologie BIODEX nécessite une expertise professionelle pour choisir la tech
nique thérapeutique appropriée. La situation de chaque patient doit déterminer le
programme de rééducation. S'assurer de bien comprendre la présente notice ainsi que
le contexte clinique associé avant d'applier la technologie pour l'examen ou la rééd
cation d'un patient. S'entraîner à faire des montages avec des sujets sains avant d'en
faire avec un patient.
• Le indications pour les montages spécifiques fournies dans les pages qui suivent prennent comme point de départ le système dans sa position neutre montré à l'image 1.1.
• Pour aider nos clients à développer leurs protocoles, cette notice contient certains
passages sur des applications cliniques. Ces textes tiennent compte de l'expérience des
utilisateurs BIODEX et des informations publiécs mais ne puevent pas remplacer
le jugement clinique.
• Les montages présents dans la présente notice couvrent la plupart des protocoles.
Toutéfois les nombreuses possibilités du système BIODEX permettent d'autres mon
tages. On conscille d'utiliser les montages de la notice avant de réaliser des improvi
sations, surtout pour les applications d'examen. Si vous utilisez un mouvement dif
férent de ceux trait´s, notez-en les détails dans votre dossier patient.
!
ATTENTION: Placer vos mains ou doigts entre le dynamometer données (ou attachement) et le mécanique ROM arrêts peut résulter dans sérieux blessure.
BEFORE PROCEEDING
— VI —
X
Figure 1.1. The Biodex Multi-Joint System - Quick-Set positioning configuration.
— VII —
BEFORE PROCEEDING
1. CONTROLS AND ADJUSTMENTS
2
12
13
11
4
BIODEX
9
1
8
HOLD / RESUME
COMFORT STOP
10
3
5
6
7
Figure 1.2. Dynamometer positioning controls and adjustments.
1. Dynamometer Rotation Knob
2. Dynamometer Tilt Knob
3. Dynamometer Height Lever
4. Shaft Red Dot (on dynamometer shaft)
5. Rotate Counterclockwise Button
6. Rotate Clockwise Button
7. Hold/Resume Button
8. Comfort Stop
9. Dynamometer Locking Knob Storage
10. Dynamometer Position Color Code Label
11. Dynamometer Yoke
12. Dynamometer Tilt Scale
13. 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 —
8
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.
!
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 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 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.
— 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
4
7
8
5
Figure 1.3. Positioning
Chair adjustments:
1.
2.
3.
4.
5.
6.
7.
6
Seat Rotation Handle
Receiving Tubes
Chair Foot Pedals
Cervical Support
Adjustment Knob
Seatback Tilt Handle
Seatback Fore/Aft Handle
Stabilization Handles
2
3
1
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
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
— 1-7 —
CONTROLS AND ADJUSTMENTS
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
CONTROLS AND ADJUSTMENTS
Wrist Adapter
— 1-8 —
CONTENTS
Figure 1.14.
Combination Ankle Attachment
Patterns:
Ankle:
Plantar/Dorsi Flexion
Inversion/Eversion
NOTE: See "Using The Combination Ankle Attachment
(next section).
Figure 1.15.
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.
— 1-9 —
CONTROLS AND ADJUSTMENTS
CLINICAL CONSIDERATIONS
USING THE COMBINATION ANKLE ATTACHMENT
(See Figure 1.16.)
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 1.16 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
CONTROLS AND ADJUSTMENTS
— 1-10 —
COMPUTER PRELIMINARIES
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 plantar\dorsiflexion
or the green “I” to the red dot for Inversion\Eversion. 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.
— 1-11 —
CONTROLS AND ADJUSTMENTS
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
APPLICATIONS
!
POINTS à RETENIR POUR UN FONCTIONNEMENT SéCURITAIRE DE VOTRE
SYSTèME BIODEX
1.
Le clinicien doit toujours être présent durant les séances de test ou d’exercice. Ne pas permettre aux sujets de se tester ou de s’exercer seuls.
2.
Les limites d’amplitude doivent toujours être fixées après avoir positionné le sujet suivant le
protocole et avant de passer à un mode de test ou d’exercice. On ne doit jamais régler les
limites à des points qui dépassent l’amplitude du mouvement maximale permissible pour la
sécurité du sujet dont il s’agit.
Toujours partir du principe que les limites fixées précédemment sont inappropriées pour les
sujets qui suivront ou pour une succession d’articulations chez le même sujet. Il faut annuler
les limites en appuyant sur Réglage, Départ, puis Réglage à nouveau, à la fin de chaque
séance de test ou d’exercice.
3.
On doit fixer les limites de l’amplitude du mouvement de telle sorte que l’arrêt mécanique de
l’accessoire ou de la fixation n’entre pas en contact avec l’arrêt mécanique du dynamomètre.
Tout contact métal sur métal de ces pièces en cours de fonctionnement désactive la fonction normale de décélération (coussin), entraînant des impacts durs en fin de course.
4.
Toujours veiller à bien informer le sujet de la fonction et de l’utilisation des touches Arrêt
confort. Toujours placer la télécommande Arrêt confort (avec cordon extensible noir) dans la
main libre du sujet avant le départ de toute séance de test, d’exercice, ou de biofeedback.
5.
Durant le réglage, vérifier le positionnement du patient et sa capacité de se mouvoir (lentement)
dans toute l’amplitude du mouvement, avant de fixer les sangles de stabilisation. S’assurer que
le siège de positionnement et le dynamomètre sont tous deux bien verrouillés dans leurs crans
d’arrêt avant de permettre au sujet d’évoluer dans l’amplitude du mouvement.
6.
Avant d’appuyer sur la touche Départ, toujours informer le sujet que le bras de saisie peut
maintenant se déplacer.
7.
Garder en tout temps la zone environnante libre de tout équipement et d’autres personnes,
surtout lorsqu’on utilise le mode passif. S’assurer d’une trajectoire libre de tout obstacle
pour les évolutions dans toute l’amplitude du mouvement.
8.
Ne pas faire fonctionner un équipement qui a subi une panne avant qu’il n’ait fait l’objet
d’un entretien par un technicien qualifié, ou que son utilisation n’ait été autorisée par un
agent du service après-vente de Biodex.
9.
N’utiliser l’équipement qu’avec les alimentations électriques, la mise à la terre et la protection contre les surtensions préconisées. (Se reporter au sondage sur les installations de
Biodex ou communiquer avec le service après-vente de Biodex pour le cahier des charges.)
!
OPERATION
ATTENTION: Placer vos mains ou doigts entre le dynamometer données (ou attachement) et le mécanique ROM arrêts peut résulter dans sérieux blessure.
— 2-2 —
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 <Turn Off> to bring up the Shut Down window.
4. Select <Turn Off> 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 Quick-Set 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
COMPUTER PRELIMINARIES
Isokinetic Mode
In this mode, the dynamometer acts to control velocity, allowing the subject to accelerate up to,
but no higher than, the maximum speed value selected for each direction of shaft rotation (accommodating resistance). The subject may freely decelerate or change direction of movement at any
point within the range of motion.
The following general procedure is provided to help clarify use of Isokinetic mode.
Isokinetic Mode Clinical Applications
1. The Isokinetic mode may be used at higher speeds in order to simulate functional or sports
activities. It can also be used early on in the rehabilitation process to prevent compression and
translation in the knee joint.
2.
The Isokinetic mode may be used with differing bi-directional velocities to simulate functional activities or place the focus of the activity on one specific muscle group.
3.
There is a 15-degree physiologic overflow in strength on each side of the end ROM (30º total
carry-over) with a limited range of motion strengthening program performed isokinetically
(Halbach, 1985).
4.
Choose con/ecc or ecc/con to isolate one muscle group.
5.
Exercising at a specific speed has shown strength gains which overflow to both faster and
slower speeds. However, there is enough research to demonstrate that by exercising at every
30 degrees/second, physiological overflow will occur with regards to specific strengthening
at each speed exercised (Davies, G.J., 1987.)
6.
In the Isokinetic mode, the Force-Velocity relationship of muscle dictates that as speed of contraction increases concentrically, the muscular tension (and therefore torque) decreases.
(Davies, G.J., 1987.)
7.
A velocity spectrum is recommended which will start the subject at either a high or low speed,
depending on the pathology and status of the subject, and progress to other speeds. Varying
the number of repetitions (i.e., less reps at slow speeds, more reps at high speeds), will help
keep the work performed consistent over the range of the velocity spectrum.
8.
Exercising at higher speeds has shown excellent benefits for endurance gains. This will limit
compression on joints, tension developed in the muscles and tendons, and generally allows
the subject to do larger numbers of sets or repetitions, which transfers to daily activities.
9.
Keep in mind the stretch shortening cycle. It has been found that an eccentric contraction performed before a concentric contraction results in a more forceful concentric contraction than
a concentric contraction performed alone (Duncan, P., et. al., 1989). High speed contractions
followed by slow speed contractions will simulate an isolated plyometric activity.
OPERATION
— 2-4 —
2. OPERATION
The Passive Mode
The Biodex Passive mode allows the dynamometer to provide continuous motion at constant
velocity, with direction changes occurring only when range of motion limits are reached.
In Passive mode, the dynamometer initiates motion when the Start button is pressed, requiring no
active participation by the subject.
Passive Mode Clinical Applications
1. The Passive mode is frequently used post-operatively for the benefits of continuous passive
motion, which assist with nourishment of the joint.
2.
The Passive mode may be used isokinetically in the agonistic direction and then passively in
the antagonistic direction or vice versa.
3.
The Passive mode may be used to exercise or test isokinetically. Subjects that cannot meet the
speed, will be passively moved through this portion of the range.
4.
The Passive mode may be used for passive stretching. When this is performed, the torque limits in each direction should be set low. If the subject feels uncomfortable, they may resist the
motion and the unit will stop, e.g., if the clinician is trying to increase knee flexion the subject
will be passively flexed. If at any time the subject is uncomfortable, they may resist the flexion movement and isometrically exceed the Toward torque limit.
5.
For knee, shoulder flex/ex, ab/ad, and lumbar movements, ensure torque limits are set to
overcome limb weight.
6.
Passive motion may be used to warm-up and cool-down a subject, stretching ROM, and to
perform contract/relax protocols . Used during rest periods, passive motion can help prevent
muscles from “tightening up” before the next set of repetitions.
7.
By instructing the subject to move the limb at a speed that will keep the Away and Toward
Applied Torque Indicator ON and the middle Applied Torque Indicator OFF, the Passive
mode can be used to provide biofeedback and stimulate joint and muscle mechanoreceptors
to improve proprioception.
8.
In the case of poor muscle strength, passive mode allows for active assistive motion which
will initiate or continue motion of the subject.
9. Contract/Relax may be performed in the Passive mode. Range of motion limits are selected
to include the entire range the subject should be able to achieve that day. The subject is placed
on the unit with the comfort stop in hand. As the subject is passively moved in one direction,
they exert force in the opposite direction. The torque limit in the opposing direction must be
set low enough so that the subject exceeds the limit and performs an isometric contraction. At
this time, the clinician slightly increases the percent range of motion in the appropriate direction. The procedure is repeated for as many cycles as desired.
— 2-5 —
OPERATION
XXX
10. Immediately post exercise, some subjects exhibit joint effusion. Application of ice while moving passively at 20 degrees per second has been reported to reduce post exercise swelling and
discomfort. This may also be done in conjunction with electric stimulation to further assist
edema control.
Isometric Mode
In this mode, the dynamometer maintains zero velocity at any selected point in the range of
motion. Significant change in joint angle and overall muscle length does not occur.
Isometric Mode Clinical Applications
1. The Isometric mode may be used pre- or post-surgery with discretion.
2.
The Isometric mode may be used near a painful range for strength carryover into the painful
range. Overflow has been found to be plus or minus as much as 10 degrees.
3.
Isometric holds can be checked for quality of contraction. Monitoring these can help set goals
and monitor progress.
4.
The Isometric mode can be used very effectively to initiate contractions submaximally. Make
sure to stabilize other body parts to prevent compensation. Relaxation can be assisted by the
application of heat, cold, or biofeedback.
Isotonic Mode
In this mode, the dynamometer requires the patient to meet a minimum selected torque limit in
order to move the input arm. Thus, speed is variable but torque is constant.
Isotonic Mode Clinical Considerations
1. The Isotonic Mode may be used concentrically or eccentrically to train a selected muscle group.
2.
Torque limits may be set independently (in each direction) for agonist/antagonist muscle
groups in order to focus the activity on one specific muscle group or compensate for dominance in strength of either the agonist or antagonist muscle group.
3.
In this mode it is possible to set a “pre-load” for the patient to overcome prior to movement.
This ensures that the patient is performing the contraction with a minimal amount of force.
4.
Concentric/concentric isotonics can be completed before concentric/eccentric movements.
This improves safety for the patient as the limb will not be forceably moved into any portion
of the range of motion should the patient not have ample neuromuscular control.
OPERATION
— 2-6 —
TESTING A PATIENT
The Reactive Eccentric Mode
In this mode the dynamometer responds to torque exerted by the patient by moving in the opposite direction of the applied torque.
In Reactive Eccentric or mode, the Torque controls are used to specify a window of desired human
force output. To initiate shaft motion, the subject is required to meet a minimum torque threshold
corresponding to 10% of the Torque button setting. If the subject exceeds the torque limit value
selected for either direction of motion, the shaft stops rotating until the subject’s force output is
reduced to within the desired range. The subject is therefore required to exceed a specified torque
value to achieve motion, and to keep torque output at the specified level to continue movement.
Low torque limits require greater neuromuscular control. Setting a torque limit of 20 ft-lb will
require 2 ft-lb of force to initiate motion and 20 ft-lb to stop, resulting in a window of 18 ft-lb
Setting the window at 100 ft-lb results in a window of 90 ft-lb.
Reactive Eccentric mode allows for direction changes at any point in the range of motion.
Reactive Eccentric Mode Clinical Applications
1. The Reactive Eccentric mode may be used to perform submaximal or maximal eccentrics.
2.
The Reactive Eccentric mode may be used to work on proprioception. When torque limits are
set, the subject must exert at least one-tenth of the torque limit to keep the shaft moving. If the
subject exceeds the limits, the unit will stop.
3.
At higher velocities the stretch reflex is more active than at lower velocities.
4.
It is possible to generate 30-40% more force eccentrically than concentrically. (Set the torque
limits appropriately.) In that the stimulus for strength gain is contraction intensity, it is suggested by some research that eccentric contractions will result in significant strength gains.
(Knuttgen, H.G., et. al., 1971; Komi, P.V., 1972).
5.
There is patient specific eccentric speed above which muscular force will not increase.
(Knuttgen, H.G., et. al., 1972).
6.
Eccentric contraction involves a “training” of the non-contractual elements of muscle so that
the muscle “learns” to function in a higher force environment. (Komi, P.V.,1972).
7.
In eccentric exercise, the force increases as the velocity of contraction increases (up to a certain point) which is in contrast to concentric exercise in which the force decreases as the speed
of contraction increases. (Davies, G.J., 1987.)
8.
It has been suggested that eccentric exercise produces the greatest force in the least amount of
time (Komi & Cavanaugh, 1977).
— 2-7 —
OPERATION
XX
9.
Eccentric contractions enhance muscle force production and are less costly metabolically than
concentric contractions (Bosco & Komi, 1979, Asmussen, 1953).
10. Eccentric rehabilitation is usually performed no more than two times a week secondary to
delayed onset muscle soreness.
ADDITIONAL CONSIDERATIONS
1. Very often clinicians use the following progression during the rehabilitation process: Passive
mode, isometrics, multi-angle isometrics, sub-maximal eccentrics, concentric isokinetics.
2.
Electrical stimulation may be used in conjunction with any of the tests or exercise modes on
the Biodex.
3.
Consider ending a rehabilitation set by work or time, especially if the goal is to improve endurance.
4.
Giving a subject copies of their rehabilitation reports can help with motivation.
5.
Submaximal exercise prevents neural dissociation, promotes articular cartilage nourishment
and proprioception, and retards muscular atrophy.
6.
Delayed Onset Muscle Soreness (DOMS) is not usually apparent until one to two days after
treatment. Work submaximally to minimize and develop protocols accordingly.
7.
The Biodex Multi-Joint System is a versatile piece of equipment, making it difficult to document every possible setup position. If a non-documented position is used, document it. If it
becomes a position that is used often, send the information to Biodex.
PROPER TESTING TECHNIQUE
1. Verify calibration at least twice a month. If you are going to use your data in court or for
research, calibrate and verify before a test is performed.
2.
Be consistent in warm-up procedures, commands, setups and instructions, (i.e., Four total repetitions, first one at 25% effort, next at 50% effort, then 75% effort and, finally, 100% max effort.)
3.
Each patient should perform trial repetitions before each speed to become familiar with what
to expect.
4.
Be sure to familiarize the subject with the equipment before testing to eliminate a learning
curve. It is recommended that the patient peform two or three exercise sessions on the system
prior to testing.
5.
Use proper stabilization techniques, making every attempt to restrict motion only to the area
of interest. Body parts on either side of the joint(s) being rehabilitated or tested should be
firmly secured. Studies have reported significant differences in data generated with and without stabilization. Uncontrolled movement leads to testing errors. If you add or remove stabilization devices, document it.
Axis alignment of the dynamometer shaft with the subject’s anatomical axis of rotation is cru-
6.
OPERATION
— 2-8 —
XX
cial to ensure that during testing and rehabilitation the pattern performed is consistent with
the proper biomechanics of the joint. Correct alignment also helps eliminate stressful loading
of the joint and recruitment of other muscle groups.
7.
Use standardized setups. If you use an unconventional setup, document it.
8.
Make sure to set the correct anatomical reference angle. The internal goniometer of the software is based on this reference angle, and is important for later data interpertation.
9.
Verbal and visual encouragement should be consistent.
NOTE: Allowing a patient to view the monitor during a test may cause the patient to change force
output based on perception. For testing consistency, it is recommended that the patient not be
allowed to view the monitor.
— 2-9 —
OPERATION
3. SETUP AND POSITIONING
The following section details the Biodex Multi-Joint System setup and positioning for each of the
standard test and exercise patterns. Included is information on both mechanical and anatomical
aspects.
It is suggested that clinicians who are not familiar with the Biodex Multi-Joint System read the
preceding chapters and practice each setup with a healthy subject before attempting to position
any person for actual testing or exercise. Instruction can also be gained through the use of the
AVIs which are in the Advantage Software Program.
While the following setups are standard, it should be noted that other positioning setups are possible. The Biodex Multi-Joint System is extremely versatile and can accommodate to many test and
rehabilitation needs. If you find a new setup to be especially useful in your practice, be sure to
document it and pass the information along so it can be included in our database.
NOTE: All attachments have “R” (right) and “L” (left) designations. In the case of the ankle and wrist
attachment, R&L are together (R L). Proper range of motion is ensured by aligning the dynamometer shaft red dot with the appropriate designation for the side to be exercised or tested.
NOTE: Check the dynamometer, gimbal and seat for proper positioning before each testing, exercise or
biofeedback session.
NOTE: When performing bilateral testing, make sure the length of the attachment is equal on both sides to
assure validity and reliability of results.
— 3-1 —
SETUP AND POSITIONING
SERVICE PROCEDURES
KNEE: EXTENSION/FLEXION
Figure 3.2
Figure 3.1
0
Away
135
Toward
Figure 3.3
Quick Reference
Dynamometer Orientation:
Dynamometer Tilt:
Seat Orientation:
Seatback Tilt:
45º
0º
45º
70º - 85°
Axis of Rotation:
Axis is through the lateral femoral condyle on a sagittal plane.
Ready Position:
Full Flexion
Parts Needed
Dynamometer:
Positioning Chair:
Knee Attachment (left or right)
No additional parts required.
SETUP AND POSITIONING
— 3-2 —
X
KNEE EXTENSION/FLEXION
Because of multiple factors such as stability through mostly ligamentous and muscular support,
the bearing of high forces, and the fact that it is located between the body’s two longest lever arms,
the knee is one of the most commonly injured joints in the body. The knee is also the most commonly tested and rehabilitated joint on the Biodex System.
Setup and Positioning
(Starting Movement: Away/Extension)
1. Seat patient on chair.
2. Rotate chair to 45 degrees.
3. Rotate dynamometer to 45 degrees. Slide chair forward along travel to position outside leg to
be tested or exercised.
4. Attach knee attachment to dynamometer. Align dynamometer shaft red dot with red dot on
attachment.
5. Move patient into position.
6. Align patient knee axis of rotation with dynamometer shaft.
7. Adjust knee attachment so that it is proximal to medial malloli. Secure with strap.
NOTE: Moving the pad proximally has been demonstrated to decrease anterior tibular translation.
8.
9.
Stabilize patient with shoulder, waist and thigh straps.
Set ROM stops.
Opposite Side
1. Unstrap patient’s knee from attachment and thigh strap.
2. With patient remaining in chair, slide chair back away from dynamometer.
3. Press Hold button to retain dynamometer shaft position. Remove attachment. Get knee
attachment for opposite side.
4. Rotate dynamometer to 45 degrees on opposite side.
5. Attach knee attachment to dynamometer. Align dynamometer shaft red dot with red dot on
attachment.
6. Move patient into position.
7. Slide chair back toward dynamometer and align patient knee axis of rotation with
dynamometer shaft.
8. Adjust knee attachment so that it is proximal to medial malloli. Secure with strap.
9. Stabilize patient with shoulder, waist and thigh straps.
10. Set ROM stops.
Clinical Applications of Biodex Operating Modes
Passive Mode
1. The passive mode is frequently used post-operatively, especially with anterior cruciate ligament repairs, abrasion arthroplasties, and total knee replacements, for the benefits of continuous passive motion.
— 3-3 —
SETUP AND POSITIONING
X
2.
The passive mode may be used to move the limb in one direction and concentrically assist or
eccentrically resist in the other direction (i.e., in early rehab for ACL reconstructions, the limb
may be moved passively through partial range extension. The subject may then assist or resist
flexion with voluntary effort.
3.
The passive mode may be used for active-assisted exercise (i.e., a subject status post medial
menisectomy may be moved passively through a range where voluntary effort cannot be
exerted and may assist in the parts of the range where able).
4.
The passive mode may be used to do concentric contractions. After an ACL reconstruction,
the hamstrings may be worked eccentrically and concentrically through limited range and
then through the full range. At end stage rehab, the quadriceps may be worked at the end of
the range, both concentrically and eccentrically, to decrease an extensor lag.
Reactive Eccentric Mode
1. The Reactive Eccentric mode may be used maximally or submaximally to replicate functional activities. The role of submaximal eccentrics has been greatly overlooked. With ACL reconstructions, the hamstrings may be worked through full range of motion eccentrically with
submaximal effort.
2.
Specific areas of weakness in a range of motion such as quadriceps extensor lag may be
worked eccentrically at the last 30º of extension with submaximal effort.
3.
Submaximal eccentrics may be used to protect injured or grafted structures (i.e., post-operatively, subjects may exercise in the eccentric mode with the torque limits set very low. If the
subject were to exceed the set torque limit, the input shaft would stop).
Isokinetic Mode
1. The isokinetic mode may be used at high speeds to simulate functional or athletic activities.
2.
The isokinetic mode may be used for bi-directional velocities (i.e., during early ACL reconstruction rehabilitation, the hamstrings may be worked at low speeds and the quadriceps at
high speeds. At end stage rehab, the quads may be worked at low speeds and the hamstrings
at high speeds).
Isometric Mode
1. The isometric mode may be used with pre- or post-operative subjects or when pain is a factor.
Isotonic Mode
1. Prior to performing traditional isotonics on weight equipment, a patient can perform various
contractions isotonically to ensure proper muscular function.
2. Since a pre-load is required, gravity and momentum play a minimal role in exercise. This
ensures patient compliance.
SETUP AND POSITIONING
— 3-4 —
X
Additional Comments
1. The pause may be used for passive stretching or to perform contract/relax for the facilitation
of motion. This is especially important after a total knee replacement when early motion is
crucial. The pause may also be used when working in the passive mode to do eccentric or nonreciprocal contractions.
2. All modes may be used in combination with electrical stimulation.
3. With anterior cruciate ligament rehabilitation, pay attention to the shin pad placement.
Research has shown that while working the quadriceps group, less stress is placed on the ACL
when the pad is placed in the proximal position. For hamstring work, place the pad in a more
distal position.
4. Subjects may be worked through only a partial range using the percent range of motion controls. This is important to assist with focusing on range of motion specific weakness..
5. When treating the knee, total leg strength should be considered, especially the strength of hip
abductors and adductors.
6. It has been found that most ACL injuries occur during deceleration therfore, eccentric exercise
is an important part of the rehabilitation process.
7. Because a subject is proximally stabilized, very little substitution will occur. Proximal stabilization lends itself to joint isolation.
8. The seatback of the positioning chair may be adjusted to accommodate any hip angle the clinician finds appropriate.
9. Typically, a 70° incline will place the hamstrings and quadriceps in an optomal length-tension
relationship allowing for improved muscle output. Increasing speeds (180º 300º/sec.) decreases anterior tibial translation and joint compressive forces, important applications for rehabing
anterior cruciate injuries and patellofemoral dysfunction.
— 3-5 —
SETUP AND POSITIONING
X
ANKLE: PLANTAR/DORSIFLEXION (SEATED)
Figure 3.5
PlantarFlexion/DorsiFlexion
30
0
Figure 3.4
50
Figure 3.6
Left Ankle
75°
0°
75°
70 - 85°
0°
Red dot to P/D
20 - 30°
Quick Reference
Dynamometer Orientation:
Dynamometer Tilt:
Seat Orientation:
Seatback Tilt:
Footplate Tilt:
Footplate Code:
Knee Flexion:
Right Ankle
60º
0º
65º
70 - 85º
0º
Red dot to P/D
20 - 30º
Axis of Rotation:
In neutral position, axis passes through the body of talus, fibular
malleolus, and through or just below the tibial malleolus.
Ready Position:
Full Dorsiflexion
Parts Needed
Dynamometer:
Positioning Chair:
Ankle Attachment
Limb-Support Pad, T-Bar, Footrest (optional)
SETUP AND POSITIONING
— 3-6 —
X
ANKLE PLANTAR/DORSIFLEXION (SEATED)
The ankle joint or talocrural joint is really three joints (tibiotalar, fibulotalar, and tibiofibular)
formed by the superior portion of the body of the talus fitting within the cavity created by the
combined distal ends of the tibia and fibula. The subtalar joint is the articulation between the talus
and calcaneus.
Motions of the ankle are rarely true single plane motions. This holds for dorsiflexion/plantarflexion, which usually occurs in conjunction with other movements.
Setup and Positioning
(Starting Movement: Away/Plantarflexion)
1. Seat patient on chair.
2. Install Limb Support Pad (with T-Bar) in chair side receiving tube for side to be exercised or
tested. Angle support toward chair. Place pad under distal femur and secure with strap. The
pad should be positioned to allow for approximately 20º to 30º of knee flexion.
NOTE: Because the origin of insertion of the gastrocnemius is above the knee, the extent of ankle dorsiflexion will generally increase with increased knee flexion and decrease with knee extension.
Positioning should be recorded for valid comparisons and reproducibility.
3. Attach input tube to dynamometer.
• P/D engraving faces outward.
• Ankle input tube is orientated away from patient. Align shaft red dot with R/L.
• With attachment horizontal, press Hold.
4. Install footplate. Red dot to P/D.
5. Rotate dynamometer to 60 degrees.
6. Raise dynamometer to accommodate angle of knee.
7. Rotate chair to 65 degrees.
8. Set dynamometer tilt to 0 degrees.
9. Set seat back tilt to 70 - 85 degrees.
10. Move patient into position and align patient ankle axis of rotation (subtalar joint) with
dynamometer shaft.
11. Strap foot to footplate
12. Set ROM stops
Opposite Ankle
1. Press Hold to retain dynamometer shaft position.
2. Unstrap patient’s ankle and thigh.
3. With patient remaining in chair, slide chair back along travel.
4. Place limb support in the opposite receiving tube. Angle limb support toward chair (switch
with footrest if needed).
5. Place limb support pad under distal femur and secure with strap.
6. Remove footplate.
7. Rotate footplate input tube 180 degrees and attach to dynamometer.
• P/D engraving faces outward.
• Ankle input tube is directed away from patient. Align shaft red dot with R/L.
• Install footplate. Red dot to white dot for P/D.
• With attachment horizontal, press Hold.
— 3-7 —
SETUP AND POSITIONING
X
8.
9.
10.
11.
12.
Rotate dynamometer to opposite 75 degrees.
Rotate chair to opposite 75 degrees.
Move patient forward and secure leg in limb support with foot on footplate.
Align patient ankle axis of rotation (subtalar joint) with dynamometer shaft.
Reset ROM Stops.
SETUP AND POSITIONING
— 3-8 —
Clinical Applications of Biodex Operating Modes
Passive Mode
1. The passive mode may be used after a period of immobilization for the benefits of continuous
passive motion.
2. The passive mode may be used to perform non-reciprocal contractions (e.g., many times the
plantarflexors are considered to be the more essential muscle group to be rehabilitated after
injury. The plantar flexors may be worked both concentrically and eccentrically in the passive
mode.
Reactive Eccentric Mode
1. The eccentric mode may be used to strengthen the musculotendinous junction. Many times
injuries occur at the ankle secondary to eccentric loading to failure. It may be especially
important to rehab athletes in the eccentric mode.
Isokinetic Mode
1. The isokinetic mode may be used at bi-directional velocities. This is especially important at
the ankle complex where the muscular strength is so unbalanced. Many clinicians work the
plantarflexors at slower speeds and the dorsiflexors at higher speeds.
Isometric Mode
1. Multi-angle isometrics may be used pre- and post-operatively or after periods of immobilization.
Isotonic Mode
1. In later phases of rehab, perform various concentric contractions to isolate one muscle group
only.
2. Set torque limit higher for plantarflexors and lower for dorsiflexors to ensure fatigue time
remains constant.
Additional Comments
1. The ankle is known to be unstable in the plantarflexed position, an important fact to keep in
mind when dealing with athletes.
2. It has been stated that peroneal and dorsiflexor strengthening may help in resisting an inversion/plantarflexion injury.
3. The gait cycle may be simulated by using the passive mode in this sequence:
• Subject works eccentric dorsiflexion (heelstrike).
• Subject works eccentric plantarflexion (midstance).
• Subject works concentric plantarflexion (toe off).
• Subject works concentric dorsiflexion motion (swing phase).
4. It has been suggested for the subject to work barefoot with a piece of malleable material
between the foot and the attachment to work the intrinsics of the foot.
5. When rehabilitating the ankle, it is important to consider total leg strength.
6. If swelling is a consideration, the dynamometer may be raised. If cramping is a problem, the
dynamometer may be lowered to bring the ankle into a more dependent position to allow
enhanced blood flow.
7. Optionally, the seatback can be placed in the horizontal position to allow testing or exercise
in the supine position.
— 3-9 —
SETUP AND POSITIONING
X
ANKLE: EVERSION/INVERSION
Figure 3.8
Eversion/Inversion
Figure 3.7
55
Toward
40
Away
Figure 3.9
Quick Reference
Dynamometer Orientation:
Dynamometer Tilt:
Seat Orientation:
Seatback Tilt:
Footplate Color Code:
Knee Flexion:
Axis of Rotation:
Ready Position:
0º
50º - 70º (shaft up)
90º
70º
Red dot to I/E
30º - 45º
Passes through the syndesmosis and the body of the talus at an angle
of 35º.
Full Inversion
Parts Needed
Dynamometer:
Positioning Chair:
Ankle Attachment
Limb-Support, T-bar, Footrest
SETUP AND POSITIONING
— 3-10 —
GENERAL MAINTENANCE
ANKLE: EVERSION/INVERSION (SEATED)
The ankle is vulnerable to inversion injuries making injuries to the anterior talofibular complex a
common occurrence that may be difficult to rehabilitate.
Recurrent injuries to the lateral ligamentous complex have been shown to decrease proprioception of the ankle and athletic performance.
Setup and Positioning
(Starting Movement: Away/Eversion)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Seat patient on chair.
Install Limb Support Pad (with T-Bar) in chair front receiving tube for side to be exercised or
tested. Angle Limb Support toward chair. Place pad under distal femur and secure with strap.
Attach input tube to dynamometer.
• I/E engraving faces outward.
• Right Ankle and Left Ankle are oriented with input shaft straight up. Align shaft red dot
with R L.
• With attachment vertical, press Hold.
Install footplate. Red dot to green dot for I/E.
Adjust the footplate angle to align red dot with "I" markers..
Rotate dynamometer to 0 degrees and position in line with limb support.
Lower dynamometer all the way down in pedestal.
Rotate chair to 90 degrees.
Set dynamometer tilt to 50 - 70 degrees (shaft up, see label on dynamometer face)
Set seat back tilt to 70 degrees
Move patient into position and align ankle axis of rotation.
Raise chair as needed to fine-tune axis of rotation.
Strap foot to footplate.
Set ROM Stops.
Ensure the subject's lower leg is parallel to the floor.
Opposite Side
1. Press Hold to retain dynamometer shaft position.
2. Unstrap patient’s ankle and leg.
3. With patient remaining in chair, slide chair back along travel.
4. Place limb support in the opposite receiving tube. Angle limb support toward chair.
5. Move patient into position and secure leg in limb support with foot on footplate.
6. Align ankle axis of rotation with dynamometer shaft.
7. Strap foot to footplate.
8. Reset ROM Stops.
— 3-11 —
SETUP AND POSITIONING
SERVICE PROCEDURES
Clinical Applications of Biodex Operating Modes
Passive Mode
1. The passive mode may be used after immobilization for the benefits of continuous passive
motion. The passive mode may also be used to assist with neurologic retraining in the first
few weeks after injury or surgery.
2. The passive mode may be used in combination with electric stimalation, ice and elevation for
acute ankle sprains to help reduce swelling.
3. The passive mode may be used after a lateral ligamentous sprain to evert submaximally and
passively invert. Inversion may be limited by ROM setings or using the percent range settings
during Biofeedback operation warranted.
4. The passive mode may be used after lateral ligamentous sprain to work the evertors both concentrically and eccentrically. Range of motion may be limited as stated above.
Reactive Eccentric Mode
1. The eccentric mode may be used to perform maximal or submaximal activities, develop prioproceptiory and to simulate function or sports activities.
Isokinetic Mode
1. The isokinetic mode may be set bidirectionally. In the case of a lateral sprain, evertors may be
set at relatively low speeds and invertors at higher speeds. Range of motion should be limited as warranted.
2.
The concentric/eccentric setting may be used in the later stages of rehab for muscle strengthening.
Isometric Mode
1. Multi-angle isometrics may be performed in the isometric mode. Strength carry-over has been
found to be plus or minus ten degrees of the ankle exercise performed. Isometrics may be used
to stress either the agonist or antagonist.
Isotonic
1. Set torque limits accordingly to ensure adequate force production throughout the ROM.
Additional Comments
1. Ankle inversion injury has been noted to be caused by eccentric peroneal activity to failure.
2. A piece of malleable foam may be placed between the subject’s bare foot and the attachment
to work the intrinsics of the foot during rehabilitation.
3. Athletes who have poor static balance have been found to have weak evertors. Evertor
strengthening may be helpful.
4. Consider the importance of total leg strength in the process of rehabilitating the ankle.
5. The ankle may be rehabilitated in an elevated position if edema is present.
6. If swelling is a consideration, the Dynamometer may be raised. If cramping is a problem, the
Dynamometer may be lowered to bring the ankle into a more dependent position, allowing
enhanced blood flow.
7. Seat tilt may be placed in the horizontal plane to allow testing in the supine position. This may
require a slight adjustment of the dynamometer.
SETUP AND POSITIONING
— 3-12 —
CONTENTS
SHOULDER: FLEXION/EXTENSION (SEATED)
Shoulder/Elbow Adapter
Shoulder Attachment
Figure 3.11
180
Away
Figure 3.10
60
Toward
0
Figure 3.12
Quick Reference
Dynamometer Orientation:
Dynamometer Tilt:
Seat Orientation:
Seatback Tilt:
Axis of Rotation:
Ready Position:
15º
0º
30º
70 - 85º
Compromise axis is acromial process in the sagittal plane.
Full Extension
Parts Needed
Dynamometer:
Positioning Chair:
Shoulder/Elbow Adapter (remove cuff), Shoulder Attachment
Footrest (optional)
— 3-13 —
SETUP AND POSITIONING
REPLACEMENT PARTS
SHOULDER: FLEXION/EXTENSION (SEATED)
Shoulder extension/flexion is a motion that is usually initiated early in the rehabilitation process,
however, clinicians must be careful not to cause impingement. An impingement sign is produced
when the shoulder is fully flexed and there is jamming of the greater tuberosity against the antero
inferior surface of the acromion. For this reason, the clinician may want to limit flexion range of
motion in the early stages of the rehabilitation process.
Setup and Positioning
(Starting Movement: Away/Flexion)
NOTE: This pattern may be accomplished with the positioning chair seatback reclined to any position which
provides for both subject comfort and proper alignment of the anatomical axis. (The seatback and
dynamometer tilt must, however, be set parallel.)
1. Seat patient on chair.
2. Attach Shoulder/Elbow adapter to dynamometer (remove cuff). Insert shoulder attachment
into adapter.
3. Align shaft red dot with R or L and move attachment to almost full extension. Press Hold.
4. Rotate dynamometer to 15 degrees.
5. Tilt dynamometer to 0 degrees
6. Rotate chair to 30 degrees.
7. Move patient into position. Align patient axis of rotation with dynamometer shaft. Raising
dynamometer or tilting seatback can accommodate various size patients.
8. Check for proper ROM. Keep handgrip loose during motion to allow for the compromising
positions of the glenoid humeral joint as it goes through the motions.
9. Stabilize patient with shoulder, waist and thigh straps.
10. Set ROM stops.
Opposite Side
1. With patient remaining in chair, slide chair back along travel.
2. Remove attachment and rotate it 180 degrees. Align Shaft red dot with R or L.
3. Move attachment to almost full extension.
4. Rotate dynamometer to opposite 15 degrees.
5. Rotate chair to opposite 30 degrees.
6. Move patient into position. Align patient axis of rotation with dynamometer shaft. Raising
dynamometer or tilting seatback can accommodate various size patients.
7. Check for proper ROM. Keep handgrip loose during motion to allow for the compromising
positions of the glenoid humeral joint as it goes through the motions.
8. Stabilize patient with shoulder, waist and thigh straps.
9. Reset ROM stops.
SETUP AND POSITIONING
— 3-14 —
REPLACEMENT PARTS
Clinical Applications of Biodex Operating Modes
Passive Mode
1. The passive mode may be used initially for the benefits of continuous passive motion. It has
been suggested that early re-establishment of neural pathways without stressing an inflamed
capsule is essential.
2. It has been suggested to increase anterior shoulder flexibility in the acute phase of a rotator
cuff strain without offering resistance. The passive mode may be used to carry the limb into
the flexed position. The subject may be instructed to assist the extensors as the arm is moved
in the away direction.
3. It has been suggested by some clinicians that submaximal eccentrics that can be performed in
the passive mode may be used to treat subjects with bicipital tendonitis.
4. With adhesive capsulitis, the subject may be placed in the passive mode with a four second
pause at end range.
Isokinetic Mode
1. The isokinetic mode may be used bi-directionally to focus on one specific muscle group (i.e.,
in an impingement syndrome the flexors may be worked at a fast speed through a limited
range and the extensors at a lower speed).
Isometric Mode
1. Isometrics may be used immediately pre- and post-operatively. Multi-angle isometrics are
recommended to achieve physiological overflow into that portion of the range which has not
been exercised.
Isotonic
1. Set torque limits accordingly to ensure adequate force production throughout the ROM.
Additional Comments
1. With impingement syndrome and anterior subluxation, it has been recommended to initially
limit motion to under 90 degrees and progress slowly past this point.
2. It is important to consider that glenohumeral motion requires a coordinated effort between
the deltoid and the rotator cuff musculature. Working the anterior deltoid non-reciprocally
will strengthen this muscle concentrically and eccentrically.
— 3-15 —
SETUP AND POSITIONING
REPLACEMENT PARTS
SHOULDER: ABDUCTION/ADDUCTION (SEATED)
Shoulder/Elbow Adapter
Shoulder Attachment
Figure 3.14
180
Away
Figure 3.13
75
0
Toward
Figure 3.15
Quick Reference
Dynamometer Orientation:
Dynamometer Tilt:
Seat Orientation:
Seatback Tilt:
Axis of Rotation:
Ready Position:
10º
10º
75º
70 - 85º
Axis of rotation for this pattern approximates the axis of the acromioclavicular joint, which connects the distal end of the clavicle to the
anterior medial portion of the acromial process.
Full adduction
Parts Needed
Dynamometer:
Positioning Chair:
Shoulder/Elbow Adapter (remove cuff), Shoulder Attachment
Footrest (optional)
SETUP AND POSITIONING
— 3-16 —
REPLACEMENT PARTS
SHOULDER: ABDUCTION/ADDUCTION (SEATED)
The shoulder complex is made up of multiple linkages. These include the glenohumeral joint,
acromioclavicular joint, sternoclavicular joint, and scapulothoracic articulation. The glenohumeral joint is the most mobile joint in the body with global freedom. Because of this, stability is sacrificed. Only a little more than 1/3 of the head of the humerus makes contact with the glenoidfossa at any one time.
Abduction/adduction is usually one of the last motions exercised in rehabilitation of the shoulder. The clinician must exercise great care in order to avoid impingement.
Setup and Positioning
(Starting Movement: Away/Abduction)
NOTE: This pattern may be accomplished with the seatback reclined to any position which provides for both
patient comfort and proper alignment of the anatomical axis. The seatback and dynamometer tilt
must, however, be set to the same angle.
1. Seat patient on chair.
2. Attach Shoulder/Elbow adapter to dynamometer (remove cuff). Insert shoulder attachment
into adapter.
3. Align Shaft red dot with R or L and move attachment to almost full abduction. Press Hold.
4. Rotate chair to 75 degrees.
5. Rotate dynamometer to 10 degrees.
6. Raise dynamometer fully.
7. Tilt dynamometer to 10 degrees.
8. Move patient into position (patient is facing away from dynamometer). Slide dynamometer
along travel to align axis of rotation.
9. Check for proper ROM. Keep handgrip loose during motion to allow for the compromising
positions of the glenoid humeral joint as it goes through the motions.
10. Stabilize patient with shoulder and waist straps.
11. Set ROM stops.
Opposite Side
1. With patient remaining in chair, slide chair back away from dynamometer.
2. Remove attachment and rotate it 180 degrees opposite. Align Shaft red dot with R or L.
3. Move attachment to almost full abduction. Press Hold.
4. Rotate chair to opposite 75 degrees.
5. Rotate dynamometer to opposite 10 degrees.
6. Move patient into position (patient is facing away from dynamometer). Slide dynamometer
along travel to align axis of rotation.
7. Check for proper ROM. Keep handgrip loose during motion to allow for the compromising
positions of the glenoid humeral joint as it goes through the motions.
8. Stabilize patient with shoulder and waist straps.
9. Reset ROM stops.
— 3-17 —
SETUP AND POSITIONING
SCHEMATICS
Clinical Applications of Biodex Operating Modes
Passive Mode
1. The passive mode may be used initially for the benefits of continuous passive motion. This is
especially important post-surgically. It has been suggested that early re-establishment of
neural pathways without overstressing an inflamed capsule is essential.
2.
The passive mode may be used to work the adductors early in the rehabilitation, both concentrically and eccentrically. Conversely, the abductors may be stressed in the same way later
in rehabilitation.
Eccentric Mode
1. The eccentric mode may be used to perform submaximal eccentrics especially in cases of tendonitis.
Isokinetic Mode
1. The isokinetic mode may be used at bi-directional velocities to stress either the abductors or
adductors (i.e., in early rotator cuff rehabilitation, the focus may be placed on the adductors).
The adductors may be worked at low speeds concentrically and the abductors at higher
speeds concentrically. Set limits as appropriate.
Isometric Mode
1. Multi-angle isometrics may be performed (i.e., with adhesive capsulitis, if the subject performs an isometric contraction at the end of the range, he/she will develop strength gains in
a greater range due to the overflow principle.
Isotonic
1. Set torque limits accordingly to ensure adequate force production throughout the ROM.
Additional Comments
1. The pause may be used at end range simply to focus on that portion of the range.
2.
The limit set buttons and/or percent range of motion controls, may be used in subjects with
impingement syndrome to limit the range of motion to 90 degrees or less.
3.
It has been recommended in some cases that a strong supraspinatus contraction be present in
the first 30 degrees of motion before other strengthening may begin.
4.
It has been suggested that strengthening the abductors is very important in the rehabilitation
of acromioclavicular separations.
5.
It has been suggested that the force of the abducting musculature is very important in establishing equilibrium at the glenohumeral joint and that the supraspinatus helps prevent downward dislocation of the humerus.
6.
It has been stated that the long head of the biceps may act as an accessory shoulder abductor.
If the glenohumeral joint is externally rotated.
7.
For alternate positioning, the seat and dynamometer can be positioned at any 15º of rotation.
SETUP AND POSITIONING
— 3-18 —
CONTENTS
SHOULDER: EXTERNAL/INTERNAL ROTATION IN THE
MODIFIED NEUTRAL POSITION (SEATED)
Figure 3.17
Figure 3.16
Away
Toward
50
90
Figure 3.18
Quick Reference
Dynamometer Orientation:
Dynamometer Tilt:
Seat Orientation:
Seatback Tilt:
Axis of Rotation:
Ready Position:
20º
30º-50º
15º
55º - 85º
Axis alignment is longitudinal through the head of the shaft of the
humerus in a horizontal plane.
Full Internal Rotation
Parts Needed
Dynamometer:
Positioning Chair:
Elbow/Shoulder Attachment with Cuff
Footrest (optional)
— 3-19 —
SETUP AND POSITIONING
CONTENTS
SHOULDER: EXTERNAL/INTERNAL ROTATION IN THE MODIFIED NEUTRAL
POSITION (SEATED)
The rotator cuff is one of the most important structures in maintaining the integrity of the shoulder complex. The stability of the glenohumeral joint depends largely on an intact and functioning
rotator cuff. A strong rotator cuff is especially important for a balanced and smooth movement of
the upper extremity.
There are several different positions available to set up a subject for testing or rehabilitation of the
internal/external rotation movement. Two are presented in this manual: the modified neutral
position and the and shoulder internal/external rotation in 90º of abduction.
Setup and Positioning
(Starting Movement: Away/External Rotation)
NOTE: Attachment must be reversed for Right to Left. Align shaft dot with R or L.
1.
2.
3.
4.
5.
6.
7.
8.
9.
Seat patient on chair.
Rotate chair to 15 degrees.
Rotate dynamometer to 20 degrees.
Tilt dynamometer to 30 - 50 degrees.
Attach Elbow/Shoulder attachment. Align shaft dot with R or L. Secure with locking knob.
Move chair and patient into position.
Raise dynamometer to align axis of rotation. If needed, adjust seat back tilt to accommodate
various patient sizes.
Stabilize patient with shoulder, waist and thigh straps.
Set ROM stops.
Opposite side.
1. Press hold.
2. With patient remaining in chair, slide chair back away from dynamometer.
3. Rotate chair to 15 degrees on opposite side.
4. Rotate dynamometer to 20 degrees on opposite side.
5. Remove attachment and rotate it 180 degrees opposite.
6. Reattach Shoulder/Elbow attachment to dynamometer and align shaft dot with R or L. Secure
with locking knob.
7. Move chair and patient into position.
8. Adjust dynamometer to align axis of rotation. If needed, adjust seat back tilt to accommodate
various patient sizes.
9. Stabilize patient with shoulder, waist and thigh straps.
10. Reset ROM stops.
SETUP AND POSITIONING
— 3-20 —
CONTENTS
Clinical Applications of Biodex Operating Modes
Passive Mode
1. The passive mode may be used initially for the benefits of continuous passive motion. This is
especially important post-surgically. Many clinicians are using this early on post arthroscopic surgery.
2.
The passive mode may be used to work one muscle group both concentrically and eccentrically, (i.e., after an anterior shoulder dislocation, the internal rotators may be worked both
concentrically and eccentrically through a limited range. With a tear in the posterior rotator
cuff, the internal rotators may also be stressed initially in this way).
Eccentric Mode
1. The eccentric mode may be used to perform submaximal eccentrics for the diagnosis of tendonitis (i.e., this technique may be used in cases of supraspinatus tendonitis).
Isokinetic Mode
1. The isokinetic mode may be used at bi-directional velocities to stress either the internal rotators or the external rotators. This mode may also be used to replicate function (i.e., the athlete
may work the external rotators at lower speeds and the internal rotators at higher speeds to
replicate the throwing motion.)
Isometric Mode
1. Multi-angle isometrics may be performed early in the rehabilitation process or to work near
painful points in the ROM. In this way, strength gains will be made through a portion of the
unworked range.
Isotonic
1. To increase speed of movement, set torque limits lower.
2. Set torque accordingly (internal rotation high, external rotation low).
Additional Comments
1. Subjects with impingement syndrome may best be worked in the modified neutral position
and not 90 degrees of abduction.
2.
A subject may be started in the modified neutral position and be worked into increasing
degrees of abduction as tolerated.
3.
Athletes, especially pitchers, may be worked at the 90 degree abduction position and full
external rotation since this is a functional position for this group.
4.
It has been found that the posterior cuff muscles act to decelerate the arm motion eccentrically during the follow-through phase of throwing. This eccentric motion may be simulated on
the Biodex.
— 3-21 —
SETUP AND POSITIONING
CONTENTS
5.
Some clinicians have thought of impingement syndrome as an ineffective action of the rotator cuff musculature. Use the eccentric mode to work on control.
6.
As the glenohumeral joint is externally rotated, the anterior capsule undergoes a wringing
which may cause an inflammatory response in the capsule. External rotation may initially be
limited with ROM stop buttons or percent dials to prevent this.
SETUP AND POSITIONING
— 3-22 —
CONTENTS
SHOULDER: EXTERNAL/INTERNAL ROTATION IN 90˚ OF ABDUCTION
Figure 3.20
Figure 3.19
40-45
Away
55
Toward
Figure 3.21
Quick Reference
Dynamometer Orientation:
Dynamometer Tilt:
Seat Orientation:
Seatback Tilt:
Axis of Rotation:
Ready Position:
35º
5º
30º
55 - 85º
Axis alignment is longitudinal through the head of the shaft of the
humerus in a horizontal plane.
Full Internal Rotation
Parts Needed
Dynamometer:
Positioning Chair:
Elbow/Shoulder Attachment
Footrest (optional)
— 3-23 —
SETUP AND POSITIONING
CONTENTS
SHOULDER: EXTERNAL/INTERNAL ROTATION IN 90º OF ABDUCTION
The rotator cuff is one of the most important structures in maintaining the integrity of the shoulder complex. The stability of the glenohumeral joint depends largely on an intact and functioning
rotator cuff. A strong rotator cuff is especially important for a balanced and smooth movement of
the upper extremity.
There are several different positions available to set up a subject for testing or rehabilitation of the
internal/external rotation movement. The setup for this pattern in 90º of abduction is as follows.
Setup and Positioning
(Starting Movement: Away/External Rotation)
NOTE: Attachment must be reversed for Right to Left. Align shaft dot with R or L. Cuff must be removed
to reverse.
1.
2.
3.
4.
5.
6.
7.
8.
Seat patient on chair.
Attach Elbow/Shoulder attachment. Align shaft dot with R or L. Secure with locking knob.
Tilt dynamometer to 5 degrees.
Rotate dynamometer to 35 degrees.
Rotate chair to 30 degrees. Move patient into position and raise dynamometer to align patient
axis of rotation.
Tilt seat back to 55 - 85 degrees. If needed, adjust seat back tilt to accommodate various patient
sizes.
Stabilize patient with shoulder and thigh straps.
Set ROM stops.
Opposite Side
1. Press Hold.
2. With patient remaining in chair, move seat away from dynamometer.
3. Remove attachment and align shaft dot with R or L. Shaft will have to rotate 180 degrees.
4. Place attachment back onto shaft, secure with locking knob.
5. Rotate dynamometer to opposite side.
6. Rotate chair to 30 degrees opposite position.
7. Move patient into position. Raise dynamometer to align axis of rotation.
8. Tilt seat back to 55 - 85 degrees. If needed, adjust seat back tilt to accommodate various patient
sizes.
9. Stabilize patient with shoulder and thigh straps.
10. Reset ROM stops.
SETUP AND POSITIONING
— 3-24 —
CONTENTS
Clinical Applications of Biodex Operating Modes
Passive Mode
1. The passive mode may be used initially for the benefits of continuous passive motion. This is
especially important post-surgically. Many clinicians are using this mode one day post-op
after arthroscopic surgery.
2. The passive mode may be used to work one muscle group both concentrically and eccentrically, (i.e., after an anterior shoulder dislocation, the internal rotators may be worked both
concentrically and eccentrically through a limited range. With a tear in the posterior rotator
cuff, the internal rotators may also be stressed initially in this way).
Eccentric Mode
1. The eccentric mode may be used to perform submaximal eccentrics for the diagnosis of tendonitis (i.e., this technique may be used in cases of supraspinatus tendonitis).
Isokinetic Mode
1. The isokinetic mode may be used at bi-directional velocities to stress either the internal rotators or the external rotators. This mode may also be used to replicate function (i.e., the athlete
may work the external rotators at lower speeds and the internal rotators at higher speeds to
replicate the throwing motion.)
Isometric Mode
1. Multi-angle isometrics may be performed early in the rehabilitation process or to work near
painful points in the ROM. In this way, strength gains will be made through a portion of the
unworked range.
Isotonic
1. Set torque accordingly (internal rotation high, external rotation low).
2. To increase speed of movement, set torque limits lower.
Additional Comments
1. Subjects with impingement syndrome may best be worked in the modified neutral position
and not 90 degrees of abduction.
2. A subject may be started in the modified neutral position and be worked into increasing
degrees of abduction as tolerated.
3. Athletes, especially pitchers, may be worked at the 90 degree abduction position and full
external rotation since this is a functional position for this group.
4. It has been found that the posterior cuff muscles act to decelerate the arm motion eccentrically during the follow-through phase of throwing. This eccentric motion may be simulated on
the Biodex.
— 3-25 —
SETUP AND POSITIONING
CONTENTS
5. Some clinicians have thought of impingement syndrome as an ineffective action of the rotator
cuff musculature. Use the eccentric mode to work on control.
6. As the glenohumeral joint is externally rotated, the anterior capsule undergoes a wringing
which may cause an inflammatory response in the capsule. External rotation may initially be
limited with ROM stop buttons or percent dials to prevent this.
SETUP AND POSITIONING
— 3-26 —
CONTENTS
SHOULDER: DIAGONAL (SEATED)
Shoulder/Elbow Adapter
Shoulder Attachment
Figure 3.23
180
Away
Figure 3.22
0
Toward
Figure 3.24
Quick Reference
Dynamometer Orientation:
Dynamometer Tilt:
Seat Orientation:
Seatback Tilt:
Axis of Rotation:
Ready Position:
30º
10 - 35º
0º
70 - 85º
Off axis through the glenohumeral joint.
Full Extension
Parts Needed
Dynamometer:
Positioning Chair:
Shoulder/Elbow Adapter (remove cuff), Shoulder Attachment
Footrest (optional)
— 3-27 —
SETUP AND POSITIONING
CONTENTS
SHOULDER: DIAGONAL (SEATED)
Setup and Positioning
(Starting Movement: Away/Flexion)
1. Seat patient on chair.
2. Attach Shoulder/Elbow adapter to dynamometer (remove cuff). Insert shoulder attachment
into adapter.
3. Align Shaft red dot with R or L. Move attachment to an upright position. Press Hold.
4. Rotate chair to 0 degrees.
5. Rotate dynamometer to 30 degrees.
6. Tilt dynamometer 10 - 35 degrees. Increase or decrease the amount of horizontal abduction by
varying the dynamometer height and tilt. A lower dynamometer requires more tilt, which
increases abduction.
7. Move chair and patient into position to align patient axis of rotation with dynamometer shaft.
Seat back can be tilted to accommodate various size patients.
8. Check for proper ROM. Keep handgrip loose during motion to allow for the compromising
positions of the glenoid humeral joint as it goes through the motions.
9. Stabilize patient with shoulder, waist and thigh straps.
10. Set ROM stops.
Opposite Side
1. With patient remaining in chair, slide chair back away from dynamometer.
2. Remove attachment and rotate 180 degrees opposite. Align Shaft red dot with R or L and reattach Shoulder attachment.
3. Move attachment to an upright position. Press Hold.
4. Rotate dynamometer to opposite 30 degrees.
5. Seat orientation remains at 0 degrees.
6. Move chair and patient into position to align patient axis of rotation with dynamometer shaft.
Seat back can be tilted to accommodate various size patients.
7. Check for proper ROM. Keep handgrip loose during motion to allow for the compromising
positions of the glenoid humeral joint as it goes through the motions.
8. Stabilize patient with shoulder, waist and thigh straps.
9. Reset ROM stops.
Clinical Applications of Biodex Operating Modes
Passive Mode
1. Have patient work with the system in active assist fashion.
SETUP AND POSITIONING
— 3-28 —
CONTENTS
Isokinetic Mode
1. Seat patient to isolate the muscular surrounding the shoulder responsible for Glenohumeral
stabilization.
2. Stand patient to become more functional in the throwing pattern.
3. To isolate the D2 flexors, select ecc/con. Vary speeds accordingly.
Reactive Eccentric
1. For nueromuscular reeducation, vary torque limits and have patient apply the “correct” force
to ensure proper attachment movement (to challenge the patient, make various changes to
torque limits without patient knowledge - but ensure that correct movement occurs.
Isometric
1. Multi-angle isometrics may be performed early in the rehabilitation process or to work near
painful points in the ROM. In this way, strength gains will be made through a portion of the
unworked range.
Isotonic
1. The Isotonic mode can be utilized to ensure a proper force limit is achieved.
— 3-29 —
SETUP AND POSITIONING
CONTENTS
SHOULDER: DIAGONAL (STANDING)
Shoulder/Elbow Adapter
Shoulder Attachment
Figure 3.26
180
Away
Figure 3.25
0
Toward
Figure 3.27
Quick Reference
Dynamometer Orientation:
Dynamometer Tilt:
Axis of Rotation:
Ready Position:
50º
10 - 35º
Off axis through the glenohumeral joint.
Full Extension
Parts Needed
Dynamometer:
Shoulder/Elbow Adapter (remove cuff), Shoulder Attachment
SETUP AND POSITIONING
— 3-30 —
CONTENTS
SHOULDER: DIAGONAL (STANDING)
Setup and Positioning
(Starting Movement: Away/Flexion)
1.
2.
3.
4.
5.
6.
7.
Tilt dynamometer to 10 - 35 degrees. Increase or decrease the amount of horizontal abduction
by varying the dynamometer height and tilt. A lower dynamometer requires more tilt, which
increases abduction.
Attach Shoulder Attachment to dynamometer. Align Shaft red dot with R or L. Move attachment to an upright position. Press Hold.
Have patient stand perpendicular to dynamometer.
Rotate dynamometer to 35 degrees.
Align patient axis of rotation.
Check for proper ROM. Keep handgrip loose during motion to allow for the compromising
positions of the glenoid humeral joint as it goes through the motions.
Set ROM stops
Opposite Side
1. Remove attachment and rotate it 180 degrees opposite. Align Shaft red dot with R or L and
reattach.
2. Move attachment to an upright position. Press Hold
3. Have patient face opposite way and grasp handgrip.
4. Align axis of rotation.
5. Check for proper ROM. Keep handgrip loose during motion to allow for the compromising
positions of the glenoid humeral joint as it goes through the motions.
6. Reset ROM stops.
Clinical Applications of Biodex Operating Modes
Passive Mode
1. Have patient work with the system in active assist fashion.
2. Have patient light the Applied Torque indicator at all times to work the D2 flexors.
Isokinetic Mode
1. Seat patient to isolate the muscular surrounding the shoulder responsible for Glenohumeral
stabilization.
2. Stand patient to become more functional in the throwing pattern.
3. To isolate the D2 flexors, select ecc/con. Vary speeds accordingly.
Reactive Eccentric
1. For nueromuscular reeducation, vary torque limits and have patient apply the “correct” force
to ensure proper attachment movement (to challenge the patient, make various changes to
torque limits without patient knowledge - but ensure that correct movement occurs.
Isometric
1. Multi-angle isometrics may be performed early in the rehabilitation process or to work near
painful points in the ROM. In this way, strength gains will be made through a portion of the
unworked range.
Isotonic
1. The Isotonic mode can be utilized to ensure a proper force limit is achieved.
— 3-31 —
SETUP AND POSITIONING
CONTENTS
ELBOW: EXTENSION/FLEXION (SEATED)
Figure 3.29
Toward
Figure 3.28
160
0 Away
Figure 3.30
Quick Reference
Dynamometer Orientation:
Dynamometer Tilt:
Positioning Chair Orientation:
Seatback Tilt:
Axis of Rotation:
Ready Position:
15º
0º
15º
70 - 85º
Passes through the center of the trochlea and the capitulum,
bisecting the longitudinal axis of the shaft of the humerus.
Full Flexion
Parts Needed
Dynamometer:
Positioning Chair:
Elbow/Shoulder Attachment, (remove cuff)
Limb-Support Pad, Footrest (optional)
SETUP AND POSITIONING
— 3-32 —
CONTENTS
ELBOW: EXTENSION/FLEXION
The elbow joint consists of the articulation between the trochlea of the humerus and the trochlear
notch of the ulna, the capitulum of the humerus and the facet on the head of the radius and the
circumference of the head of the radius and the radial notch of the ulna. Any bony malalignment
(such as a fracture) interferes with the critical angles of these articulations making normal movement impossible.
Of special note at the elbow are the tendinous origins of the wrist musculature. The flexor/pronator muscles of the wrist originate at the medial epicondyle of the humerus and wrist extensor
group at the lateral epicondyle. These are areas that frequently become inflamed with overuse.
Setup and Positioning
(Starting Movement: Away/Extension)
1. Seat patient on chair.
2. Place Elbow/Shoulder attachment onto dynamometer shaft (remove cuff). Align shaft dot
with either R or L. Bring attachment to vertical. Press Hold.
3. Install limb support (angled toward patient) in chair side receiving tube for side to be tested
or exercised.
4. Rest elbow on limb support. Limb support pad should be angled back with pad angled slightly downward, allowing full extension. Securing strap may not be necessary.
5. Rotate chair to 15 degrees.
6. Rotate dynamometer to 15 degrees.
7. Set Seatback tilt to 70 - 85 degrees.
8. Tilt dynamometer to 0 degrees.
9. Move chair and patient into position. Raise dynamometer if necessary, to align patient axis of
rotation.
10. Stabilize patient with shoulder, waist and thigh straps.
11. Allow handgrip to rotate as patient goes through motion.
12. Set ROM stops.
Opposite Side
1. Press Hold.
2. Unstrap patient from support pad. With patient remaining in chair, slide chair back away
from dynamometer.
3. Place limb support in opposite side chair receiving tube.
4. Remove attachment and rotate it 180 degrees opposite. Align shaft dot with R or L. Place
attachment back onto shaft and secure with locking knob.
5. Rotate dynamometer to 15 degrees on opposite side.
6. Rotate chair to 15 degrees on opposite side.
7. Move chair and patient into position. Raise dynamometer if necessary, to align patient axis of
rotation.
8. Allow handgrip to rotate as patient goes through motion.
9. Stabilize patient with shoulder, waist and thigh straps.
10. Reset ROM stops.
— 3-33 —
SETUP AND POSITIONING
CONTENTS
Clinical Applications of Biodex Operating Modes
Passive Mode
1. The passive mode may be used to treat inflammatory conditions of the elbow. Many times
when rest is recommended it does not mean total immobilization but the elimination of activities that cause pain. The passive mode may be used for the effects of continuous passive
motion.
2. The passive mode may be used to perform non-reciprocal contractions, e.g., working the
extensors at the end range of motion both concentrically and eccentrically, as it is not uncommon for elbow extension to be compromised after injury or fracture.
Eccentric Mode
1. The eccentric mode may be used to simulate job specific tasks, e.g., the eccentric mode may be
used to work the elbow flexors, eccentrically as if the worker were lowering a heavy box.
Isokinetic Mode
1. The isokinetic mode may be used to work the elbow bi-directionally. In this way job specific
tasks, functional tasks, or sports activities may be simulated.
Isometric Mode
1. Isometrics may be used when pain or inflammation is a concern. Multi-angle isometrics are
recommended.
Isotonic Mode
1. To simulate a functional activity, set the isotonic force accordingly to a patient task.
2. Perform eccentric/concentric movements t do bicep-only exercise.
Additional Comments
1. It has been recommended by some clinicians that the dominant arm should be 5% stronger
than the nondominant arm in recreational athletes and 10% stronger in competitive athletes.
2. Ice may be applied to the site of the lesion while the patient is in the
passive mode for approximately fifteen minutes.
3. For cases of capsular tightness, place the patient in passive mode. The percent range of motion
settings should be reduced 55% and the patient should be placed on he unit. Slowly and with
caution, increase the percent ROM. NEVER EXCEED A COMFORTABLE OR PHYSIOLOGICAL RANGE OF MOTION. ALWAYS HAVE THE COMFORT STOP AVAILABLE. The
pause may also be used for a passive stretch at the end range.
SETUP AND POSITIONING
— 3-34 —
CONTENTS
4. The elbow is frequently injured by the repeated application of stresses. Throwing injuries
commonly occur secondary to throwing too frequently and throwing repeatedly at maximum
force. These injuries may be treated by working either passively, isokinetically, or eccentrically at submaximal levels.
5. Position the handgrip to concentrate on specific muscle groups. If desired, keep the handgrip
loose to obtain active supination or pronation.
— 3-35 —
SETUP AND POSITIONING
CONTENTS
FOREARM: SUPINATION/PRONATION
Figure 3.32
0
Away 80
Figure 3.31
Quick Reference
Dynamometer Orientation:
Dynamometer Tilt:
Seat Orientation:
Seatback Tilt:
Elbow Flexion:
Axis of Rotation:
80
Figure 3.33
Ready Position:
30º
5º (shaft down)
60º
85º
90º
Axis of rotation for this pattern is the longitudinal line through the
center of the head of the radius proximally, and through the center of
the head of the ulna distally.
Full Pronation
Parts Needed
Dynamometer:
Positioning Chair:
Wrist Attachment
Limb-Support Pad, Footrest (optional)
SETUP AND POSITIONING
— 3-36 —
CONTENTS
FOREARM: SUPINATION/PRONATION
Pronation and supination occur when the forearm rotates around a longitudinal axis passing
through the head of the radius and center of the distal ulna. During pronation/supination, the
radial head articulates with the capitellum of the humerus and the radial notch of the ulna.
Distally the radius and articular disc of the distal radioulnar joint articulates with the scaphoid,
lunate and triquetrum. The radius carries the wrist about the ulna during pronation and supination. Pronation/supination may be a particularly difficult motion to fully achieve after injury secondary to the complex nature of the movement.
Setup and Positioning
(Starting Movement: Away/Supination)
NOTE: Right and Left use same dot orientation for this pattern.
1. Seat patient on chair.
2. Install limb support (angled away from patient) in chair side receiving tube for side to be tested or exercised.
3. Attach Wrist attachment to dynamometer. Align shaft dot with R L. Handgrip orientation
should be up.
4. Rotate chair to 60 degrees.
5. Rotate dynamometer to 30 degrees.
6. Move chair and patient into position and align patient axis of rotation.
7. Tilt dynamometer to 5 degrees (shaft down).
8. Stabilize patient with shoulder and waist straps.
9. Set ROM stops.
Opposite Side
1. With patient remaining in chair, slide chair back away from dynamometer.
2. Move limb support to opposite side of chair.
3. Rotate attachment (do not remove) to horizontal. Rotate handgrip to angle up. Press Hold.
4. Slide dynamometer to opposite side.
5. Move patient into position and align patient axis of rotation.
6. Stabilize patient with shoulder and waist straps.
7. Reset ROM stops.
— 3-37 —
SETUP AND POSITIONING
CONTENTS
Clinical Applications of Biodex Operating Modes:
Passive Mode
1. The passive mode is important for the effects of continuous passive motion. The passive mode
may be used to initiate treatment of reflex sympathetic dystrophy.
2. The passive mode may be used to work a specific muscle group both concentrically and eccentrically, e.g., after a colles fracture, supination may be limited secondary to immobilization.
The supinators may be worked both concentrically and eccentrically to gain motion and
increase strength.
Eccentric Mode
1. The eccentric mode may be used to strengthen the musculotendinous junction. This may be
important since the wrist is frequently used eccentrically during functional activities.
Isokinetic Mode
1. The isokinetic mode may be used at bi-directional velocities in order to simulate functional or
sports activities.
Isometric Mode
1. The isometric mode may be used to strengthen musculature when pain, instability or surgery
is a factor.
Isotonic Mode
1. To simulate a functional activity, set the isotonic force accordingly to a patient task.
Additional Comments
1. At certain times, full range of motion may never be achieved, e.g., if in a colles fracture the
distal radial fragment moves toward supination, there may be a permanent loss of pronation.
2. With involvement of the wrist, be careful of shoulder-hand syndrome. Be sure to mobilize the
entire upper extremity.
3. If edema is a concern, the dynamometer and multi-support fixture may be raised during rehabilitation.
SETUP AND POSITIONING
— 3-38 —
CONTENTS
WRIST: EXTENSION/FLEXION
Figure 3.35
Away
70
Figure 3.34
0
80
Toward
Figure 3.36
Quick Reference
Dynamometer Orientation:
Dynamometer Tilt:
Seat Orientation:
Seatback Tilt:
Elbow Flexion:
Axis of Rotation:
Ready Position:
15 - 25º
0º
15º
85º
90º
Axis of rotation for this pattern lies between the proximal row of the
carpals, at the capitate bone, and the radius at the radiocarpal joint.
Full Flexion
Parts Needed
Dynamometer:
Positioning Chair:
Wrist Attachment
Limb-Support Pad, Footrest (optional)
— 3-39 —
SETUP AND POSITIONING
CONTENTS
WRIST: EXTENSION/FLEXION
The wrist joint consists of the distal end of the radius and the articular disc of the distal radioulnar joint articulate with the proximal row of carpal bones (scaphoid, lunate, and triquetrum.) The
carpal bones form a much larger surface than do the radius and the articular cartilage. This allows
for adduction/abduction, flexion/extension and circumduction to occur. Movement also occurs
between the proximal and distal row of carpal bones. The midcarpal joint adds considerably to
flexion and extension of the wrist.
Setup and Positioning
(Starting Movement: Away/Extension)
NOTE: Right and left side use same dot orientation for this pattern.
1. Seat patient on chair.
2. Install limb support (angled away from patient) in chair side receiving tube.
3. Attach Wrist attachment to dynamometer. Align shaft dot with R L. Handgrip
orientation is in.
4. Rotate dynamometer to 15 - 25 degrees.
5. Rotate chair to 15 degrees.
6. Set dynamometer tilt to 0 degrees.
7. Move chair and patient into position with wrist to be exercised or tested closest to the
dynamometer. Align patient’s axis of rotation with dynamometer shaft (raise dynamometer if
necessary).
8. Stabilize patient with shoulder and waist straps.
9. Set ROM Stops.
Opposite Side
1. With patient remaining in chair, slide chair back away from dynamometer.
2. Move limb support to opposite side of chair.
3. Rotate chair to opposite 15 degrees setting.
4. Rotate Wrist attachment so handgrip faces in (do not remove). Press Hold.
5. Move chair and patient into position with wrist to be exercised or tested closest to the
dynamometer. Align patient’s axis of rotation with dynamometer shaft.
6. Stabilize patient with shoulder and waist straps.
7. Reset ROM Stops.
SETUP AND POSITIONING
— 3-40 —
CONTENTS
Clinical Applications of Biodex Operating Modes
Passive Mode
1. The passive mode may be used for continuous passive motion effects. It may also be used to
maintain/increase range of motion, e.g., this is especially important in a colles fracture when
regaining range of motion is most difficult.
2. The passive mode may be used in cases of reflex sympathetic dystrophy which frequently
develops in conjunction with a colles fracture. These patients may receive sympathetic blocks
followed by mobilization and range of motion. The patient may move passively at first and,
as tolerated, begin to assist the motion in each direction.
3. The passive mode may be used to work non-reciprocally. In this way the wrist, both muscle
groups or one muscle group may be exercised concentrically/eccentrically or vice versa, (e.g.,
in cases of tennis elbow with involvement of the common extensor tendon at the elbow, the
wrist extensors may be worked concentrically/eccentrically by having the patient assist wrist
extension and resist wrist flexion).
Eccentric Mode
1. The eccentric mode may be used to simulate functional activities. Sub-maximal eccentrics
have been used successfully to treat tendonitis.
Isokinetic Mode
1. The isokinetic mode may be used bi-directionally to emphasize one particular muscle group,
e.g., in cases of golfer's elbow where there is involvement of the flexor tendon at the elbow,
the wrist flexors may be worked at low speeds and the extensors at high speeds.
Isometric Mode
1. Isometrics may be used after periods of immobilization or surgery. Isometrics may be used to
strengthen musculature after very delicate surgical procedures, e.g., isometrics may be the
first step in treating a scapholunate advanced collapse wrist.
Isotonic Mode
1. To simulate a functional activity, set the isotonic force accordingly to a patient task.
Additional Comments
1. Whenever there is wrist involvement, it is important to examine shoulder and elbow movements. If there is immobility in these areas, the passive mode may be used to improve ROM.
2. Wrist flexion and extension exercises are frequently performed with the forearm pronated
because tests have demonstrated that a greater mean torque can be produced than when in
supination.
3.
Use of the work tools may be an important adjunct in returning a patient to work.
— 3-41 —
SETUP AND POSITIONING
WRIST: RADIAL/ULNAR DEVIATION
Figure 3.38
Away
25
Figure 3.37
0
35
Toward
Figure 3.39
Quick Reference
Dynamometer Orientation:
Dynamometer Tilt:
Seat Orientation:
Seatback Tilt:
Elbow Flexion:
Axis of Rotation:
Ready Position:
15 - 25º
0º
15º
85º
90º
Axis of rotation for this pattern is at approximate center of capitate
bone if viewed from the palmar surface of the hand.
Full Ulnar Deviation
Parts Needed
Dynamometer:
Positioning Chair:
Wrist Attachment
Limb-Support Pad, Footrest (optional)
SETUP AND POSITIONING
— 3-42 —
CONTENTS
Wrist: Radial/Ulnar
Radial/Ulnar deviation involves radiocarpal and midcarpal movement. Ulnar deviation occurs
over a greater ROM than radial deviation. Radial deviation is limited by bony contact of the
scaphoid tubercle against the radial styloid.
Setup and Positioning
(Starting Movement: Away/Radial Deviation)
NOTE: Right and left side use same dot orientation for this pattern.
1.
2.
3.
4.
5.
6.
7.
8.
9.
Seat patient on chair.
Install limb support (angled away from patient) in chair side receiving tube.
Attach Wrist attachment to dynamometer. Align shaft dot with R L. Handgrip
orientation is up.
Rotate dynamometer to 15 - 25 degrees.
Rotate chair to 15 degrees.
Set dynamometer tilt to 0 degrees.
Move chair and patient into position with wrist to be exercised or tested closest to the
dynamometer. Align patient’s axis of rotation with dynamometer shaft (raise dynamometer
if necessary).
Stabilize patient with shoulder and waist straps.
Set ROM Stops.
Opposite Side
1. With patient remaining in chair, slide chair back away from dynamometer.
2. Move limb support to opposite side of chair.
3. Rotate chair to opposite 15 degrees setting.
4. Rotate Wrist attachment so handgrip faces up (do not remove). Press Hold.
5. Move chair and patient into position with wrist to be exercised or tested closest to the
dynamometer. Align patient’s axis of rotation with dynamometer shaft.
6. Stabilize patient with shoulder and waist straps.
7. Reset ROM Stops.
— 3-43 —
SETUP AND POSITIONING
CONTENTS
Clinical Applications of Biodex Operating Modes
Passive Mode
1. The passive mode may be used post-surgically in order to gain range of motion. e.g. After
surgery to correct a scapholunate advanced collapse, place the patient in the passive mode at
the range he/she has available and gradually increase as warranted.
2.
The passive mode may be used to perform concentric/concentric, concentric/eccentric, eccentric/concentric, and eccentric/eccentric contraction types. It is important to perform multiple
contraction types when rehabilitating the wrist since the hand performs such a wide variety
of functional tasks.
Eccentric Mode
1. The eccentric mode may be used to perform submaximal eccentrics or to simulate functional
activities.
Isokinetic Mode
1. The isokinetic mode may be used at bi-directional velocities to simulate function or to emphasize one particular muscle group.
Isometric Mode
1. Isometrics may be used after delicate surgical procedures or when instability is a concern. The
physician and therapist’s expertise and the type of surgery that has been performed must be
taken into account when beginning any form of exercise.
Isotonic Mode
1. To simulate a functional activity, set the isotonic force accordingly to a patient task.
Additional Comments
1. Swelling may be a concern when exercising the wrist and hand. If so, the multi-support fixture and dynamometer may be raised to keep the hand above the level of the heart.
2.
At times, there may be situations where full range of motion cannot be achieved. In a colles
fracture, secondary to malalignment during healing, there may be a permanent loss in ulnar
deviation. In this case, it is important to work on motions that may have been limited during
immobilization such as ulnar deviation.
3.
Whenever the wrist is involved, it is important to evaluate the entire upper extremity for lack
of mobility and then treat accordingly.
SETUP AND POSITIONING
— 3-44 —
5. REFERENCE MATERIALSCONTENTS
SUGGESTED TEST SPEEDS
Joint
Pattern
Orthopedic
Patient
Athlete
Knee
Extension/Flexion
(60), 180, 300
180, 300, 450
Shoulder
Abduction/Adduction
(60), 180, 300
180, 300, 450
Shoulder
Flexion/Extension
(60), 180, 300
180, 300, 450
Shoulder
External/Internal Rotation
(60), 180, 300
180, 300, 450
Shoulder
D2
(60), 180, 300
180, 300, 450
Elbow
Flexion/Extension
(60), 180, 300
180, 300
Wrist
Extension/Flexion
60, 120
120, 180
Wrist
Radial/Ulnar Deviation
60, 120
120, 180
Forearm
Supination/Pronation
60, 120
120, 180, 240
Ankle
Plantarflexion/
Dorsiflexion
60, 120
(60), 120, 180
Ankle
Eversion/Inversion
60, 120
(60), 120, 180
Hip
Flexion/Extension
(120), 180, 300
180, 300, 450
Hip
Abduction/Adduction
(120), 180, 300
180, 300, 450
NOTE: Test speeds in parenthesis may be approximate depending on pathology.
— 4-1 —
REFERENCE MATERIALS
LEGAL PRECEDENT FOR BIODEX EVIDENCE
In a Florida court decision, the Biodex System was accepted into evidence as a measure of dynamic human function. This decision establishes a precedent with important medical/legal implications for all rehabilitation professionals. In the future, the testifying therapist need only cite the
precedent case number for Biodex evidence to be accepted as valid.
Sue Chestnut, P.T., of Plantation Physical Therapy, testified as a witness for the plaintiff during
the trial Larry Beard vs. State Paving Co. The trial convened the week of May 21, 1986 in Broward
County Circuit Court, Fort Lauderdale, Florida. Case #81-12431 CH.
The plaintiff had sustained injuries in an automobile accident and was recommended to
Chestnut’s offices in Plantation, Florida for rehabilitation. Shortly before trial, a work-up on the
patient was done on the Biodex System. Evidence introduced indicated that the individual had a
functional deficit on his affected side of 50%.
“Biodex evidence was integral to the case,” says Chestnut. “The evidence was the only factual
measure of his functional ability introduced during the trial.”
Chestnut was able to explain to the jury exactly how the Biodex functioned and what it was used
for. This included explaining the difference between the Biodex and one of the original Isokinetic
devices. The attorney for the defense was familiar with the older system, but the Biodex was new
to him.
After Chestnut had outlined the differences to the attorney, neither the presiding judge,
Honorable Robert Andrews, nor the attorney had any further question or objection. The evidence
was then legally admitted in a United States court of law for the first time.
Evidently, the judge and attorneys were not the only ones impressed with Chestnut’s testimony.
The jury retired to consider its verdict and returned with a ruling in favor of Chestnut’s client.
BIODEX DATA ADMITTED AS MEDICAL EVIDENCE IN COURT
1.
Larry Beard vs. State Paving Co.
Broward County Circuit Court
Ft. Lauderdale, FL
Docket No. 81-12431 CH
Judge: Hon. Robert Andrews
2.
Gilbert Green vs. Delta Airlines
Federal Court
Ft. Lauderdale, FL
Docket No. 85-6656 CIVJAG
Attorney: David Kratlin, Esq.
3.
Grace Monico vs. G.E. Credit Corp.
Broward County Court
Plantation, FL
Docket No. 87-000 75CA
Attorney: Jeffrey Fenster, Esq.
REFERENCE MATERIALS
— 4-2 —
CONTENTS
BIODEX
PATIENT PROGRESS CHART
— 4-3 —
REFERENCE MATERIALS
CONTENTS
CURRENT RECORDED NORMATIVE GOALS (ENGLISH UNITS)
JOINT MOVEMENT
AND POSITION
SPEED
PEAK TORQUE/BW RANGE
DEGREES/SECONDS
MALE
FEMALE
Lumbar Flexion
Semi Standing
60
90
120
114
*
*
121
*
*
*
*
*
*
*
*
Lumbar Extension
Semi Standing
60
90
120
150
133
145
162
139
150
*
*
*
*
*
*
Shoulder External Rot.
Mod. Neutral
60
180
13
11
17
15
10
8
13
12
Shoulder Internal Rot.
Mod. Neutral
60
180
19
17
26
23
14
13
18
17
Shoulder Flexion
Seated
60
180
300
25
22
9
34
29
12
23
20
21
30
26
27
Shoulder Extension
Seated
60
180
300
28
22
28
37
30
37
24
18
17
31
23
23
Shoulder Abduction
Seated
60
180
20
18
27
24
16
14
20
18
Shoulder Adduction
Seated
60
180
32
27
43
36
27
25
35
33
Ankle Plantarflexion
Seated
30
60
120
49
36
23
65
48
31
43
36
20
55
46
26
Ankle Dorsiflexion
Seated
30
60
120
13
11
9
17
15
12
16
15
11
21
20
14
Ankle Eversion
Seated
30
60
13
9
17
12
12
9
16
12
Ankle Inversion
Seated
30
60
12
11
16
14
14
12
19
15
*
*
*
*
*
*
*
*
*
*
Knee Extension
Seated
60
180
300
86
58
40
115
75
55
80
50
30
95
65
45
Hip Flexion
Supine
45
300
40
10
52
13
38
7
50
9
Hip Extension
Supine
45
300
63
34
82
44
57
28
77
37
Elbow Flexion
60
120
21
21
28
28
20
34
26
45
Elbow Extension
60
120
21
23
28
30
23
18
30
24
Wrist Flexion
60
120
4
2
7
4
4
2
7
4
Wrist Extension
60
120
2
2
4
4
2
2
4
4
Knee Flexion
Seated
Seated
Seated
Seated
Seated
FLEX/EXT RATIO
MALE
FEMALE
49
59
51
EXT ROT/INT ROT RATIO
MALE
FEMALE
DORSI/PLANTAR RATIO
MALE
FEMALE
EVER/INVER RATIO
MALE
FEMALE
49
59
51
64
66
90
83
69
ABD/ADD RATIO
MALE
FEMALE
71
71
79
83
81
66
53
64
78
26
31
39
39
43
54
87
90
61
72
78
62
76
79
64
29
66
25
97
93
88
98
57
97
57
97
* The Biodex normative database is a compilation of published information to be used as unilateral goals.
Peak Torque to body weight is expressed in a range which enables these goals to be recommended for various groups (Prepubescent patients do not apply)
REFERENCE MATERIALS
— 4-4 —
81
80
CONTENTS
CURRENT RECORDED NORMATIVE GOALS- (METRIC UNITS)
JOINT MOVEMENT
SPEED
AND POSITION
DEGREES/SECONDS
PEAK TORQUE/BW RANGE
MALE
FEMALE
Lumbar Flexion
Semi Standing
60
90
120
38.1 40.4
*
*
*
*
*
*
*
*
*
*
Lumbar Extension
Semi Standing
60
90
120
50.1 54.1
44.4 46.4
48.4 50.1
*
*
*
*
*
*
Shoulder External Rot.
Mod. Neutral
60
180
4.3
3.7
5.7
5.0
3.3
2.7
4.3
4.0
Shoulder Internal Rot.
Mod. Neutral
60
180
6.3
5.7
8.7
7.7
4.7
4.3
6.0
5.7
Shoulder Flexion
Seated
60
180
300
8.4
7.4
3.0
11.4
9.7
4.0
7.7
6.7
7.0
10.0
8.7
9.0
Shoulder Extension
Seated
60
180
300
9.4
7.3
9.4
12.4
10.0
12.4
8.0
6.0
5.7
10.4
7.7
7.7
Shoulder Abduction
Seated
60
180
6.7
6.0
9.0
8.0
5.3
4.7
6.7
6.0
Shoulder Adduction
Seated
60
180
10.7 14.3
9.0 12.0
9.0
8.4
11.7
11.0
Ankle Plantarflexion
Seated
30
60
120
16.4 21.7
12.0 16.0
7.7 10.4
14.4
12.0
6.7
18.4
15.4
8.7
Ankle Dorsiflexion
Seated
30
60
120
4.3
3.7
3.0
5.7
5.0
4.0
5.3
5.0
3.7
7.0
6.7
4.7
Ankle Eversion
Seated
30
60
4.3
3.0
5.7
4.0
4.0
3.0
5.3
4.0
Ankle Inversion
Seated
30
60
4.0
3.7
5.3
4.7
4.7
4.0
6.3
5.0
*
*
*
*
*
*
*
*
*
*
Knee Flexion
Seated
Knee Extension
Seated
60
180
300
28.7 38.4
19.4 25.1
13.4 18.4
2.7
16.7
10.0
31.7
21.7
15.0
Hip Flexion
Supine
45
300
13.4 17.4
3.3 4.3
12.7
2.3
16.7
3.0
Hip Extension
Supine
45
300
21.0 27.4
11.4 14.7
19.0
9.4
25.7
12.4
Elbow Flexion
60
120
7.0
7.0
6.7 8.7
11.4 15.0
Elbow Extension
60
120
7.0 9.4
7.7 10.0
7.7
6.0
10.0
8.0
Wrist Flexion
60
120
1.3
.7
2.3
1.3
1.3
.7
2.3
1.3
Wrist Extension
60
120
.7
.7
1.3
1.3
.7
.7
1.3
1.3
Seated
Seated
Seated
Seated
9.4
9.4
FLEX/EXT RATIO
MALE
FEMALE
49
59
51
EXT ROT/INT ROT RATIO
MALE
FEMALE
DORSI/PLANTAR RATIO
MALE
FEMALE
EVER/INVER RATIO
MALE
FEMALE
49
59
51
64
66
90
83
69
ABD/ADD RATIO
MALE
FEMALE
71
71
79
83
81
66
53
64
78
26
31
39
39
43
54
87
90
61
72
78
62
76
79
64
29
66
25
97
93
88
98
57
97
57
97
— 4-5 —
REFERENCE MATERIALS
81
80
6. APPENDICESENTS
(OPTIONAL) EMG/ANALOG SIGNAL ACCESS INTERFACE*
The (optional) EMG/Analog Signal Access Configuration Utility (ASA Config) is part of the
EMG/Analog Signal Access Interface option to the Advantage Software Program. The utility configures the scale factors and operating modes of the analog signal outputs for velocity, torque and
position.
With the configuration capability, the analog signals can be custom tailored to provide the best
and most appropriate analog data for a wide variety of usages.
Installation and Usage
The ASA Config utility must be installed on the computer, which runs the Advantage Software
program. Insert the provided ASA Config utility CD into the CD drive, and it will automatically
start the setup installation. If all the defaults are chosen during setup, a shortcut will be created
on your desktop called: System – ASA Config.
The utility cannot be run simultaneously with the Advantage Software application. Typically you
must exit the application, run the ASA Config utility to setup the scaling and modes, then run the
Advantage Software application to perform your tests and data capture.
All settings performed in the ASA Config utility will be permanently set in the Biodex Multi-Joint
System, even if the unit is completely shut down and re-started. The current settings can always
be verified by running the utility – it will show the current active settings. Status information on
the Biodex Multi-Joint System is shown on the top of the screen for your reference. As long as the
status shows ONLINE, the current displayed Analog Signal settings are accurate.
The Analog Signal Access port is an output of analog signals of velocity, torque and position data
in real-time directly from the motor control Digital Signal Processor (DSP). In addition to the realtime data, a synchronization pulse is issued whenever the real-time data is updated. The synchronization pulse can be used by the monitoring equipment to know when the real-time data
output has changed.
NOTE: For the pin-out definition of the port, please refer to the diagram at the back of this document entitled: EMG/Analog Signal Port Pin Configuration
Analog Signal Resolution Effected By Scale Factor
The analog signals range from –5 volts to +5 volts, resulting in a total range of 10 volts. The System
defaults to full scale. Full scale for torque as an example is –512 ft-lbs to +512 ft-lbs, for a total
range of 1024 ft-lbs. This results in an output resolution scale factor as follows:
1024 ft-lbs = 10 volts,
1 ft-lb = 9.8 milli-volts
*Consult with Biodex Customer Service before ordering.
— 5-1 —
APPENDICE
CONTENTS
9.8 milli-volts is well below the signal noise rated for this port, therefore it’s not possible to see 1
ft-lb increments on this analog signal. This program provides scaling options separately for all
three analog signals, so if typical usage is well below the maximum levels, 1 ft-lb increments can
be seen on typical analog monitoring equipment. For example, applying a range of +/- 0 to 64 ftlbs, the output resolution scale factor would look as follows:
128 ft-lbs = 10 volts,
1 ft-lb = 78.1 milli-volts
78.1 milli-volts is well above the worse case of signal noise (15 – 35 mV), so increments as low as
1/4 to 1/2 ft-lbs can be seen reliably.
Operating Modes
The Output Frequency, or update rate, controls how frequently the system will change the analog
outputs. The best it can do is 2,000 times per second, which is the default. If this high frequency is not
needed or may even be causing problems with the monitoring equipment, the update rate can be
lowered. Every time the analog signals are output, the synchronization signal is pulsed also.
Therefore the update rate controls how frequent the synchronization signal (i.e.: “syncout”) is pulsed.
NOTE: Syncout is a Digital TTL pulse which is Active High and has a continuous pulse width of 29
micro-seconds.
The Output Mode selects in what state the analog signal outputs are updated. The options are
as follows:
On Always - always output regardless of current operational state
On Timed - turns on analog outputs only for the next fixed period of time (in seconds)
Off (disabled) - totally shuts down the analog signal outputs
Auto, when active - is automatically on only when the system is in an active state, meaning not
STOP’ed and not in HOLD
On Go command - synchronizes the analog signal output with the Advantage Software application’s GO command, so the output is performed only during the trials exercised
NOTE: Use the <Refresh> button to display the current Remote Access Port setting in effect.
APPENDICES
— 5-2 —
CONTENTS
Table Of Scale Range and Factors
Following is the break down of ranges and the resulting scale factors for all three signals:
Scaling Option
Range
Scale Factor
0 – 512 deg/sec
0 – 256 deg/sec
0 – 128 deg/sec
0 – 64 deg/sec
0 – 32 deg/sec
-512 to +512 deg/sec
-256 to +256 deg/sec
-128 to +128 deg/sec
-64 to +64 deg/sec
-32 to +32 deg/sec
9.8 mV per deg/sec
19.5 mV per deg/sec
39.1 mV per deg/sec
78.1 mV per deg/sec
156.3 mV per deg/sec
0 – 512 ft-lbs
0 – 256 ft-lbs
0 – 128 ft-lbs
0 – 64 ft-lbs
0 – 32 ft-lbs
-512 to +512 ft-lbs
-256 to +256 ft-lbs
-128 to +128 ft-lbs
-64 to +64 ft-lbs
-32 to +32 ft-lbs
9.8 mV per ft-lb
19.5 mV per ft-lb
39.1 mV per ft-lb
78.1 mV per ft-lb
156.3 mV per ft-lb
Full scale (~ 348.6 deg)
ROM Only (varies)
12 to 320 degrees
Ex: 45 degrees
28.7 mV per degree
Ex: 222.2 mV per degree
Velocity:
Torque:
Position:
EMG/Analog Signal Port PIN Configuration
PIN #
DESIGNATION
DESCRIPTION
1
2
3
4
5
6-9
10
11-15
Common
Torque
Velocity
Position
Syncout
reserved
Common
not connected
Signal ground
Analog torque signal
Analog velocity signal
Analog position signal
TTL pulse
Do not connect!
Signal ground [same as pin 1]
— 5-3 —
APPENDICES
MAINTENANCE
MAINTENANCE
Cleaning Instructions
With the system turned OFF, wipe down all surfaces with a damp cloth. Mild soap and water can
be used to remove stains and scuff marks. Pay particular attention to the upholstery, which can
be damaged by exposure to perspiration and other body fluids.
NOTE: DO NOT use cleaning solutions containing ammonia or alcohol to clean upholstery. Mild soap and
water should be sufficient. Allow the system to dry thoroughly before resuming testing, rehab or exercise sessions.
A leather cleaner/conditioner can be used monthly on all upholstery.
Hardware
As needed, inspect all locking and adjustment mechanisms for signs of wear or damage.
If you have any questions or need further assistance, contact the Biodex Customer Service Department.
APPENDICES
— 5-4 —
CONTENTS
SYSTEM SPECIFICATIONS
Features:
Multi-Mode operation: Isokinetic, Isometric, Isotonic, Reactive Eccentric and Passive
Concentric speed up to 500 deg/sec
Eccentric speed up to 300 deg/sec
Concentric torque up to 500 ft-lb (680 Nm)
Eccentric torque up to 400 ft-lb (544 Nm)
Passive speed as low as .25 deg/sec
Passive torque as low as .5 ft-lb
Isotonic torque as low as .5 ft-lb
Clinical Data Station:
2.8 GHz Pentium 4 CPU
80 GB Hard Drive
512 MB RAM
48x CDRW
Windows™ XP Operating System
Biodex Advantage Software
LCD Flat Panel Touch Screen Color Monitor with integrated speakers
Color Printer
Attachments for Ankle, Knee, Shoulder, Elbow, Wrist ( Hip optional)
Attachment Cart
Calibration Kit
Manuals and Wall Chart
32 square feet operating space (3 square meters)
220 VAC
Certification:
ETL and cETL listed to UL 60601-1,
CAN/CSA C22.2 No.: 601-1-M90 and EN60601-1.
CE conformity to M.D.D. 93/42/EEC
Authorized European Community Representative:
EC
REP
Emergo Europe
Molenstraat 15
2513 BH, The Hague
The Netherlands
0413
— 5-5 —
APPENDICES
CONTENTS
CONFORMANCE TO STANDARDS
This equipment conforms to the following safety standards:
Standard
IEC60601-1-2
Edition and/or date
First edition, 2007
Table 1.1 Safety standards
Accompanying EMC Documents
This medical electrical equipment needs special precautions regarding EMC and needs to be
installed and put into service according to the EMC information provided in this manual.
• Portable and mobile RF communications equipment can affect medical electrical equipment.
• Use of accessories, transducers and cables other than those specified, with the exception of
accessories, transducers and cables sold by the manufacturer of this equipment, as replacement parts for internal and external components, may result in increased emissions or
decreased immunity of the equipment.
• The System 4 Multi Joint Device should not be used adjacent to or stacked with other equipment. If the System 4 Multi Joint Device is used while positioned adjacent to other equipment,
it should be observed to verify normal operation in the configuration in which it will be used.
List of Cable Accessories
The list in Table 1.2 includes all accessory cables supplied with the System 4 Multi Joint Device
for which the manufacturer of this equipment claims compliance to EN 60601-1-2 when used with
the System 4 Multi Joint Device.
Cable Description
Motor Power Cable
Dyna Sensor Cable
Power Input Cable
CDS Pwr Input Cable
Part No.
Biodex #830-210-E752
Biodex #830-101-E700
Biodex #850-111
Biodex #835-210-E721
Table 1.2 System 4 Multi Joint Device cables
APPENDICES
— 5-6 —
Cable Length
10ft
10ft
10ft
15ft
CONTENTS
DECLARATION OF CONFORMITY
Em
issio ns
Emissions
Manufacturer’s
Manufacturer’s d
declaration
eclla
aration eelectromagnetic
lectromagn
netic emissions
emissions
The Sy
oint Device
Device is in
use in
in the
the electromagnetic
electromagnetic environment
environment specified
The
System
stem 4 Multi
Multi JJoint
intended
tended for
for use
speciffiied below.
below. The
The customer
customer or
or the
the
us
user
er o
off the
the System
System 4 Multi
Multi JJoint
should
ould assure
assure tthat
hat it
it is
is used
used in
in such
such an
an environment
environment
oint Device
Device sh
est
Emission ttest
Emission
RF emissions
em
miissions
CI
CISPR
SP R 11
11
Comp liance
Compliance
Group 1
Group
El
ectromagnetic environment
Electromagnetic
environment
RF emissions
em
miissions
CI
SP R 11
11
CISPR
Cl
Class
ass A
Thee Sy
System
stem 4 Multi
Multi Joint
uitaable for
for use
use in all
all
Th
Joint Device
Device is ssuitable
es
tablishments other
other th
establishments
than
an domestic
domestic and
and those
those directly
diirrectly connected
con
nn
nected to
to the
the
low-voltage power
used
public
pu
ubllic low-voltage
power ssupply
upply ne
network
twork supplying
suppl ying buildings
buildings used
fo
forr d
domestic
omestic purposes.
purposes.
distorrttion
Harmonic
Ha
armonic distortion
EN 61000-3-2
61000 -3-2
Vo
Voltage
ltage fluctuations
fflluctuations
an
and
d flicker
ffllicker
EN 6
61000-3-3
1000-3-3
Cl
ass A
Class
Device generates
generattes RF
RF en
ergy o
Th
Joint Device
Thee Sy
System
stem 4 Multi
Multi Joint
energy
only
nly for
for its
its
in
Therefore, its
internal
nterrn
nal functions.
functions. Therefore,
its RF
RF emission
emission is
is very
very low
low and
and is not
not
equipment
li
likely
kely to cause
cause an
any
y interference
inter fer ence in
in nearby
nearb y electronic
electronic equipment
Co
Complies
mplliies
Immunity
Immunity
Manufacturer’s
Manufacturer’s d
declaration
eclla
aration eelectromagnetic
lectromagn
netic immunity
immunity
oint Device
Device is in
use in
Th
Thee Sy
System
stem 4 Multi
Multi JJoint
intended
tended for
for use
in the
the electromagnetic
electromagnetic environment
environment specified
speciffiied below.
below. The
The customer
customer or
or the
the
oint Device
Device sh
it is
is used
us
user
er o
off the
the System
System 4 Multi
Multi JJoint
should
ould assure
assure tthat
hat it
used in
in such
such an
an environment.
environment.
Immunity
Immu nity test
test
Electromagnetic
netic environment
environment – g
guidance
uidance
Electromagn
IEC
60601-1-2
IEC
60601-1-2
IEC 6
0601-1-2
IE
C6
0601-1-2
Te
Test
st llevel
evel
Compliance
Co
mplliiance level
lleevel
El
Electrostatic
ectrosttaatic discharge
discharge
kV
Contact
Co
ntact ± 6 kV
kV
±6k
V contact
contact
Fl
Floor
oor should
should b
bee wood,
concrete or
or ceramic
ceramic
wood, concrete
(E
SD )
(ESD)
Airr ± 8 kV
Ai
kV
± 8 kV air
air
tiles.
If fflo
floor
loor is
is covered
covered with
with synthetic
sy
yn
nthetic
tiles. If
IE
C6
1000 -4-2
IEC
61000-4-2
material,
ma
aterial, the
the relative
relative humidity
humiditty
y should
should be
be at
at
le
least
ast 30%
of a
Power ± 2 kV
kV
Power
Mains
Ma
ains p
power
ower quality
qualitty
y should
should be
be that
that of
El
Electrical
ectrriical fast
fast
± 2 kV for
for p
power
ower lines
lines
Signal ± 1 kV
kV
ty
Signal
typical
yp
y
pical commercial
commercial or
or hospital
hospital environment
environment
transients/burst
tr
ansients/burst
± 1 kV for
for input/output
input/outtput
lin
lines
es
44
IEC
IEC 6
61000-4-4
1000 -4-4
Sur ge
Surge
IEC 6
1000 -4-5
IEC
61000-4-5
± 1 kV differential
differential mode
mode
V common
common mode
mode
±2 k
kV
±1 k
kV
V diff.
diff. mode
mode
±2 k
V com.
com. mode
mode
kV
— 5-7 —
Ma
Mains
ains power
power quality
qualitty
y should
should be
be that
that of
of a
ty
typical
yp
y
pical commercial
commercial or
or hospital
hospital environment
environment
CONTENTS
CONTENTS
Immunity
Immu nity test
test
IEC
IEC 6
60601-1-2
0601-1-2
Test
Test llevel
evel
dip s, short
Voltage
Voltage dips,
short
interruptions
in
nterrrrup
ptions and
and
voltage
vol
ltage v
variations
ar iations on
on
po
power
wer supply
suppl y iinput
npu
ut
lin
es
lines
IEC
IE
C 61000-4-11
61000-4-11
< 5%
5% U
UT
T ((>
> 95%
95% o
off d
dip
ip in
in
UT
UT)) for
for 1
1/2
/2 cycle
cycle
40
40%
%U
UT
T (6
(60%
60% o
off di
dip
ip in
in
ycle
UT)
UT) for
for 5 ccycle
70
70%
%U
UT
T ((30%
30% o
off di
dip
ip in
in
UT
UT)) for
for 25
25 cycle
cycle
in
< 5%
5% U
UT
T ((>
> 95%
95% o
off d
dip
ip in
ec
UT
UT)) for
for 5 ssec
Po
Power
wer ffrequency
r eq uency
(5
(50/60
0/60 H
Hz)
z) m
magnetic
agnetic
fi
eld
field
IEC 6
1000 -4-8
IEC
61000-4-8
3 A/m
A/ m
A/ m
3 A/m
Conducted
RF
Co
nducted R
F
IEC
IEC 61000-4-6
61000-4-6
Radiated RF
RF
Radiated
IEC
IEC 61000-4-3
61000-4-3
3 Vrms,
V rms,
15 0 KHz
KH z tto
o 80 M
Hz
150
MHz
V / m,
3 V/m,
80 M
MHz
H z to2.5
to2.5 GHz
GH z
3 Vrms,
V rms,
15 0 K H z to 8
0M
Hz
150KHz
80
MHz
V / m,
3 V/m,
MHz
to2.5
80 M
H z to
2 .5 GHz
GH z
IE
IEC
C6
60601-1-2
0601-1-2
Compliance
Co
mplliiance level
lleevel
< 5%
5% U
UT
T ((>
> 95%
95% of
of dip
dip
in UT
UT)
T) ffor
or 1/2
1/2 ccycle
ycle
40
40%
%U
UT
T (6
(60%
60% o
off di
dip
ip
in UT)
UT) ffor
or 5 ccycle
yccle
70
70%
%U
UT
T ((30%
30% o
off di
dip
ip
in UT)
UT) for
for 25
25 cycle
cyccle
< 5%
5% U
T ((>
> 95%
95% o
UT
off d
dip
ip in
in
sec
UT
UT)) for
for 5 sec
Electromagnetic
Electtromag
gn
netic environment
environment – g
guidance
uidance
be that
Maains power
Mains
power quality
qualitty
y should
should be
that of
of a typical
tty
yp
y
pical
If a be
commercial
co
mmercial or
or hospital
hospital environment.
enviirronmentt. If
better
tttter
it is
is
mains
ma
ains power
power quality
qualitty
y is
is required,
requiirred, it
Joint
recommended
recommended that
that the
the Sy
System
stem 4 Multi
Mullti Joint
Device
De
vice is p
powered
owered from
from an
an uninterruptible
uninterrru
uptible
power ssupply
upply
power
image distortion
distortion occurs,
occurs, it
it may
If image
may be
b e necessary
necessar y
Joint Device
Device
to p
position
osition the
the Sy
System
stem 4 Multi
Multi Joint
from sources
display
of power
di
furrtther from
splay further
sources of
power
fr
equency m
agnetic fields
fields or to
frequency
magnetic
to iinstall
nstall magnetic
magnetic
sshielding.
hielding. The
The power
power frequency
ffrrequency magnetic
magnetic field
ffiield
in the
the intended
intended installation
sh
should
ould be
be measured
measurred in
installation
to assure
assure th
low
location
location to
that
at it
it is
is sufficiently
sufffiiciently low
mobile RF
RF communications
communications
Portable
Porttaable and
and mobile
eq
uipment should
should be
be used
used no
no closer
equipment
closer to
to any
an y pa
part
arrtt
of the
the Sy
System
stem 4 M
Multi
ulti Joint
Joint Device,
Device, including
iin
ncluding
the recommended
recommended separation
cables,
ca
ables, than
than the
separattion
di
distance
stance calculated
calculaated from
ffrrom the
the equation
equation applicable
applicable
to the
the frequency
frequency of the
the transmitter.
transmitter.
Re
Recommended
commended separation
separation distance:
distance:
d=1
. 2! P 1
5 0 KHz
KH z to 8
0M
Hz
1.2!
150
80
MHz
d=1
.2! P 80 MHz
MHz to 8
00 M
Hz
1.2!
800
MHz
d=2
.3! P 80
0 MHz
MHz to 2.
5 GHz
G Hz
2.3!
800
2.5
where
where P is
is tthe
he maximum
maximu
um output
output power
power rating
rating of
the transmitter
transmitter in watt
watt (W)
(W) according
according to the
the
the
transmitter
transmitter manufacturer,
manufactur er, and
the
and d is the
in meters
meters
re
recommended
commended separation
separation distance
disttaance in
(m
).
(m).
Fi
Field
eld strengths
strengths from
ffrrom fixed
ffiixed RF
RF transmitters,
transmitttters, as
as
determined
de
ter mined by
b y an
an electromagnetic
electromagnetic site
site survey,
survey, a
co mp liance le
should
should be
b e lless
ess than
than tthe
he compliance
level
vel in
range. b
each frequency
ffrrequency range.
of
In
Interference
terference may
ma y occur
occur in
in the
the vicinity
vicinit y of
equipment
eq
quipment marked
marked with
with the
the following
following symbol:
sy
ym
mbol:
No
Note
te 1
1.. U
UT
T is
is tthe
he a.c.
a.c. mains
mains voltage
voltage prior
prior to
to application
aap
pplication of
of the
the test
test level.
level.
No
te 2
0 MHz
MHz aand
Note
2.. A
Att 8
80
nd 800
800 MHz,
MHz, tthe
he higher
high
her frequency
ffrr equency range
range applies.
aap
pplies.
Note 3.
3 . These
These g
uidelines may
propagation is
Note
guidelines
may not apply
apply in
in all
all situations.
situations. Electromagnetic
Electromagnetic propagation
is affected
affected by
b y absorption
absorrp
ption and
and
n reflections
reffllections
people
fr
from
om structures,
structtu
ures, objects
objects and
and people
a
such as
as base
base stations
Field
Field strength
strength from
from mixed
mixed transmitters,
tr ansmitters, such
stations for
for radio
radio telephones
telephones and
and land
land mobile
mobile radios,
r adios, amateur
amateur radio,
radio, AM
be predicted
predicted theoretically
with accuracy.
accuracy. To
or FM
FM b
broadcast
roadcast and
and T
TV
V broadcast
broadcast cannot
cannot be
theoretically with
To assess
assess the
the electromagnetic
electromagnetic environment
environment due
due
site survey
survey should
should be
be considered.
considered. If
If the
the measured
strength in
in th
to ffi
fixed
ixed RF
RF transmitters,
transmitters, an
an electromagnetic
electromagnetic site
measured field
ffiield strength
thee location
lo cation in
in
wh
ich the
the System
Multi Joint
Joint Device
Device is u
levels above,
above, the
the System
Joint
which
System 4 Multi
used
sed exceeds
exceeds the
the applicable
applicable RF
RF compliance
comp
pliance levels
System 4 Multi
Multi Joint
be necessary,
necessarrry
Device
Device should
should be
be observed
observed to
to verify
veriffy
y normal
norrrm
mal operation.
operation. If
If abnormal
abnorrm
mal performance
performance is
is observed,
observed, additional
additional measures
measures may
may be
y,
such aass reorienting
reorientting or relocating
Joint Device.
D evice.
such
relocating the
the System
System 4 Multi
Multi Joint
b
150 KHz
KHz tto
V/m.
Over
Over tthe
he frequency
frequency range
r ange 150
o8
80
0M
MHz,
Hz, field
field sstrengths
trengths should
should be
be less
less than
than 3 V/m.
APPENDICES
— 5-8 —
CONTENTS
Recommended Separation Distances
Re
commended separation
distances between
bettw
portabllee and
and mobile
mobile RF
RF communications
and the
ulttii
Recommended
seep
paratiio
on distances
ween portable
communicatiio
ons equipment
equipment and
the Sy
System
stem 4 Multi
Mul
Joint
Joi
int D
Device
eviice system.
systeem . Table
Tab le 6
Th
Thee Sy
System
stem 4 Multi
Multi Joint
Joint Device
intended
tended for
for use
use in
in the
the electromagnetic
electromagnetic environment
environment in
in which
which radiated
radiaated RF
RF disturbance
disttu
urbance are
are
Device is in
The cu
Joint Device
Device ca
co
stomer o
orr the
the user
user of
of the
System 4 M
Multi
ulti Joint
help prevent
prevent electromagnetic
electromagnetic interference
interference by
by
controlled.
ntrolled. The
customer
the System
can
an help
maintaining
ma
aintaining a minimum
distance be
between
ttw
ween portable
porrttable and
and mobile
mobile RF
RF communication
communication equipment
equipment (transmitters)
(ttransmitters) and
System
stem
minimum distance
and the
the Sy
4M
Multi
ulti Joint
Joint Device
Device as rrecommended
of the
the communication
communication equipment.
ecommended below,
below, according
according to
to the
the maximum
maximum output
output power
power of
equip ment.
Ra
Rated
ted maximum
maximum output
outtp
p ut
Separation
Se
eparattiion d
distance
according to
to frequency
frequency of
of transmitter
transmitter [m]
[m]
istance according
power
power o
off transmitter
transmitter [[W]
W]
15
150
0 kHz
kHz to
to 80 MHz
MHz
80 MHz
MHz tto
o 800 MHz
MHz
80
800
0 MHz
MHz tto
o 2.5
2.5 G
GHz
Hz
1.2!
d=1
1.2!
2.3!
d=1
.2 ! P
.2 ! P
d=2
.3 ! P
0.12
0.12
0.
23
0.01
0.01
0.12
0.23
0.1
0.1
0.
38
0.38
0.38
0.38
0.
73
0.73
1
1.2
1.
2
1.2
1.2
2.3
2.
3
10
3.8
3.
8
3.8
3.8
7.3
7.
3
100
12
12
23
power not
not listed
r ecommended separation
in meters
meters (m)
Fo
Forr ttransmitters
ransmitttters rated
rated at
at a maximum
maximum output
output power
listed above,
above, the
the recommended
separation distance
distance d in
(m) can
can
estimated using
equation applicable
p icab
to the
the frequency
the transmitter,
trans
n mitttter, where
is the
the maximum
maximum output
output power
power
be estimated
appl
ble to
frequency of the
using the
the equation
where P is
rating
ra
ating of tthe
he transmitter
transmitttter in
in watts
watts (W)
( W) according
according to
to the
the transmitter
trransmitter manufacturer.
manuffacttu
urer.
No
te 1
distance for
Note
1.. At
At 80
80 M
MHz
Hz and
and 8
800
00 M
MHz,
Hz, tthe
he separation
separation distance
for the
the higher
higher frequency
ffrr equency range
range applies.
applies.
Note 2.
2 . These
These g
uidelines may
Note
guidelines
may not
not apply
appl y in
in all
all situations.
sittua
uations. Electromagnetic
Electromagnetic propagation
propagation is
is affected
affected by
b y absorption
absorrpt
pttion and
and reflection
reffllection
people.
from
from structures,
structtu
ures, objects
objects and
and people.
Operating Temperature
Do not expose the equipment to a temperature change of more than 5° F (3° C) per hour.
Limits of low and high operating temperature ranges are 59° to 86° F (15° C to 30° C).
— 5-9 —
APPENDICES
CONTENTS
GENERAL PRODUCT WARRANTY
A. Warranty
BIODEX MEDICAL SYSTEMS warrants that all products covered hereby shall be free from
defects in workmanship and materials and shall conform to published specifications or other
specifications accepted in writing by BIODEX for:
Description:
Controller
Dynamometer
Clinical DataStation
Printer
Cables
Adjust. Positioning Chair
Attachments
Threads
Knobs
Upholstery
Straps
Pads
Parts:
1 year
1 year
1 year
1 year
1 year
1 year
1 year
1 year
1 year
60 days
60 days
60 days
Labor:
1 year
1 year
1 year
1 year
1 year
1 year
1 year
1 year
1 year
60 days
60 days
60 days
under normal use as prescribed in the operator’s manual. The foregoing warranty does not apply
to any products which have been subject to use other than as specified as standard operating procedure in the system manual, neglect, accident or modification. BIODEX’s sole obligation to buyer
hereunder for products failing to meet aforesaid warranty shall be, at BIODEX’s discretion, to
replace or repair the non-conforming product (parts and labor) or issue buyer credit for the purchase price of the non-conforming product where within warranty period:
1.
BIODEX has received written notice of any nonconformity and
2.
After BIODEX’s attempts to remedy such nonconformity, BIODEX has
determined that the nonconformity is not a result of improper use,
accident, repair or other misuse by buyer.
Any replacement product shall carry the unexpired term of the warranty which was applicable to
the replaced product or a period of 30 days, whichever is longest.
BIODEX MAY RETAIN THE RIGHT TO VOID ALL SYSTEM WARRANTIES IF PAYMENT IS
NOT RECEIVED AS PRESCRIBED IN TERMS OF PURCHASE.
EXCEPT AS SPECIFICALLY PROVIDED HEREIN, THERE ARE NO OTHER WARRANTIES,
EXPRESS OR IMPLIED, INCLUDING, BUT NOT LIMITED TO, ANY IMPLIED WARRANTIES
OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE.
IN NO EVENT SHALL BIODEX BE LIABLE FOR LOSS OF PROFITS, INDIRECT, SPECIAL, CONSEQUENTIAL, OR OTHER SIMILAR DAMAGES ARISING OUT OF ANY BREACH HEREOF.
APPENDICES
— 5-10 —
CONTENTS
B. Warranty Period
Warranty time period stated in paragraph “A”, is from date of invoice (shipment) unless otherwise specified in writing by BIODEX.
C. Repaired or Replacement Products (out of warranty)
BIODEX MEDICAL SYSTEMS, for a period of 60 days, warrants that its standard products
repaired or replaced hereunder shall be free from defects in workmanship or materials under normal use as described in the system’s Operator’s Manual. Warranty period will begin upon shipment of repaired or replacement products. The sole responsibility of BIODEX under this warranty is, at its option, to repair or replace any defective component parts of such products. This warranty does not apply to:
1.
Products which have been repaired or altered other than under specific
instructions from BIODEX’S Service Department instruction as listed in
system’s manuals or procedures previously approved in writing by
BIODEX Service Department,or
2.
Products which have been subject to use other than described as standard use in the system’s
operator’s manual, neglect or accident.
THIS WARRANTY IS NOT TRANSFERABLE (SITE, OWNERSHIP, ETC.) WITHOUT THE WRITTEN PERMISSION OF BIODEX MEDICAL SYSTEMS. WARRANTY IS VOID UNLESS EQUIPMENT IS INSTALLED BY BIODEX PERSONNEL.
— 5-11 —
APPENDICES
BIODEX
Biodex Medical Systems, Inc.
20 Ramsey Road, Shirley, New York, 11967-4704, Tel: 800-224-6339 (Int’l 631-924-9000), Fax: 631-924-9338, Email: info@biodex.com, www.biodex.com
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