Biodex Balance System SD Operation Manual

BALANCE SYSTEM SD

OPERATION/SERVICE MANUAL

950-300

950-302

950-304

FN: 08-060 2/08

B

IODEX

Biodex Medical Systems, Inc.

20 Ramsay Road, Shirley, New York, 11967-4704, Tel: 800-224-6339 (Int’l 631-924-9000), Fax: 631-924-9338, Email: [email protected], www.biodex.com

BALANCE SYSTEM

This manual covers installation and operation procedures for the following products:

#950-300

#950-302

#950-304

System, Balance SD, 115 VAC

System, Balance SD, 230VAC

System, Balance SD, 100V Japanese

NOTE: The following symbol on your Biodex Balance System corresponds to this operation manual:

Symbol Meaning: attention, consult accompanying documents

Symbol Signification: Attention, se référer à la notice

CAUTION: Federal law restricts this device to sale or on the order of a medical practitioner. When prescribed for therapeutic purpose, a physician should clearly define the parameters of use (i.e., total work, maximum heart rate, etc.) to reduce the risk of patient injury.

— II —

TABLE OF CONTENTS

1. Introduction ......................................................................................................................................1-1

2. System Specifications ......................................................................................................................2-1

3. Assembly and Installation ..............................................................................................................3-1

• Printer Installation

• Parts and Adjustments

4. Clinical Considerations....................................................................................................................4-1

• General Clinical Considerations

• Additional Considerations For Fall Prevention Programs

5. Applications ......................................................................................................................................5-1

• Orthopedic and Sports Medicine

• Fall Prevention

• Reference Notes

6. Getting Started ..................................................................................................................................6-1

• Accessing the Main Menu

• Display Panel Keys Described

• Screen Keys

7. The Training Routine........................................................................................................................7-1

• Postural Stability Training

• Limits of Stability (LOS) Training

• Weight Shift Training

• Maze Control Training

• Random Control Training

• Percent Weight-Bearing Training

8. Testing ................................................................................................................................................8-1

• The Postural Stability Test

• The Limits of Stability Test

• Athlete Single Leg Stability Testing

• Performing a Fall Risk Test

9. Reports................................................................................................................................................9-1

• Report Parameters Defined

• Progress Reports

• Sample Balance Reports

10. Data ..................................................................................................................................................10-1

• Assessing Limits of Stability With The Biodex Balance System

• Understanding Patient Performance

• Balance System Statistics Defined

11. System Utilities................................................................................................................................11-1

• Configuration ..............................................................................................................................11-2

• Patient Management ..................................................................................................................11-2

12. Reimbursement ..............................................................................................................................12-1

13. General Maintenance ....................................................................................................................13-1

14. Bibliography ....................................................................................................................................14-1

Appendix A: Calculation of Limits of Stability Direction Control..................................................A-1

Appendix B: Normative Data Referenced in Predictive Values Report..........................................B-1

Replacement: R-1

— III — TABLE OF CONTENTS

1. INTRODUCTION

Display Module

Auxillary Serial Port

USB Printer port

Display Height Locking Knob

Support Handle

Support Handle Release Pin

Printer

Printer Stand

Power Cord

Wheels

Foot Platform

Figure 1.1: The Biodex Balance System SD primary components and adjustment mechanisms.

— 1-1 — INTRODUCTION

1. INTRODUCTION

Featuring four test protocols, six training modes and intuitive “touch-screen” operation, the

Balance System SD allows testing and training in both static and dynamic formats. Extremely versatile, it is the only system that provides fast, accurate Fall Risk Assessment and Conditioning for older adults plus closed-chain, weight-bearing assessment and training for lower extremity patients.

Using this unique device, clinicians can assess neuromuscular control by quantifying the ability to maintain dynamic bilateral and unilateral postural stability on a static or unstable surface. Use any of four test protocols including fall risk, athletic single leg stability, limits of stability and postural stability. The Balance System SD also serves as a valuable training device to enhance kinesthetic abilities that may provide some degree of compensation for impaired proprioceptive reflex mechanisms following injury.

An easy to follow touch-screen format makes the system simple to learn and operate, leading the user step-by-step through testing protocols and training modes. All test results and training sessions are documented on easy to read 8.5" x 11" reports which can be placed into the patient's file. Comparisons to normative data can be made for population-specific tests using the Fall Screening and Athlete Single Leg Stability protocols.

INTRODUCTION — 1-2 —

2. SYSTEM SPECIFICATIONS

Dimensions:

Base: 30" w x 44" depth x 8" h (76 x 112 x 20 cm)

Platform: 21.5" dia (55 cm)

Display Height: Adjustable from 53" to 68" h above platform (135 x 173 cm); 76" h (193 cm) maximum from floor.

Support Rails: Adjustable from 25" to 36.5" above platform (64 to 93 cm).

Rails can swing away from platform when not in use.

Platform Tilt: 20 degrees from horizontal in all directions

Stability Levels: Twelve levels, plus locked for static measurements

Game Port: Simulates joystick output suitable for PC compatible game port

Color Touch-Screen Display:

Viewing Area: 6.6" w x 5" h (168 x 127 mm)

Resolution: 800 pixels x 600 pixels

Accuracy: +/- 1 degree of tilt

Angle: Adjustable from vertical back to approximately 45 degrees

Printer: HP DeskJet

Printer Stand: 24" x 24" (61 x 61 cm)

Patient Capacity: Up to 400 lb (136 kg)

Weight: 196 lb (89 kg)

Power: 115 VAC, 50/60 Hz, 15 amp line or 230 VAC, 50/60 Hz, 15 amp line

Power Rating: 350 watts

Certification: ETL listed to UL 2601-1 and cETL listed to CAN/CSA C22.2 No. 601-1-M90,

IEC 60601-1

Warranty: 2-years parts, 1-year labor

— 2-1 — SYSTEM SPECIFICATIONS

3. ASSEMBLY & INSTALLATION

The Biodex Balance System SD is shipped in a single carton. Except for the printer, which the user must install as explained below, the entire system is factory assembled and ready to operate.

If desired, the system can be configured for PC computer compatibility, allowing the foot plate to be used like a joystick for interactive video game use. Joystick options are discussed in the

System Utilities chapter.

PRINTER INSTALLATION

(See Figures 3.1 and 3.2)

NOTE: It may be necessary to have the help of another person to steady the printer during the following procedure.

1. Refer to the supplied printer manual to unpack the printer and ensure that it has not been damaged by shipping.

2. Position the printer on the printer stand as shown.

3. Locate the black printer power cable. Plug the small end into the power receptacle on the back of the printer. Do not connect any other equipment to this receptacle.

4. Plug the AC plug end of the power cable into power cable port on the back, lower base of the

Balance System.

5. Locate the white USB cable. Connect one end of the cable to the USB port on back of the

Balance System display. Connect the other end of the cable to the USB port at the back of the printer directly above the power cable port.

6. Ensure both cables are positioned so that they will not interfere with the patient or get caught in the Balance System platform or handles.

7. Insert several sheets of paper into the printer paper holder. Insert the paper holder into the top of the printer so that the open end interlocks with the printer and the paper faces out toward you.

8. With power ON to the Balance System, press the <Power ON> switch on the printer. Ensure the printer's green Ready LED comes on to indicate the printer is receiving power. Refer to the supplied printer manual for additional printer information.

— 3-1 — ASSEMBLY & INSTALLATION

CONTENTS

USB Printer Port

Auxiliary

Serial Port

Figure 3.1. The printer power cable should be plugged into the AC receptacle on the rear base of the display support post. The printer USB cable should be plugged into the USB port on back of the display.

Figure 3.2. Connect the power cable and USB cable to the rear of the printer.

ASSEMBLY & INSTALLATION — 3-2 —

4. PARTS AND ADJUSTMENTS

PARTS AND ADJUSTMENTS

(See Figure 3.3.)

Mechanical adjustments to the Biodex Balance System are straightforward and uncomplicated.

In fact, there are only three adjustments that need be addressed to accommodate any patient:

Support Handle Position, Display Height and Display Tilt. All other test and exercise functions are software controlled.

To Adjust the Support Handle:

1. To position the Support Handle for patient use, hold the Support Handle while pulling out on the Support Handle Release Pin. Rotate the handle to the desired position. Release the pin to lock the Support Handle in place.

2. To release the Support Handle so that it cannot be used by the patient, hold the handle while pulling out on the Support Handle Release Pin. Fully lower the handle, then release the pin.

Ajustement de l’appui

1. Pour régler l’angle de l’appui, le tenir tout en tirant sur le verrou. Trouver la position voulue, relâcher le verrou pour garder la position ainsi trouvée.

2. Pour écarter l’appui, le baisser tout en tirant sur le verrou.

To Adjust the Display Height:

1. Loosen the Display Height Locking Knob.

2. Pull up or push down on the display until the desired height is achieved.

3. Tighten the locking knob to secure the display in the desired position.

NOTE: Position the display so that the patient can look straight at it. This will help ensure good posture during the test or exercise session.

Pour adjuster la hauteur de l’ecran

1. Desserrer la mollette de réglage de hauteur.

2. Déplacer l’écran à la hauteur voulue.

3. Serrer la mollette.

To Adjust the Display Tilt:

1. Simply tilt the Display as required by patient or testing/exercise protocol.

Ajustement de l’inclinaison de l’ecran

1. Pivoter l’écran pour obtenir l’angle voulu.

— 3-3 — ASSEMBLY & INSTALLATION

CONTENTS

Display Height

Locking Knob

Display Module

Auxiliary

Serial Port

USB Printer Port

Joystick Port

Support Handle

Release Pin

Printer

Printer Stand

Support Handle

Power Cord

AC Receptacle

Wheels

Foot Platform

Figure 3.3. Balance System adjustment mechanisms.

ASSEMBLY & INSTALLATION — 3-4 —

4. CLINICAL CONSIDERATIONS

Prior to allowing any patient to use this device, make certain to read and comprehend this entire manual. Ensure that you are completely familiar with all aspects of adjustment, training and testing, as well as patient history. Be sure to adhere to the following clinical guidelines at all times when using this system.

NOTE: Never allow a patient to use the Balance System while unsupervised.

CONSIDERATIONS CLINIQUES

Avant d’appliquer le systäme de stabilité à un patient, lire avec soin la présente notice. Il faut se familiariser avec tous les aspects de réglage, d’entraâneemnt et d’examen ainsi qu’avec le dossier du patient. Respecter les consigues indiquées ci-dessous lors de l’utilisation du systéme.

NOTA: Ne jamais laisser un patient sans surveillance sur le systéme de stabilité.

GENERAL CLINICAL CONSIDERATIONS

1. All users should have a verbal understanding of the Balance System prior to stepping on the device.

2. To ensure patient safety, begin each session with the balance platform in the "locked" or static position.

NOTE: The Balance System automatically places the platform in the locked position when the unit is turned ON, or after a time period of three minutes when the system is not in use.

3. Adjust support rail and biofeedback display for patient comfort and safety.

4. When dealing with post-operative patients, ensure they possess adequate muscular control to stabilize the joint prior to placing them on the foot platform. Inadequate muscular control could lead to increased joint translation.

5. When patients are working with their eyes closed, ensure that a clinician is ready to assist in case of loss of balance or use the optional patient support stand.

6. Since the entire lower extremity is required to work to stabilize the balance device, ensure that supporting structures above and below the joint are adequately strengthened prior to beginning rehabilitation on this device.

7. For optimal operation, ensure the patient is standing in the center of the platform.

8. Patients should progress from "hands-on" to "hands-off" the support handle. This will ensure that new or unstable patients have an adequate understanding of the Balance System and will help protect the patient against sudden or unexpected movement of the platform.

9. Position the display so that the patient can look straight at it. This will help ensure good posture during the test or exercise session.

10. There is a learning curve that must be considered when testing with this device. Clinical research suggests three trials be performed prior to testing. For dynamic balance testing, the

"default settings" are preselected with three trials per side. This should assist with the learning curve and better average the data.

— 4-1 — CLINICAL CONSIDERATIONS

CONTENTS

CONSIDERATIONS CLINIQUES GENERALES

1. Tout patient doit comrendre les principles du systàme de stabilité avant de s’y mettre.

2. Démarrer toutes les séances avec le platcau en position bloquéc.

NOTA: Lors de la misc sous tension, le systàme de stabilité se met automatiquement en position bloquée. De la màme facan, si le systäme n’est pas utilisé pendant un intervalle de 3 minutes, il se bloque.

3. Régler l’appui et l’ecran pour maximizer le confort et la sécurité du patient.

4. Pour des patients post-opératoires, vérifier avant de les faire monter sur le plateau qu’ils sont capables de stabiliser leurs articulations. Un contrìle insuffisant pourrait les mettre à risque.

5. Si les patients travaillent les yeux fermés, il faut se tenir pràt à les aider ou mettre en place l’appui.

6. Puisque l’utilisation du plateau de stabilité sollicite toutes les articulations de l’extrémité, s’assurer que les cicatrisations sont suffisamment avancées pour supporter l’exercice.

7. Les résultats sont meilleurs avec le patient placé au milieu du plateau.

8. Les patients doivent démarrer avec l’appui et apprendre progressivement à ne plus s’en servir. De cette facon les patients développment leur compréhension du plateau de stabilité en minimisant les risques.

9. La courbe d’apprentissage du systäme peut influencer les résultats d’un examen. La littérature clinique suggàre qu’il faut réaliser trois examens à blanc avant de faire un examen définitif.

10. Régler l’écran droit devant les yeux du patient. Ceci aidera à maintenir une bonne position pendant l’exmen ou l’entraånement.

ADDITIONAL CONSIDERATIONS FOR FALL PREVENTION PROGRAMS

In addition to the above, the following considerations should also be considered when working with patients in a fall prevention program.

1. It is strongly recommended that the Biodex Unweighing System be used in conjunction with balance training/testing.

NOTE: The Biodex Unweighing System is intended to assist the patient who has balance deficits.

Clinicians should not rely on this device to prevent falls.

2. Since the Biodex Balance System allows up to 20-degrees of surface tilt, begin with static or stability level 12 and progress as tolerated.

NOTE: The static setting is most stable, level one is least stable. Levels 12 to 1 provide a full 20 degrees of surface tilt.

3. Patients with extreme weakness or atrophy, especially of the lower extremity, should be closely monitored.

CLINICAL CONSIDERATIONS — 4-2 —

CONTENTS

NOTE: The ankle provides a critical source of sensory input, controlling the degree of sway in elderly patients.

4. Repeat bouts of balance training where the joint is displaced nearly to its limits have been shown to increase muscle tone, thus increasing muscle spindle sensitivity and enhancing the somatosensory response.

AUTRES CONSIDERTIONS POUR DES PROGRAMMES DE PREVENTION DE CHUTES

En plus de ce qui précàde, les points évoqués ci-dessous doivent àtre étudiés dans le cadre d’un travail avec des patients dans un programme de preévention de chute.

1. L’utilisation du harnais de soutieu est recommendé lors de l’entraànement et de l ‘évaluation de la stabilité.

NOTA: Le harnais ne sert qu’à aider le patient à atteindre le déficit de stabilité. Le harnais seul ne peut pas prévenir des chutes.

2. Puisque le sysàme de stabilité permet une inclinaison de 20º, démarrer avec une stabilité 8 et avancer en fonction de la tolérance rencontrée.

NOTA: Le niveau 8 est le niveau le plus stable et le niveau l est le niveau le moins stable les deux réglages permettent 20ºd’inclinaison.

3. Des patients particuliérement faibles ou atrophiées surtout dans les extrémités infériures doivent àtre surveillées de präs.

NOTA: La cheville fournit une source capitale d’informatioons sensorielles particuliérement importantes pour les personnes Égées.

4. Des séances répétées d’entraânement de stabilité dans lesquelles l’articulation se déplace proche de ses limites entraånent une augmentation de la tonalité musculaire, une sensibilité améliorée et des réponses somato-sensorielles plus vives.

— 4-3 — CLINICAL CONSIDERATIONS

5. APPLICATIONS

ORTHOPEDIC AND SPORTS MEDICINE

1. Bilateral Balance Activities

• Select desired training mode

• Begin at level 12 or static and progress as tolerated

• Begin with handrails in the upright position and progress to lowering them

• Move platform as per training protocol

• Use ball toss drill to increase eye/hand coordination

2. Unilateral Balance Activities

• Select desired training mode

• Begin at level 12 or static and progress as tolerated

• Begin with handrails in the upright position and progress to lowering them

• Move platform as per training protocol

3. Bilateral Upper Extremity Activities

• Place both hands in a north/south, east/west and diagonal position

• Select desired training mode

• Begin with a stable platform and progress accordingly

• Move platform as per training protocol

• Begin on knees and progress to toes, to one knee, to one foot

• Progress to unilateral balance, palm centered on the platform

FALL PREVENTION

1. Bilateral Exercises

• Begin with static level weight shifts

• Progress to dynamic level (12) weight shifts

• Use circular grid to demonstrate where tendency to fall occurs

• Have patient perform both anterior/posterior and medial/lateral exercises

2. Unilateral Exercises

• Have patient hold platform steady and illustrate how well the patient holds the platform stable

• Different patterns (circles, anterior/posterior, medial/lateral) to increase strength of the lower extremity

REFERENCE NOTES

1. Caution must be noted when performing this activity. Ensure that the patient has the ability to handle this challenging activity.

2. Ensure proper bilateral stabilization prior to unilateral stabilization.

3. Ensure that patient uses the handrails as needed.

4. Ensure that bilateral and unilateral static stability are adequate prior to progressing to unilateral dynamic stability.

5. The more unstable the platform (12 vs. one) the more challenging the activity will become.

Ensure the patient uses the handrails at all times.

— 5-1 — APPLICATIONS

5. APPLICATIONS

NOTE DE RÉFÉRENCE

1. Cette activité doit àtre entreprise avec précaution. S’assurer que le patient est capable de réaliser l’activité.

2. S’assurer d’une bonne stabilité bilatérale avant de commencer un travail sur la stabilité unilatérale.

3. S’assurer que le patient sait utiliser l’appui correctement.

4. S’assurer que la stabilité bilatérale statique sur une seule jambe est adéquate avant de procéder à la stabilité unilaterérale.

5. Plus le plateau est instable (8 équivaut à un réglage plus stable, le réglage l équivaut à un niveau moins stable), plus l’activité est difficile ä réaliser. S’assurer que la patient utilise l’appui

à tout moment.

APPLICATIONS — 5-2 —

6. GETTING STARTED

The Biodex Balance System software program is easy to master. Simply follow the screen prompts as they lead you step-by-step through testing and training protocols or software utility options. For each screen, active option keys are highlighted in boldface type. Touch the desired on-screen key to make your selection. Option choices progress logically based on the selections made.

ACCESSING THE MAIN MENU

To access the Balance System Main Menu:

(See Figure 6.1.)

1. Press the <ON/STANDBY> button on the display to turn the Balance System ON. The Main

Menu screen should now be displayed. This screen allows the user to select the Training, Testing or Utilities menus.

DISPLAY PANEL BUTTONS DESCRIBED

(See Figure 6.2.)

There are only three buttons located on the Display Panel. These buttons operate as follows:

On/Standby

Located at the bottom left corner of the display panel, the <ON/STANDBY> button is used to turn the system ON or to STANDBY (system is turned ON but display is still OFF).

• For ON, the Balance System Main Menu screen will appear on the display and the foot platform will automatically advance to the fully locked (stable) position if it is not already locked.

CAUTION: The foot platform does not automatically lock when the system is turned to STAND-

BY. Thus, it is recommended that you first bring the platform to the fully locked position by pressing the ON/STANDBY button to set the system to STANDBY.

ATTENTION: Le plateau ne roste pas dans la position bloquée en mode d’attente (STANDBY) pour cette raison il faut d’abord bloquer le plateau avant de sélectionner ce mode.

• For STANDBY, the display will turn OFF, all data will be lost, and power to the foot platform will cease.

Start

The <Start> button is used to begin the selected training or testing protocol selected.

Stop

The <Stop> button is used to end the selected training or testing protocol selected.

— 6-1 — GETTING STARTED

CONTENTS

SCREEN KEYS

The following on-screen touch keys are consistent whenever they appear throughout the entire

Balance System SD program.

<HOME>: Touch this key to return to the Main Menu.

<NEXT>: Touch this key to advance to the next logical screen.

<BACK>: Touch this key to return to the previous screen.

<OK>: Touch this key to confirm selections or entries and advance to the next screen.

Figure 6.1. The Balance System Main Menu.

Figure 6.2 The Display Panel Keys.

GETTING STARTED — 6-2 —

7. THE TRAINING MODES

The training modes provide a simple means of setting up a training or exercise session. Six interactive game-like training modes are provided. These allow for fast patient setups, less formal protocols than the testing routines, and the ability to change stability level from very unstable to static during the actual training session. All five training modes can be customized to provide specific rehab goals with the on-screen grid and score-keeping functions used to both help motivate users and keep them focused on the task at hand.

In training mode, only the most basic parameters are addressed. If desired, a pre-existing patient can be recalled from the Test/Rehab Results option in Patient Maintenance menu to allow for quick and easy repeat of a training or test session. The print screen function will allow the user to generate a printout of training results.

Training results can also be saved and recalled for later use by touching the <Save> icon on the results screen following any training session. A patient name is required to save the results. If no pre-existing name is available, the name entry screen will be displayed. Fill out the patient information and touch <Save> to record the training result numeric values, along with patient foot position on the platform.

To recall a patient and repeat an exercise session, select the desired patient from the Patient

Management screen (see chapter 11, System Utilities) and touch <Repeat>. The Position Patient screen with previous values is presented so the patient can be easily repositioned exactly as in the previous training session.

Training mode formats include: postural stability, limits of stability, weight shift, maze control, random control and percent weight bearing training as described in the following sections.

Figure 7.1. The Training Menu screen provides access to the Postural Stability, Limits of Stability,

Weight Shift, Maze Control, % Weight Bearing and Random Control training modes.

— 7-1 — THE TRAINING MODES

7. THE TRAINING ROUTINE

POSTURAL STABILITY TRAINING

(See Figure 7.2.)

The Postural Stability Training mode is designed to emphasize specific movement patterns or strategies by placing markers anywhere on the screen grid. The patient’s score is a tally of how many times the patient can touch targets with the on-screen cursor during any session. Time counts up or down as set.

Figure 7-2. The Postural Stability Training screen.

To Access The Postural Stability Mode:

1. Position the support handles as per patient protocol.

2. Position the display height and tilt for patient comfort.

3. At the Main Menu, touch <Training>. The Training Menu screen should now be displayed.

4. Touch <Postural Stability>. The User Setup Information screen should now be displayed. If this is a new patient and you want to save this training session after its completion, you must enter the patient’s name, height and weight. If you do not need to save the training session, touch <Next> and skip to step 8.

5. Touch the <Keypad> icon for “Name” and enter the patient’s name. Touch <OK> to return to the User Information screen.

6. Touch the <Keypad> icon for “Age” and enter the patient’s age. Touch <OK> to return to the

User Information screen.

7. Touch the <Keypad> icon for “Height” and enter the patient’s height. Touch <Next> to advance to the Postural Stability Training screen.

THE TRAINING MODES — 7-2 —

CONTENTS

8. At the Postural Stability Training screen, touch <Place Target> and then touch the screen location where you would like a target to be placed. Repeat this process to place up to nine targets on the screen.

9. To clear any misplaced or unwanted targets, touch <Clear Target>. Each time this key is pressed, the most recent target added to the screen will be removed.

10. Touch <More Options> to advance to the Postural Stability Training Options screen if desired.

Here you can set the total time for the exercise, enter initial and ending platform stability settings, and turn tracing ON/OFF. Touch <OK> to confirm your selections and return to the

Postural Stability Training Options screen, or <Cancel> to return to the Postural Stability

Training Options screen without making changes.

• Use the <▲> or <▼> keys to set the total time in 10-second increments (during the routine the system will count down from the time setting selected).

NOTE: Total time must be set before you can set beginning and ending platform stability.

• To set initial platform stability, touch the appropriate key and then enter the setting from the keypad displayed (static, 12 is most stable, 1 is least stable). Touch <OK> to return to the Postural

Stability Training Options screen and set the ending platform stability in the same manner.

• To turn tracing ON/OFF, touch <Tracing> to toggle between choices.

11. At the Postural Stability Training screen touch the <▲> or <▼> keys to select the desired platform stability if not already selected (static, 12 is most stable, 1 is least stable).

12. Explain the training protocol to the patient and then press <Start> on the display to begin the training session. The Stability Training grid on the screen charts the patient’s stability performance through the course of the training session (touch the <Magnifying Glass> to enlarge the screen if desired). The Elapsed Time from the start of the training session is shown at the top right of the display while the stability level is illustrated by a bar graph in the upper right-hand corner. Note that the stability level of the foot platform can be changed at any time during the exercise session.

NOTE: If you have selected to enlarge the screen by touching the <Magnifying Glass>, you must return to the normal viewing screen format to make any changes.

NOTE: As the patient moves the platform during the training session, a "tracing" feature records the route of the cursor on the grid. This feature can be used to visually illustrate a patient’s positioning throughout the routine, or as a target, i.e., asking the patient to "trace" a letter, square, circle, etc.

13. At any time during the training session, the "tracing" can be erased by pressing <Clear

Tracing>.

14. To stop the training session at any time, press <Stop> on the display. The system will stop gathering data and the platform will advance to the locked position.

15. When you are finished reviewing the training screen, touch <Print> to print the screen, or <Save Results> to save the training session (numeric data only).

16. After printing or reviewing the screen, press <Start> to immediately begin another training session using the same parameters, or press <Back> to return to the Training Setup screen.

— 7-3 — THE TRAINING MODES

CONTENTS

LIMITS OF STABILITY (LOS) TRAINING ROUTINE

(See Figure 7.3.)

The Limits of Stability Training screen is designed to challenge the user to move through a movement pattern consistent with the sway envelope. The sway envelope is that area a person can move their COG within their base of support. It is approximated from vertical as 8 degrees to one side, 8 degrees to the other (total of 16 degrees of sway,) and 8 degrees forward and 4 degrees back (12 degrees total). Limits of Stability training and testing are based on challenging the patient within this sway envelope. Testing is usually done at 75% LOS, which is the moderate skill level. Easy skill level is 50% and hard skill level is 100% of the sway envelop.

Scoring percentage-based and reflects the directional accuracy of the movement to the blinking targets (see Appendix B-1) time counts up.

Figure 7.3. The Limits of Stability (LOS) Training Screen.

To Access The Limits of Stability Training Mode:

1. Position the support handles as per patient protocol.

2. Position the display height and tilt for patient comfort.

3. At the Main Menu, touch <Training>. The Training Menu screen should now be displayed.

4. Touch <Limits of Stability>. The User Setup Information screen should now be displayed. If this is a new patient and you want to save this training session after its completion, you must enter the patient’s name, height and weight. If you do not need to save the training session, touch <Next> and skip to step 8.

5. Touch the <Keypad> icon for “Name” and enter the patient’s name. Touch <OK> to return to the User Information screen.

6. Touch the <Keypad> icon for “Age” and enter the patient’s age. Touch <OK> to return to the

User Information screen.

THE TRAINING MODES — 7-4 —

8. TESTING A PATIENT

7. Touch the <Keypad> icon for “Height” and enter the patient’s height. Touch <Next> to advance to the Limits of Stability Training screen.

8. At the Limits of Stability Training screen, touch <Stance> to toggle though the patient stance positions until the desired choice, right leg, left leg or both legs, is displayed.

9. Touch <Skill Level> to tighten or widen the spread between targets. Three skill levels are available from which to choose. Touch <Skill Level> until the desired target configuration is displayed.

10. If desired, touch <Clear Tracing> to remove any tracing that remains on the screen from a previous exercise session.

11. Touch <More Options> to advance to the Limits of Stability Training Options screen if desired. Here you can set the Limits of Stability Hold Time for the exercise and turn Tracing

ON/OFF. Touch <OK> to confirm your selections and return to the Limits of Stability screen, or

<Cancel> to return to the Limits of Stability screen without making changes.

• To set a Limits of Stability Hold Time, use the <▲> or <▼> keys to scroll to the desired setting. Hold times range from .025 to 5 seconds.

• To turn tracing ON/OFF, touch <Tracing> to toggle between choices.

12. At the Limits of Stability Training screen touch the <▲> or <▼> keys to select the desired platform stability (static, 12 is most stable, 1 is least stable).

13. Explain the training protocol to the patient, then press <Start> to begin the LOS training session. The LOS Training screen reflects the patient’s stability performance through the course of the LOS training session. The Elapsed Time from the start of the training session is shown at the top right of the display while the stability level is illustrated by a bar graph. A running patient score is also provided in the upper right corner. Note that the stability level of the foot platform can be changed at any time during the exercise session.

NOTE: If you have selected to enlarge the screen by touching the <Magnifying Glass>, you must return to the normal viewing screen format to make any changes.

14. At any time during the training session, the "tracing" can be erased by pressing <Clear Tracing>.

15. To stop the training session at any time, press <Stop> on the display. The system will stop gathering data and the platform will advance to the locked position.

16. When you are finished reviewing the training screen, touch <Print> to print the screen, or <Save Results> to save the training session (numeric data only).

17. After printing or reviewing the screen, press <Start> to immediately begin another training session using the same parameters, or press <Back> to return to the Training Setup screen.

— 7-5 — THE TRAINING MODES

CONTENTS

WEIGHT SHIFT TRAINING

(See Figure 7.4)

This training mode allows for exercise in the most basic of activities weight shifting. The patient has the ability to shift weight in medial/lateral, anterior/posterior and diagonal planes. This can be done with both static and dynamic settings. During this training routine the target zone, defined by two parallel lines, can be rotated to any of three positions while the amount of excursion within the target area can be modified to allow for the most limited to most difficult degree of weight shifting. To reposition the target zone hit lines at any time, simply touch the desired line and re-touch the screen where you want the line to be relocated.

Scoring is percentage-based and equals net good hits/total target hits. If you cross the boundary, that counts against the good hit total. All outside boundary hits are subtracted from the total amount of target hits. This value equals the net good hits.

For example: Enter 10 as the # of target hits. There were 4 times the cursor went outside the boundary. 10-4 = 6 good hits. Score = 6/10 or 60%.

For weight shift training the time value always counts up.

NOTE: A wall hit is counted as one hit within the path to the target hit.

Target zone hit lines

Figure 7.4. The Weight Shift Training Screen.

To Access The Weight Shift Training Mode:

1. Position the support handles as per patient protocol.

2. Position the display height and tilt for patient comfort.

3. At the Main Menu, touch <Training>. The Training Menu screen should now be displayed.

4. Touch <Weight Shift >. The User Setup Information screen should now be displayed. If this is a new patient and you want to save this training session after its completion, you must enter the patient’s name, height and weight. If you do not need to save the training session, touch <Next> and skip to step 8.

THE TRAINING MODES — 7-6 —

CONTENTS

5. Touch the <Keypad> icon for “Name” and enter the patient’s name. Touch <OK> to return to the User Information screen.

6. Touch the <Keypad> icon for “Age” and enter the patient’s age. Touch <OK> to return to the

User Information screen.

7. Touch the <Keypad> icon for “Height” and enter the patient’s height. Touch <Next> to advance to the Weight Shift Training screen.

8. At the Weight Shift Training screen, touch <Rotate Target > to toggle through the three patient target positions until the desired rotation is displayed on the grid.

9. Touch <Skill Level> to enlarge or decrease the target box size. Three skill levels are available from which to choose. Touch <Skill Level> until the desired target configuration is displayed.

10. If desired, touch <Clear Tracing> to remove any tracing that remains on the screen from a previous exercise session.

11. Touch <More Options> to advance to the Weight Shift Training Options screen if desired. Here you can set the total hits for the exercise (default = 60), set platform stability and turn tracing

ON/OFF. Touch <OK> to confirm your selections and return to the Weight Shift Training Options screen, or <Cancel> to return to the Weight Shift Training Options screen without making changes.

• Use the <▲> or <▼> keys to set the total hits.

NOTE: Total hits must be set before you can set beginning and ending platform stability.

• To set initial platform stability, touch the appropriate key and then enter the setting from the keypad displayed (static, 12 is most stable, 1 is least stable). Touch <OK> to return to the Weight

Shift Training Options screen and set the ending platform stability in the same manner.

• To turn tracing ON/OFF, touch <Tracing> to toggle between choices.

12. At the Weight Shift Training screen touch the <▲> or <▼> keys to select the desired platform stability if not already selected (static, 12 is most stable, 1 is least stable).

13. Explain the training protocol to the patient and then press <Start> on the display to begin the training session. The Stability Training grid on the screen charts the patient’s stability performance through the course of the training session (touch the <Magnifying Glass> to enlarge the screen if desired). The Elapsed Time from the start of the training session is shown at the top right of the display while the stability level is illustrated by a bar graph in the upper right corner. A running patient score is also provided in the upper right corner. Note that the stability level of the foot platform can be changed at any time during the exercise session.

NOTE: If you have selected to enlarge the screen by touching the <Magnifying Glass>, you must return to the normal viewing screen format to make any changes.

14. At any time during the training session, the "tracing" can be erased by pressing <Clear Tracing>.

15. To stop the training session at any time, press <Stop> on the display. The system will stop gathering data and the platform will advance to the locked position.

16. When you are finished reviewing the Weight Shift Training screen, touch <Print> to print the screen, or <Save Results> to save the training session (numeric data only).

17. After printing or reviewing the screen, press <Start> to immediately begin another training session using the same parameters, or press <Back> to return to the Training Setup screen.

— 7-7 — THE TRAINING MODES

CONTENTS

MAZE CONTROL TRAINING

(See Figure 7.5.)

This mode allows the patient to follow a reproducible pattern of movement throughout a maze in both static and dynamic environments. Three skill levels allow the maze to be modified to create a simple or more difficult environment for the patient to navigate through. Change the platform from static mode to dynamic mode to facilitate progression. Time counts up or down as set.

Scoring is percentage-based on the net good hits/total target hits. If the cursor hits the boundary that hit is subtracted from the total possible amount of good hits.

• Easiest maze has 28 total targets, 14 in each direction

• Moderate has 36 targets, 18 in each direction

• Most difficult has 72 targets, 36 in each direction

In the case of the easiest maze. If the wall is hit 6 times the resulting score will be 22/28 = 78%

Figure 7.5. The Maze Control Training screen.

To Access The Maze Control Mode:

1. Position the support handles as per patient protocol.

2. Position the display height and tilt for patient comfort.

3. At the Main Menu, touch <Training>. The Training Menu screen should now be displayed.

4. Touch <Maze Control >. The User Setup Information screen should now be displayed. If this is a new patient and you want to save this training session after its completion, you must enter the patient’s name, height and weight. If you do not need to save the training session, touch

<Next> and skip to step 8.

THE TRAINING MODES — 7-8 —

CONTENTS

5. Touch the <Keypad> icon for “Name” and enter the patient’s name. Touch <OK> to return to the User Information screen.

6. Touch the <Keypad> icon for “Age” and enter the patient’s age. Touch <OK> to return to the

User Information screen.

7. Touch the <Keypad> icon for “Height” and enter the patient’s height. Touch <Next> to advance to the Maze Control Training screen.

8. Touch <Skill Level> to increase or decrease the number of targets displayed on the graph.

Three skill levels are available from which to choose. Touch <Skill Level> until the desired target configuration is displayed.

9. If desired, touch <Clear Tracing> to remove any tracing that remains on the screen from a previous exercise session.

10. Touch <More Options> to advance to the Maze Control Training Options screen if desired.

Here you can set the total time for the exercise, enter initial and ending platform stability settings, and turn tracing ON/OFF. Touch <OK> to confirm your selections and return to the Maze

Control Training Options screen, or <Cancel> to return to the Maze Control Training Options screen without making changes.

• Use the <▲> or <▼> keys to set the total hits.

NOTE: Total time must be set before you can set beginning and ending platform stability.

• To set initial platform stability, touch the appropriate key and then enter the setting from the keypad displayed (static, 12 is most stable, 1 is least stable). Touch <OK> to return to the Maze

Control Training Options screen and set the ending platform stability in the same manner.

• To turn tracing ON/OFF, touch <Tracing> to toggle between choices.

11. At the Maze Control Training screen touch the <▲> or <▼> keys to select the desired platform stability if not already selected (static, 12 is most stable, 1 is least stable).

12. Explain the training protocol to the patient and then press <Start> on the display to begin the training session. The Stability Training grid on the screen charts the patient’s stability performance through the course of the training session (touch the <Magnifying Glass> to enlarge the screen if desired). The Elapsed Time from the start of the training session is shown at the top right of the display while the stability level is illustrated by a bar graph in the upper right corner. A running patient score is also provided in the upper right corner. Note that the stability level of the foot platform can be changed at any time during the exercise session.

NOTE: If you have selected to enlarge the screen by touching the <Magnifying Glass>, you must return to the normal viewing screen format to make any changes.

13. At any time during the training session, the "tracing" can be erased by pressing <Clear Tracing>.

14. To stop the training session at any time, press <Stop> on the display. The system will stop gathering data and the platform will advance to the locked position.

15. When you are finished reviewing the Maze Control Training screen, touch <Print> to print the screen, or <Save Results> to save the training session (numeric data only).

16. After printing or reviewing the screen, press <Start> to immediately begin another training session using the same parameters, or press <Back> to return to the Training Setup screen.

— 7-9 — THE TRAINING MODES

CONTENTS

THE RANDOM CONTROL TRAINING

This training mode allows the patient to perform neuromuscular control activities in random patterns generated by the display and is ideal for motor control and vestibular training. The size and speed of the target can be modified for progressions ranging from easy to difficult. While in static mode the patient can work within their sway envelope to move the cursor and attempt to keep it within the moving target. In dynamic mode the patient must utilize various hip, knee and ankle strategies to manipulate the moving platform's cursor to within the random moving target.

Scoring is percentage-based and equals the total time inside the circle/total time in and outside of the circle. Time counts up or down as set.

Figure 7.6. The Random Control Training screen.

To Access The Random Control Training Mode:

1. Position the support handles as per patient protocol.

2. Position the display height and tilt for patient comfort.

3. At the Main Menu, touch <Training>. The Training Menu screen should now be displayed.

4. Touch <Random Control >. The User Setup Information screen should now be displayed. If this is a new patient and you want to save this training session after its completion, you must enter the patient’s name, height and weight. If you do not need to save the training session, touch <Next> and skip to step 8.

5. Touch the <Keypad> icon for “Name” and enter the patient’s name. Touch <OK> to return to the User Information screen.

6. Touch the <Keypad> icon for “Age” and enter the patient’s age. Touch <OK> to return to the

User Information screen.

7. Touch the <Keypad> icon for “Height” and enter the patient’s height. Touch <Next> to advance to the Random Control Training screen.

THE TRAINING MODES — 7-10 —

CONTENTS

8. At the Random Control Training screen, the target circle should be flashing in the center of the stability grid. Touch <Circle Speed > to toggle though the three target circle speeds until the target circle flashes at the desired speed.

9. Touch <Skill Level> to enlarge or decrease the target circle size. Three skill levels are available from which to choose. Touch <Skill Level> until the desired target size is displayed.

10. If desired, touch <Clear Tracing> to remove any tracing that remains on the screen from a previous exercise session.

11. Touch <More Options> to advance to the Random Control Training Options screen if desired. Here you can set the total time for the exercise, enter initial and ending platform stability settings, and turn tracing ON/OFF. Touch <OK> to confirm your selections and return to the

Random Control Training Options screen, or <Cancel> to return to the Random Control Training

Options screen without making changes.

• Use the <▲> or <▼> keys to set the total time in 10-second increments (during the routine the system will count down from the time setting selected).

NOTE: Total time must be set before you can set beginning and ending platform stability.

• To set initial platform stability, touch the appropriate key and then enter the setting from the keypad displayed (static, 12 is most stable, 1 is least stable). Touch <OK> to return to the Random

Control Training Options screen and set the ending platform stability in the same manner.

• To turn tracing ON/OFF, touch <Tracing> to toggle between choices.

12. At the Random Control Training screen touch the <▲> or <▼> keys to select the desired platform stability if not already selected (static, 12 is most stable, 1 is least stable).

13. Explain the training protocol to the patient and then press <Start> on the display to begin the training session. The Stability Training grid on the screen charts the patient’s stability performance through the course of the training session (touch the <Magnifying Glass> to enlarge the screen if desired). The Elapsed Time from the start of the training session is shown at the top right of the display while the stability level is illustrated by a bar graph in the upper right corner. A running patient score is also provided in the upper right corner. Note that the stability level of the foot platform can be changed at any time during the exercise session.

NOTE: If you have selected to enlarge the screen by touching the <Magnifying Glass>, you must return to the normal viewing screen format to make any changes.

14. At any time during the training session, the "tracing" can be erased by pressing <Clear Tracing>.

15. To stop the training session at any time, press <Stop> on the display. The system will stop gathering data and the platform will advance to the locked position.

16. When you are finished reviewing the Random Control Training screen, touch <Print> to print the screen, or <Save Results> to save the training session (numeric data only).

17. After printing or reviewing the screen, press <Start> to immediately begin another training session using the same parameters, or press <Back> to return to the Training Setup screen.

— 7-11 — THE TRAINING MODES

CONTENTS

% WEIGHT-BEARING TRAINING

(See Figures 7.7 and 7.8.)

Percent Weight-Bearing Training provides real-time feedback of the percentage of weight-bearing on the patient’s foot, ankle, knee, hip, body side, etc. In this mode targets can be set that encourage patients to focus on % weight-bearing goals in anterior, posterior, medial and lateral movements. Therapists and patients should find % weight-bearing training to be an effective mode for communicating what, where and how a patient’s body weight is located or feels.

Figure 7.7. The % Weight-Bearing Training screen. If desired, the

% Weight Bearing Target zone can be shifted by dragging and dropping the appropriate red line to the desired % Weight Bearing Target.

Figure 7.8. If desired, use the More Options button to set the training grid to medial lateral only.

THE TRAINING MODES — 7-12 —

CONTENTS

To Access The % Weight-Bearing Training Mode:

NOTE: % Weight-Bearing is used with the platform in static mode only.

1. Position the support handles as per patient protocol.

2. Position the display height and position for patient comfort.

3. At the Main Menu, touch <Training>. The Training Menu screen should now be displayed.

4. Touch <% Weight Bearing>. The User Setup Information screen should now be displayed. If this is a new patient and you want to save this training session after its completion, you must enter the patient’s name, height and weight. If you do not need to save the training session, touch <Next> and skip to step 8.

5. Touch the <Keypad> icon for “Name” and enter the patient’s name. Touch <OK> to return to the User Setup Information screen.

6. Touch the <Keypad> icon for “Age” and enter the patient’s age. Touch <OK> to the return to the User Setup Information screen.

7. Touch the <Keypad> icon for “Height” and enter the patient’s height. Touch <Next> to advance to the Position Patient screen.

8. Position the patient on the system and explain the training protocol. Press <Start> on the display to activate the cursor and have the patient move the cursor to the center point on the grid.

9. Touch <Record> to bring up the Position Patient Entry screen. Using the keypads, enter the patient’s left foot, left heel, right foot and right heel positions using the midline of the foot and the platform grid as reference points. Touch <Next> to advance to the % Weight Bearing

Training screen.

10. The % Weight Bearing Training screen displays a Medial Lateral/Anterior Posterior grid. If you would prefer a Medial Lateral only grid, touch <More Options>. The More Options screen also allows the clinician to set an end by time value. Touch <OK> after making changes to return to the % Weight Bearing Training screen.

11. If desired, shift the red % Weight Bearing target zone by touching and dragging the appropriate red line to the desired % Weight Bearing target.

12. Explain the training protocol to the patient and then press <Start> on the display to begin the training session. The grid charts the patient’s weight-bearing performance though the course of the training session (touch the <Magnifying Glass> to enlarge the screen if desired.) The

Elapsed Time from the start of the session is shown at the top right of the display. A running patient score is provided in the upper right corner.

NOTE: If you have selected to enlarge the screen by touching the <Magnifying Glass>, you must return to the normal viewing screen format to make any changes.

13. To stop the training session at any time, press <Stop> on the display. The system will stop gathering data.

— 7-13 — THE TRAINING MODES

CONTENTS

14. When you are finished reviewing the % Weight Bearing Training screen, touch <Print> to print the screen, or <Save Results> to save the training session (numeric data only).

16. After printing or reviewing the screen, press <Start> to immediately begin another training session using the same parameters, or press <Back> to return to the Training Setup screen.

NOTE: Scoring is the % time spent within the target range.

THE TRAINING MODES — 7-14 —

8. TESTING

The Biodex Balance System SD allows clinicians to assess a patient’s neuromuscular control in a closed-chain, multi-plane test by quantifying the ability of the patient to maintain dynamic unilateral or bilateral postural stability on either a static or unstable surface. The degree of surface instability is controlled by the system’s microprocessor-based actuator. The clinician selects the test duration, stability level and protocol.

In a dynamic test, once the session beings the patient’s ability to control the platform angle is quantified as a variance from the locked (level) position, as well as degrees of deflection over time. A large variance may be indicative of poor neuromuscular response. Further insight into specific neuromuscular activation patterns is realized with the quantification of anterior/posterior and medial/lateral platform tilt. Predictive Values and Comparative (Bilateral)

Reports are available to chart the patient’s performance. Bilateral comparisons quickly document differences between each lower extremity.

Static testing measures the angular excursion of the patient's center of gravity. Body height must come into play for static measures. A person's Center of Gravity (COG) is approximately 55% of their height. Based on the selected height an appropriate static measure scaling is applied.

Testing in this mode is ideal for baseline testing for movement disorder, vestibular dysfunction and orthopedic patients. Good static testing scores can lead to a progression into dynamic testing and training.

Test formats include Postural Stability, Limits of Stability, Athlete Single Leg, and Fall Risk. Both the Athlete Single Leg and Fall Risk results can be compared to normative data. Postural

Stability and Limits of Stability testing are available at variable levels of difficulty. Bilateral reports

(comparsion of postural stability performance of standing on one leg versus standing on the other) are available in More Options of Postural stability testing.

As with training, patients with saved tests can be recalled for easy positioning from the Patient

Management screen by selecting the desired patient record and touching <Repeat>. See Chapter 11.

Figure 8.1. The Testing Menu screen.

— 8-1 — TESTING

CONTENTS

THE POSTURAL STABLITIY TEST

The Postural Stability Test emphasizes a patient’s ability to maintain center of balance. The patient’s score on this test assesses deviations from center, thus a lower score is more desirable than a higher score.

Platform stability can be varied during a this test by selecting <More Options> from the Postural

Stability Testing screen. Clinicians can also set trial time, number of trials, starting and ending platform stability, rest countdowns or bilateral test.

Figure 8.2. The Position Patient screen.

Figure 8.3. The Patient Position screen with patient positions entered.

TESTING — 8-2 —

CONTENTS

Figure 8.4. The Postural Stability Testing Options screen.

Figure 8.5. The Postural Stability Testing screen.

— 8-3 — TESTING

CONTENTS

Figure 8.6. A sample Postural Stability Test Results screen for a bilateral test.

PERFORMNIG A POSTRUAL STABILITY TEST

(See Figures 8.2 and 8.6.)

1. Position support handles as per patient protocol.

2. Position display height and tilt for patient comfort.

3. At the Main Menu, touch <Testing>. The Testing Menu screen should now be displayed.

4. Touch <Postural Stability>. The User Setup Information screen should now be displayed.

5. Touch the <Keypad> icon for "Name" and enter the patient’s name. Touch <OK> to return to the User Setup Information screen.

6. Touch the <Keypad> icon for "Age" and then enter the patient’s age. Touch <OK> to return to the User Setup Information screen.

7. Touch the appropriate <Height> key to highlight the patient height range setting desired.

Touch <Next> to advance to the Patient Position screen.

8. Position the patient on the system and explain the test protocol. Press <Start> on the display to activate the cursor and have the patient move the cursor to the center point on the grid.

9. Touch <Record> to bring up the Position Patient Entry screen. Using the keypads, enter the patient’s left foot, left heel, right foot and right heel positions using the midline of the foot and the platform grid as reference points. Touch <Next> to advance to the Postural Stability Testing screen.

10. At the Postural Stability Testing screen, touch <Stance> to scroll through the three stance positions provided: left, right or both.

11. Touch <Tracing> to toggle tracing ON or OFF as desired.

TESTING — 8-4 —

CONTENTS

12. Touch <Clear Tracing> to clear any tracing that remains from previous tests.

13. Touch <More Options> to advance to the Postural Stability Test Options screen if desired.

Here you can set the Test Trial Time, enter initial and ending platform stability settings, enter the number of trials, enter the Rest Countdown, or toggle bilateral comparison to "Yes" or "No" and enter the Rest Countdown. You can also toggle the cursor ON/OFF. Touch <OK> to confirm your selections and return to the Postural Stability Testing screen.

• Use the <▲> or <▼> keys to set the total time in five-second increments (during the routine the system will count down from the time setting selected).

NOTE: Total time must be set before you can set beginning and ending platform stability.

• To set initial or ending platform stability (static, 12 is most stable, 1 is least stable,) touch the appropriate key and then enter the setting from the keypad displayed. Touch <OK> to return to the Postural Stability Testing Options screen and set the ending platform stability in the same manner.

• To set the number of trials or rest countdown, touch the appropriate key and then enter the setting from the keypad displayed.

• To turn the cursor ON/OFF, touch <Cursor> to toggle between choices.

• To toggle bilateral comparison "Yes" or "No," touch <Bilateral Comparison>.

14. Press <Start> to release the platform (if not static) and activate the Postural Stability Test screen.

15. With the patient ready to begin the test, touch <Collect Data>. The screen will provide a threesecond countdown before beginning the first of three test trials. The display screen will show Total

Trial Time, Platform Setting and Stance to the left of the grid. Trial Number and score are displayed to the right of the grid. If desired, at this point you can touch the <Magnifying Glass> to select the zoom feature. You must, however, leave the zoom feature to make any changes.

NOTE: To stop a test in progress at any time and return to the Postural Stability Testing screen with the platform locked, touch <Cancel> or <Stop>.

16. When the first trial is finished, the screen will display "Trial 1 Complete," the platform will return to the locked position, and a 10-second rest countdown will begin for the second trial.

Touch <Collect Data> to begin the second test trial and continue in the same manner to complete trials two and three.

17. After completing the test, a "Test Complete" message is displayed. Touch <Results> to advance to the Postural Stability Test Results screen.

NOTE: If you have selected Bilateral Test, the system will begin by testing the initial side as set up above.

After the third trial on the initial side is finished, touch <Test Other Leg> to continue. The system automatically selects the opposite side and then allows the user to proceed from the Position Patient screen.

Repeat steps 8 – 17 to test the opposite side.

18. At the Postural Stability Test Results screen, touch <Print> to automatically generate a printed report if desired. If you have performed a Bilateral Test, the Test Results screen and report will provide a bilateral comparison.

19. To save the test data, touch <Save Results> and then touch <OK> in response to the "Save

Results for later reporting or export?" prompt. The system will display "Save Results Completed after the results are saved.

20. To return to the Opening Menu from the Postural Stability Test Results screen touch <Home>.

— 8-5 — TESTING

9. THE BALANCE REPORTS

SUGGESTED TEST PROTOCOL FOR GENERAL POSTURAL STABILITY

BALANCE TESTING

The test protocol most commonly used with the Biodex Balance System is a Dynamic Balance test as follows:

Test Duration: 20 seconds

Stability Level: 8

Stance: Two Leg

Reliability studies have been done for this protocol. In addition, much of the research being presented is at these levels. Three or four trial repetitions should be performed prior to testing at each level. Again, this is supported by research.

The patient’s performance is noted as a stability index. The stability index represents the variance of platform displacement in degrees from level. A high number is indicative of a lot of motion, which is indicative of the patient having trouble balancing. Differences between right and left limbs can be noted.

Orthopedic problems many times present neuromuscular control problems. You will see this by testing single leg involved and uninvolved. Balance training will improve their control.

Geriatric patients can also be tested for excessive sway. The direction of the sway is important with regards to the predisposition of a falls direction. Falling to either side significantly increases the chances of a hip fracture.1,2,3

References:

1. Cumming, Robert G., Klineburg, Robin J., "Fall Frequency and Characteristics and the Risk of

Hip Fractures." JAGS, 42:774-778, 1994

2. Nevitt, Michael C., Cummings, Steven R., Hudes, Estie, "Risk Factors for Injurious Falls: A

Prospective Study." Journal of Gerontology: Medical Sciences. 46:5, M164-170, 1991.

3. This information was presented in abstract form at the New England Chapter of the American

College of Sports Medicine Thursday October 1, 1998. It is titled Stability Performance

Assessment Among Subject of Disparate Balancing Abilities. J.A. Finn, M.M. Alvarez, R.E. Jett,

D.S. Axtell, D.D. Kemler, Exercise Science Department, Southern Connecticut State University,

New Haven, CT.

TESTING — 8-6 —

CONTENTS

THE LIMITS OF STABLITIY (LOS) TEST

This test challenges patients to move and control their center of gravity within their base of support. During each test trial, patients must shift their weight to move the cursor from the center target to a blinking target and back as quickly and with as little deviation as possible. The same process is repeated for each of nine targets. Targets on the screen blink in random order. Three skill levels allow the targets to be grouped closer together or spread further apart. If desired, single leg LOS test may be performed but no bilateral comparison is provided.

This test is a good indicator of dynamic control within a normalized sway envelope. Poor control, inconsistencies or increased times suggests further assessment for lower extremity strength, proprioception, vestibular or visual deficiencies may be indicated. The default setting for the

LOS test is 75% LOS (moderate still level).

References:

1. Clark S, Rose DJ, Fujimoto K. Generalizability of the Limits of Stability Test in The Evaluation of Dynamic Balance Among Older Adults. Arch Phys Med Rehabilitation, Vol 78, Oct 1997.

Figure 8.7. The Limits of Stability Testing screen.

Figure 8.8. The Limits of Stability Testing Options screen.

— 8-7 — TESTING

CONTENTS

Figure 8.9. The Limits of Stability Test Results screen for a bilateral test.

PERFORMNIG A LIMITS OF STABILITY TEST

(See Figures 8.7 and 8.9.)

1. Position support handles as per patient protocol.

2. Position display height and tilt for patient comfort.

3. At the Main Menu, touch <Testing>. The Testing Menu screen should now be displayed.

4. Touch <Limits of Stability>. The User Setup Information screen should now be displayed.

5. Touch the <Keypad> icon for "Name" and enter the patient’s name. Touch <OK> to return to the User Setup Information screen.

6. Touch the <Keypad> icon for "Age" and then enter the patient’s age. Touch <OK> to return to the User Setup Information screen.

7. Touch the appropriate <Height> key to highlight the patient height range setting desired.

Touch <Next> to advance to the Patient Position screen.

8. Position the patient on the system and explain the test protocol. Press <Start> on the display to activate the cursor and have the patient move the cursor to the center point on the grid.

9. Touch <Record> to bring up the Position Patient Entry screen. Using the keypads, enter the patient’s left foot, left heel, right foot and right heel positions using the midline of the foot and the platform grid as reference points. Touch <Next> to advance to the Limits of Stability Testing screen.

10. At the Limits of Stability Testing screen, touch <Stance> to scroll through the three stance positions provided: left, right or both.

11. Touch <Tracing> to toggle tracing ON or OFF as desired.

TESTING — 8-8 —

CONTENTS

12. Touch <Clear Tracing> to clear any tracing that remains from previous tests.

13. Touch <More Options> to advance to the Limits of Stability Test Options screen if desired.

Here you can set the number of trials, rest countdown, platform stability and limits of stability hold time. You can also toggle the cursor ON/OFF. Touch <OK> to confirm your selections and return to the Limits of Stability Testing screen.

• Use the <▲> or <▼> keys to set the Limits of Stability Hold Time.

• To turn the cursor ON/OFF, touch <Cursor> to toggle between choices.

• To set number of trials, rest countdown or platform stability (static, 12 is most stable, 1 is least stable,) touch the appropriate key and then enter the setting from the keypad displayed.

14. Press <Start> to release the platform (if not static) and activate the Limits of Stability Test screen.

15. With the patient ready to begin the test, touch <Collect Data>. The screen will provide a three-second countdown before beginning the first of three test trials. The display screen will show Test Trial Time, Platform Setting and Stance to the left of the grid. Trial Number and score are displayed to the right of the grid.

NOTE: To stop a test in progress at any time and return to the Limits of Stability Testing screen with the platform locked, touch <Cancel> or <Stop>.

16. When the first trial is finished, the screen will display "Trial 1 Complete," the platform will return to the locked position, and a 10-second rest countdown will begin for the second trial.

Touch <Collect Data> to begin the second test trial and continue in the same manner to complete trials two and three.

17. After completing the test, a "Test Complete" message is displayed. Touch <Results> to advance to the Limits of Stability Test Results screen.

18. At the Limits of Stability Test Results screen, touch <Print> to automatically generate a printed report if desired. If you have performed a Bilateral Test, the Test Results screen and report will provide a bilateral comparison.

19. To save the test data, touch <Save Results> and then touch <OK> in response to the "Save

Results for later reporting or export?" prompt. The system will display "Save Results Completed after the results are saved.

20. To return to the Opening Menu from the Limits of Stability Test Results screen touch <Home>.

— 8-9 — TESTING

CONTENTS

ATHLETE SINGLE LEG STABILITY TESTING

The test protocol for the Athlete Single Leg Stability Testing allows clinicians to test athletes against data derived from studies using the Biodex Balance System. The low stability level of four will challenge athletes and provide the data necessary to assess the athlete’s single leg postural stability.

Figure 8.10. The Athlete Single Leg Stability Testing screen.

Figure 8.11. The Athlete Single Leg Stability Testing Options screen.

TESTING — 8-10 —

CONTENTS

Figure 8.12. A sample Athlete Single Leg Stability Results report.

— 8-11 — TESTING

CONTENTS

PERFORMING AN ATHLETE SINGLE LEG STABILITY TEST

(See Figures 8.10 - 8.12.)

1. Position support handles as per patient protocol.

2. Position display height and tilt for patient comfort.

3. At the Main Menu, touch <Testing>. The Testing Menu screen should now be displayed.

4. Touch <Athlete Single Leg Stability >. The User Setup Information screen should now be displayed.

5. Touch the <Keypad> icon for "Name" and enter the patient’s name. Touch <OK> to return to the User Setup Information screen.

6. Touch the <Keypad> icon for "Age" and then enter the patient’s age. Touch <OK> to return to the User Setup Information screen.

7. Touch the appropriate <Height> key to highlight the patient height range setting desired.

Touch <Next> to advance to the Patient Position screen.

8. Position the patient on the system and explain the test protocol. Press <Start> on the display to activate the cursor and have the patient move the cursor to the center point on the grid.

9. Touch <Record> to bring up the Position Patient Entry screen. Using the keypads, enter the patient’s left foot, left heel, right foot and right heel positions using the midline of the foot and the platform grid as reference points. Touch <Next> to advance to the Athlete Single Leg

Stability Testing screen.

10. At the Athlete Single Leg Stability Testing screen, touch <Stance> to toggle between left and right leg positioning.

11. Touch <Tracing> to toggle tracing ON or OFF as desired.

12. Touch <Clear Tracing> to clear any tracing that remains from previous tests.

13. Touch <More Options> to advance to the More Options screen if desired. Here you can set the Test Trial Time, enter initial and ending platform stability settings, enter the number of trials and enter the Rest Countdown. You can also toggle the cursor ON/OFF. Touch <OK> or confirm your selections and return to the Athlete Single Leg testing screen.

• Use the <▲> or <▼> keys to set the total time in five-second increments (during the routine the system will count down from the time setting selected).

NOTE: Total time must be set before you can set beginning and ending platform stability.

• To set initial or ending platform stability (static, 12 is most stable, 1 is least stable,) touch the appropriate key and then enter the setting from the keypad displayed. Touch <OK> to return to the Athlete Single Leg Stability Testing Options screen and set the ending platform stability in the same manner.

• To set the number of trials or rest countdown, touch the appropriate key and then enter the setting from the keypad displayed.

• To turn the cursor ON/OFF, touch <Cursor> to toggle between choices.

TESTING — 8-12 —

CONTENTS

14. Press <Start> to release the platform (if not static) and activate the Limits of Stability Test screen.

15. With the patient ready to begin the test, touch <Collect Data>. The screen will provide a three-second countdown before beginning the first of three test trials. The display screen will show Test Trial Time, Platform Setting and Stance to the left of the grid. Trial Number and score are displayed to the right of the grid.

NOTE: To stop a test in progress at any time and return to the Athlete Single Leg Stability Testing screen with the platform locked, touch <Cancel> or <Stop>.

16. When the first trial is finished, the screen will display "Trial 1 Complete," the platform will return to the locked position, and a 10-second rest countdown will begin for the second trial.

Touch <Collect Data> to begin the second test trial and continue in the same manner to complete trials two and three.

17. After completing the test, a "Test Complete" message is displayed. Touch <Results> to advance to the Athlete Single Leg Stability Test Results screen.

18. At the Athlete Single Leg Stability Test Results screen, touch <Print> to automatically generate a printed report if desired.

19. To save the test data, touch <Save Results> and then touch <OK> in response to the "Save

Results for later reporting or export?" prompt. The system will display "Save Results Completed after the results are saved.

20. To return to the Opening Menu from the Athlete Single Leg Stability Test Results screen touch <Home>.

TEST PROTOCOL FOR ATHLETE SINGLE LEG STABILITY TESTING

This test protocol can be used to compare patients of similar age ranges in a normative database.

Test Duration: 20 seconds

Level: Four

Stance Type: Single leg

Trials: 3

References:

Athlete Single Leg Stability Test results compliation of data from:

•Paterno MV et al, Neuromuscular Training Improves Single Limb Stability in Young Female

Athletes. J Orthopedic Sports Therapy, June 2004

•Arnold BL, Schmitz R, Examination of Balance Measures Produced by the Biodex Stability

System. J of Athletic Training 1998:33(4):323-327.

•Rozzi S et al, Knee Joint Laxity and Neuromuscular Characteristics of Male and Female Soccer and Basketball Players. American J Sports Medicine, Vol. 27, No 3, 1999.

— 8-13 — TESTING

CONTENTS

PERFORMING A FALL RISK TEST

The Fall Risk test allows identification of potential fall candidates. Test results are compared to age dependent normative data

1

. Scores higher than normative values suggest further assessment for lower extremity strength, proprioception, and vestibular or visual deficiencies.

Previous studies have repeatedly demonstrated that poor balance is a risk factor for falls among elderly subjects

1

. The test protocol incorporated in this system was included to give the clinician normative data to assess their patient's risk for falling. During testing, the patient undergoes three trials of 20 seconds each begining with an initial platform setting of 6 and ending at a platform setting of 2, with ten-second rest periods in between each trial. The patient stands bilaterally with feet shoulder width apart over the midline of the board. At the completion of the test a

Fall Risk Assessment Report can be printed with a score compared to normative data. Results can also be viewed on the screen.

References:

1. Finn JA, et al, Biodex Balance System Assessment Amoung Subjects of Disparate Balancing

Abilities. Presented at the 1999 American College of Sports Medicine Meeting

Figure 8.13. The Fall Risk Testing screen.

Figure 8.14. The Fall Risk Testing Options screen.

TESTING — 8-14 —

CONTENTS

Figure 8.15. A sample Fall Risk Test Results screen.

PERFORMING A FALL RISK TEST

(See Figures 8.13 and 8.15.)

1. Position support handles as per patient protocol.

2. Position display height and tilt for patient comfort.

3. At the Main Menu, touch <Testing>. The Testing Menu screen should now be displayed.

4. Touch <Fall Risk>. The User Setup Information screen should now be displayed.

5. Touch the <Keypad> icon for "Name" and enter the patient’s name. Touch <OK> to return to the User Setup Information screen.

6. Touch the <Keypad> icon for "Age" and then enter the patient’s age. Touch <OK> to return to the User Setup Information screen.

7. Touch the appropriate <Height> key to highlight the patient height range setting desired.

Touch <Next> to advance to the Patient Position screen.

8. Position the patient on the system and explain the test protocol. Press <Start> on the display to activate the cursor and have the patient move the cursor to the center point on the grid.

9. Touch <Record> to bring up the Position Patient Entry screen. Using the keypads, enter the patient’s left foot, left heel, right foot and right heel positions using the midline of the foot and the platform grid as reference points. Touch <Next> to advance to the Fall Risk Testing screen.

10. At the Fall Risk Testing screen touch <Tracing> to toggle tracing ON or OFF as desired.

11. Touch <Clear Tracing> to clear any tracing that remains from previous tests.

— 8-15 — TESTING

10. DATA INTERPRETATION

12. Touch <More Options> to advance to the Fall Risk Test Options screen if desired. Here you can set the Test Trial Time, enter the number of trials and enter the Rest Countdown. You can also toggle the cursor ON/OFF. Touch <OK> to confirm your selections and return to the Fall

Risk Testing screen.

• Use the <▲> or <▼> keys to set the Test Trial time in five-second increments (during the routine the system will count down from the time setting selected).

• To turn the cursor ON/OFF, touch <Cursor> to toggle between choices.

• To set the number of trials or rest countdown, touch the appropriate key and then enter the setting from the keypad displayed.

13. Press <Start> to release the platform (if not static) and activate the Fall Risk Test screen.

14. With the patient ready to begin the test, touch <Collect Data>. The screen will provide a three-second countdown before beginning the first test trial. The display screen will show Test

Trial Time and Platform Setting to the left of the grid. Trial Number and score are displayed to the right of the grid.

NOTE: To stop a test in progress at any time and return to the Fall Risk Testing screen with the platform locked, touch <Cancel> or <Stop>.

15. When the first trial is finished, the screen will display "Trial 1 Complete," the platform will return to the locked position, and the rest countdown will begin for the second trial. Touch

<Collect Data> to begin the second test trial and continue in the same manner to complete trials two and three.

16. After completing the test, a "Test Complete" message is displayed. Touch <Results> to advance to the Fall Risk Test Results screen.

17. At the Fall Risk Test Results screen, touch <Print> to automatically generate a printed report if desired.

18. To save the test data, touch <Save Results> and then touch <OK> in response to the "Save

Results for later reporting or export?" prompt. The system will display "Save Results

Completed" after the results are saved.

19. To return to the Opening Menu from the Fall Risk Test Results screen touch <Home>.

TESTING — 8-16 —

CONTENTS

BALANCE SYSTEM SD PROTOCOL FOR FALL RISK BALANCE TESTING

This test protocol can be used to compare patients of similar age ranges in a normative database.

Test Duration: 20 seconds

Level: 6 to 2

Stance Type: Bilateral

A minimum of three test trials should be used to avoid excessive balance deviations.

The patient’s performance is noted as a stability index. Test results are compared to age dependent normative data. Scores higher than normative values suggest further assessment for lower extremity strength, proprioception and vestibular or visual deficiencies. Poor balance is a major contributor to falls. Strength, particularly high speed, and proprioceptive training have demonstrated positive results in balance improvement.

1

NOTE: For information on normative data referenced in the Predictive Values Report, see Appendix C.

NOTE: For information comparing the original Balance System Protocol for Fall Risk Balance Testing to the Balance System CD Protocol for Fall Risk Balance Testing, see note and chart page 8-17.

References:

1. Finn JA, et al, Biodex Balance System Assessment Amoung Subjects of Disparate Balancing

Abilities. Presented at the 1999 American College of Sports Medicine Meeting

— 8-17 — TESTING

CONTENTS

NOTE: The original Balance unit, in which the normative values were developed, utilized a constant level

8 for 3 trials at 20 seconds each trial.

Balance SD Test Protocol for Fall Risk Balance Testing

Test duration: 20 seconds

Level: 6 to 2

Stance Type: Bilateral

SD protocol correlation to original Balance unit.

NOTE: If you would rather continue to use the constant setting of 8, or some other setting, the default settings can be changed in the Configuration screen.

Predictive values can also be modified to reflect your patient population.

Restore defaults will return these back to the original factory settings.

TESTING — 8-18 —

9. REPORTS

Biodex Balance System SD offers reports for each of the five test modes. These can be used to objectively measure and record the patient’s ability to stabilize the involved joint under static or dynamic stress. Reports can be generated to reflect single leg, both legs and bilateral comparison testing protocols. Report formats include Postural Stability, Limits of Stability, Athlete Single

Leg, and Fall Risk. Both the Athlete Single Leg and Fall Risk Reports offer a comparison to normative data available.

1

. Progress reports that graph overall stability scores from each test date are also

Sample reports for each testing mode are provided later in this chapter.

REPORT PARAMETERS DEFINED

The following parameters appear on various reports:

Stability Level: Indicates the stability (stiffness) of the foot platform. When "locked", the foot platform is fully stable. A setting of 12 is the most stable "released" setting. A setting of one is the least stable foot platform setting. Stability settings of 12 through one allow the foot platform a full 20 degrees of deflection from level in any direction. For patient centering prior to testing, the foot platform deflection is limited to less than five degrees.

Overall Stability Index (SI): Represents the variance of foot platform displacement in degrees, from level, in all motions during a test. A high number is indicative of a lot of movement during a test with static measures; it is the angular excursion of the patient's center of gravity.

Use as a starting point for a perfectly balanced state.

COB x=0; COB y=0 COB is "Center of Balance"

∑ (0 - X)

2

+ ∑ (0 - Y)

2

number of samples

X

n

2

+ Y

n

2

(p

Anterior/Posterior (AP) Stability Index: Represents the variance of foot platform displacement in degrees, from level, for motion in the sagittal plane.

Dl

y

=

∑ (0 - Y)

2

number of samples

— 9-1 — REPORTS

12. SYSTEM UTILITIES

Medial/Lateral (M/L) Stability Index: Represents the variance of foot platform displacement in degrees, from level, for motion in the frontal plane.

Dl

x

=

∑ (0 - X)

2

number of samples

∑

Mean Deflection: Average position for the patient in all motions throughout the test.

(X

n

, Y

n

) =

∑ (X

n

, Y

n

) n

X

n

2

+ Y

n

2

(position vector magnitude)

A/P Mean Deflection: Average position of side-to-side motion for the patient throughout the test.

A/P Mean Deflection = n

n

n = # of samples

Y

n =

n th sample

M/L Mean Deflection: Average position for the patient in the frontal plane throughout the test.

M/L Mean Deflection =

∑ X n

n

n = # of samples

X

n =

n th sample

Standard Deviation: The amount of variability in the statistical measure. A low standard deviation demonstrates that the range of values from which the mean was calculated were close together.

Standard Deviation = n

(X

n

n

- X)

2

n = # of samples

X

n =

n th sample

X = mean deflection n

Index, which is a variance from level as established during the centering patient portion of the test protocol. The resulting scores for Mean, A/P and M/L Deflections are not statistically effected by the centering process.

REPORTS — 9-2 —

CONTENTS

Percent Time In Zone/Quadrant: These values represent the percentage of test time the patient spends in each Zone/Quadrant during the test.

The Target Zones, A, B, C, and D, are equal to specific ranges of deflection and radiate in concentric circles from the center of the foot platform as follows:

• Zone A = zero to five degrees foot platform deflection from level

• Zone B = six to ten degrees foot platform deflection from level

• Zone C = 11 - 15 degrees foot platform deflection from level

• Zone D = 16 - 20 degrees foot platform deflection from level

Quadrants represent the four quarters of the Test Grid in the X and Y axis as follows:

For the "Both Feet" protocol:

• Quadrant 1 = right anterior

• Quadrant 2 = left anterior

Quadrants represent the four quarters of the Test Grid in the X and Y axis as follows:

For the "Both Feet" protocol:

• Quadrant 3 = left posterior

• Quadrant 4 = right posterior

For the "Single Foot" protocol:

• Quadrant 1 = lateral anterior

• Quadrant 2 = medial anterior

• Quadrant 3 = medial posterior

• Quadrant 4 = lateral posterior

Test Grid: Provides a visual representation of Time Spent in Zone/Quadrant. View is orientated as if patient were looking down at foot platform while facing the display module.

Anterior/Posterior and Medial/Lateral Deflection Graphs: Provides a visual representation of A/P and M/L deflection during the test. View is oriented as if foot platform were positioned at eye level on a horizontal plane. X axis = time and stability level.

— 9-3 — REPORTS

CONTENTS

SAMPLE BALANCE REPORTS

(See Figures 9-1 –9-6.)

9-1: Sample Postural Stability Single Leg Test Report.

REPORTS — 9-4 —

13. BIODEX BALANCE SYSTEM REIMBURSEMENT

9-2: Sample Postural Stability Bilateral Comparison Test Report.

— 9-5 — REPORTS

14. GENERAL MAINTENANCE

9-3: Limits of Stability Single Leg Test Report (unilateral stance).

REPORTS — 9-6 —

15. SERVICE PROCEDURES

9-4: Limits of Stability Test Report (bilateral stance).

— 9-7 — REPORTS

CONTENTS

9-5: Athlete Single Leg Stability Test Report

REPORTS — 9-8 —

CONTENTS

9-6: Fall Risk Test Report.

— 9-9 — REPORTS

CONTENTS

PROGRESS REPORTS

Progress Reports graph overall stability scores for each test date selected. The tests are selected from Patient Maintenance on the Utilities Menu. The patient selected must have multiple tests, with resultant Stability Index scores, for either Postural Stability, Fall Risk or Athletic Single Leg test formats.

Figure 9.7. A Postural Stability Progress Report.

To Print A Progress Report:

1. Touch <Utilities> on the Main Menu. The System Utilities screen should now be displayed.

2. Touch <Patient Management> and enter code 781 to advance to the Patient Management screen.

3. Touch the desired patient test and then touch <Progress Report>. Note that the report will be limited to the specific test type selected.

4. Up to ten test records can be displayed on the screen. Scroll right or left to see additional tests.

5. Touch <Print> to print the Progress Report.

REPORTS — 9-10 —

10. DATA

ASSESSING LIMITS OF STABILITY WITH THE BIODEX BALANCE SYSTEM

The Limits of Stability (LOS) for standing balance has been defined as the maximum angle a body can achieve from vertical without losing one’s balance. Once the LOS is exceeded a fall, stumble or step will ensue. LOS in normal adults is eight degrees anterior, four degrees posterior, and 16 degrees in the lateral direction.

In the static mode the patient’s movements are calculated as the average amount of angular displacement of the Center of Gravity (COG). This is then further defined as a percentage of the patients’s Limits of Stability.

At 100% of the LOS, a patient will fall if they don’t respond appropriately.

Center is established in the test protocol during the centering process where patients must position themselves so the platform is flat and the cursor is centered. In actuality, this process is to position the COG over the point of the vertical ground reaction force.

An Anterior/Posterior Stability Index of 6.8 means the average displacement from center is 6.8

degrees. LOS for A/P motion is 12 degrees. In this case, the patient was able to control their balance to remain within 57% of their A/P LOS.

Balance is a complex process involving visual, vestibular and neuromuscular control. The

Biodex Balance System will prove to be a more sensitive test of balance performance because being a dynamic tilting platform it will invoke the neuromuscular control aspects more so than a static force plate type system, as well as the visual and vestibular components.

The Biodex Balance System will provide an accurate, reliable assessment of a patient’s balance performance. This objective measure can be correlated to actual functional activity performance, fall incidence and fall direction. In addition, balance mobility programs can be evaluated through objective assessment of the effects of lower extremity exercise on balance performance.

INTERPRETING PATIENT PERFORMANCE

The patient’s performance is noted in the following ways:

1. Stability Index:

The stability index represents the variance of platform displacement in degrees from level. A high number is indicative of a lot of motion which is indicative of the patients having trouble balancing. Differences between right and left limbs can be noted.

2. Percent Time in Zone Quadrant:

Example: If a patient with a right lateral ankle sprain spends the vast majority of time in Zone 1, the trend will be to fall into inversion. This gives feedback as to the exact ankle position being challenged.

3. Test Grid:

For testing, as the patient goes further and further from the center of axis, the patient is being challenged to sustain proper position. For rehabilitation, we can note how far the patient can deviate from the center and still maintain a proper position.

— 10-1 — DATA

CONTENTS

BALANCE SYSTEM STATISTIC DEFINITIONS

Stability Index: Represents the variance of platform displacement in degrees from level. A high number is indicative of the patient having trouble balancing. The patient's Actual Stability Index is represented in the Predictive Values Report (see Figure 22) under the column labeled "Actual

Values." The Actual Value can be compared to age related Predictive Value, this is found to the immediate left of the Actual Value under the column labeled "Predictive Values." Should your patient's Actual Values not fit into the range of the Predictive Values there is a balance problem.

Bilateral comparisons can be made to determine progress made during rehabilitation on the

Comparative Report (see Figure 9-2).

Anterior/Posterior Stability Index: Represents the variance of platform displacement in degrees from level for motion in the sagittal plane.

Medial/Lateral Stability Index: Represents the variance of platform displacement in degrees from level for motion in the frontal plane.

Standard Deviation: The amount of variability in the statistical measure. A low standard deviation demonstrates that the range of values from which the mean was calculated were close together.

DATA — 10-2 —

11. SYSTEM UTILITIES

The System Utilities allow users to access the System Configuration and Patient Management screens.

To access the System Utilities, touch <Utilities> on the Main Menu. The System Utilities screen should now be displayed. From here you can select Configuration or Patient Management by touching the desired icon.

CONFIGURATION

(See Figure 11.1 and 11.2.)

At the System Utilities screen, touch <Configuration> and then enter 781 in response to the

"Enter Access Code" prompt. Touch <OK>. The Configuration screen should now be displayed.

At this screen users can set values for Screen Time Out, Date/Time and Default Settings. You can also turn Tone ON/OFF, adjust LCD brightness or Tone volume, and select Measurement

Units, Printer Resolution or Joystick Emulation. When you have finished making all of your selections and adjustments, touch <OK> to return to the Main Menu.

Set Screen Time Out

The Screen Time Out setting determines how long the display screen remains ON when the system is not in use of the test/exercise is completed. Once the selected time expires, the screen fades to black even if the system remains ON.

1. At the Configuration Screen, touch <Set Screen Time Out>. The Set Test/Exercise Complete

Screen Time Out screen should now be displayed.

2. Use the <▲> or <▼> arrows to increase or decrease the value displayed in 30-second increments. Time Out range is from 00:00 to 30:00.

3. Touch <OK> to confirm your changes and return to the Configuration screen. Touch <Cancel> to return to the Configuration screen without making any changes.

Set Date/Time

Time and Date are system-wide parameters that show on all printed reports.

1. At the Configuration Screen, touch <Set Date/Time>. The Set System Date/Time screen should now be displayed.

2. Touch the parameter to set so that the selected field is highlighted.

3. Use the <▲> or <▼> arrows to increase or decrease the value displayed for the highlighted parameter.

4. Repeat steps 2 and 3 until you have adjusted all the parameters you wish to correct.

5. Touch <OK> to confirm your changes and return to the Configuration screen. Touch <Cancel> to return to the Configuration screen without making any changes.

— 11-1 — SYSTEM UTILITIES

CONTENTS

Turn Tone ON/OFF

This setting enables or disables an audible tone which signals test or exercise start, completion and countdown between trials.

1. At the Configuration screen, simply touch the ON or OFF icon to select the desired setting.

Adjust LCD Brightness

This setting brightens or darkens the display screen for all applications.

1. At the Configuration screen, simply touch along the LCD Brightness Bar Scale until the desired display brightness is achieved. The left end of the scale is darkest, the right end of the scale is lightest.

Adjust Tone Volume

This setting raises or lowers the volume of the audible tone which signals test or exercise start, completion and countdown between trials.

1. At the Configuration screen, simply touch along the Tone Volume Bar Scale until the desired level is achieved. The left end of the scale is least loud, the right end of the scale is most loud.

Select Measure Units, Printer Resolution or Joystick Emulation

All three of these setting are simple toggle choices. Simply touch the desired parameter to view the choices, then touch the setting you want to select.

•Measurer Units: Metric or US

•Printer Resolution: normal or high

•Joystick Emulation: disabled or enabled

Default Settings

At the Default Settings screen, users can set the default Fall Risk Platform setting, adjust

Predictive Values, or return these parameters to their original factory-set default values.

To adjust the Fall Risk Platform setting:

1. At the Configuration Screen, touch <Default Settings>. The Default Settings screen should now be displayed.

2. Touch <Platform Setting>.

3. Enter the desired platform setting via the key pad displayed.

4. Touch <Ok> to return to the Default Settings screen.

To Adjust the Predictive Values:

1. At the Configuration Screen, touch <Default Settings>. The Default Settings screen should now be displayed.

2. Touch to highlight the predictive value to you wish to adjust.

3. Use the <▲> or <▼> arrows to increase or decrease the value displayed.

SYSTEM UTILITIES — 11-2 —

CONTENTS

Figure 11.1. The Configuration screen.

Figure 11.2. System Default Settings.

— 11-3 — SYSTEM UTILITIES

16. TROUBLE-SHOOTING

PATIENT MANAGEMENT

(See Figure 11.3 - 11.5.)

At the System Utilities screen, touch <Patient Management > and then enter 781 in response to the

"Enter Access Code" prompt. Touch <OK>. The Patient Management screen should now be displayed. This screen shows a listing of patient and associated saved test and training sessions along with the date performed. Use the <▲> or <▼> arrows to scroll through the list of patient tests.

Figure 11.3. The Patient Management Screen.

View Test Results

(See Figure 11.4.)

To view the results of any test displayed simply touch the desired entry on the Patient

Management screen to produce an on-screen report.

Figure 11.4. A single, stored, patient Postural Stability Test Record.

Repeat (recall a patient for a test or exercise session)

To repeat any saved test or exercise session, touch <Repeat> on the on-screen report. The system will return to the appropriate test or training Position Patient screen with the position values for foot and heel reflecting the selected session. The selected name, age and height of the selected patient will also be recorded with the new test or training session if you save at completion.

SYSTEM UTILITIES — 11-4 —

17. BIBLIOGRAPHY

Print Test Results

To print test results for any patient, touch the desired test to generate an on-screen report then touch <Print> to print the test results.

Single Patient Export

To export the results of any saved test, touch <Export Data>. The data will immediately sent to the export program.

Single Patient Delete

Although the Balance System SD display can store up to 500 test records, you may want to decrease the number of stored records from time to time. To delete any full page display of saved reports, touch <Delete>. Respond <OK> to the delete prompt. The page displayed will be deleted from the display memory. The delete function only works with pages, you cannot select a specific test or patient to delete without deleting every test and patient displayed on the screen.

Multiple Patient Export

(See Figure 11.5.)

NOTE: This process requires Patient Data Export Software (Biodex part # 950-389). Install the software as per instructions and connect the serial interface cable from the Balance System SD display to the target computer. The program allows both multiple and single patient export.

In addition to exporting any single patient record, multiple patient records can be exported.

1. At the Patient Management screen touch <Multiple Export> to export multiple patient records. The Multiple Patient Data Export screen should now be displayed.

2. Four options are available for multiple export: all (export all patient records); prior-to (export all patient records prior to selected date); from (delete all patient records after a selected date); and from-to (export all records between selected dates.) Touch <Options> until the desired option is displayed.

• For prior-to and from-to, touch the date displayed to advance to the date screen. Touch the date section to change and use the ▲ or ▼ arrows to adjust.

3. Touch <Export Now> to export the selected patient files.

Figure 11.5. For multiple export or multiple deletion of patient records, touch <Option> to select records based before or after a selected date, or between two selected dates.

— 11-5 — SYSTEM UTILITIES

CONTENTS

Multiple Patient Delete

In addition to deleting any single patient record, multiple patient records can be deleted.

1. At the Patient Management screen touch <Multiple Delete> to delete multiple patient records.

The Multiple Patient Data Delete screen should now be displayed.

2. Three options are available for multiple delete: all (delete all patient records); prior-to (delete all patient records prior to selected date); and from-to (delete all records between selected dates.)

Touch <Options> until the desired option is displayed.

• For prior-to and from-to, touch the date displayed to advance to the date screen. Touch the date section to change and use the ▲ or ▼ arrows to adjust.

3. Touch <Delete Now> to delete the selected patient files.

SYSTEM UTILITIES — 11-6 —

12. REIMBURSEMENT

Biodex Rehabilitation Equipment is commonly used in rehabilitation services based on a physician referral for these ICD-9 codes. As a result, these CPT codes may be applied.

Reimbursement amounts vary among plans and states.

Physician referral and ICD-9 codes:

V15.88 Personal History of Fall

728.87 Muscle weakness

729.89 Leg weakness

715.0

Degenerative joint disease

715.2

Secondary localized osteoarthritis

781.2

Abnormal gait

719.7

Difficulty in walking

719.4

Joint pain

719.5

Joint stiffness

718.8

Instability of joint

The following CPT codes can be applied.

Reimbursement amounts vary among plans and states.

97110 Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercise to develop strength, endurance, range of motion and flexibility.

97112 Neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities.

97116 Gait Training (includes stair climbing)

97530 Therapeutic activities, direct (one-on-one) patient contact by the provider

(use of dynamic activities to improve functional performance), each 15 minutes

97535 Self-care/home management t raining (eg, activities of daily living (ADL) and compensatory training, meal preparation, safety procedures, and instructions in use of assistive technology devices/adaptive equipment) direct one-on-one contact by provider, each 15 minutes

97750 Physical performance test or measurement (eg, musculoskeletal, functional capacity) with written report, each 15 minutes

NOTE: Most insurance plans, including Medicare, cover assessment and conditioning for Fall Programs.

— 12-1 — SYSTEM REIMBURSEMENT

13. GENERAL MAINTENANCE

The Biodex Balance System requires only the most basic general maintenance, performed on an as-needed basis at least every three to four months.

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. 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.

GENERAL MAINTENANCE PROCEDURES

• Lubricate the spring assemblies with white lithium grease.

• Lubricate the eight push plates with white lithium grease.

• Lubricate the acme threaded rods with white lithium grease.

NOTE: When checking for lubrication, it may only be necessary to re-distribute the existing grease.

CAUTION! Some steps of these procedure require the Balance System to be turned ON. When this is the case, use extreme caution working on the system.

ATTENTION: Certaines étapes de la présente marche à suivre nécessitent que le système d’équilibrage soit mis SOUS TENSION. En pareille circonstance, user de précautions extrêmes dans la maniplation du système.

— 13-1 — GENERAL MAINTENANCE

14. BIBLIOGRAPHY

AKBARI, M, et al.

BALANCE PROBLEMS AFTER UNILATERAL LATERAL ANKLE SPRAINS

J of Rehabilitation Research & Development (JRRD), Vol. 43, No. 7: 819-824, Nov/Dec 2006

Biodex #91-159

ARNOLD, BL, et al.

NORMAL STABILITY PATTERNS AND RELATIONSHIP AS ASSESSED WITH THE BIODEX

BALANCE SYSTEM

J of Athletic Training, Vol. 32 (2):S-25 / April-June 1997

Biodex #93-268

EXAMINATION OF BALANCE MEASURES PRODUCED BY THE BIODEX STABILITY SYS-

TEM

J of Athletic Training, Vol. 33(4):323-27, Dec. 1998

Biodex #93-287

AYDOG, E, et al.

EVALUATION OF DYNAMIC POSTURAL BALANCE USING THE BIODEX STABILITY SYS-

TEM IN RHEUMATOID ARTHRITIS PATIENTS

Abstract only - Clin Rheumatol, 2005, Oct 25:1-6

Biodex #93-104

DYNAMIC POSTURAL BALANCE IN ANKYLOSING SPONDYLITIS PATIENTS

Abstract only – Rheumatology (Oxford), 2005, Nov. 8

Biodex #93-105

BALLARD, T

PRODUCT PROFILE: THE BIODEX BALANCE SYSTEM

Biodex Medical Systems

Biodex #91-111

BEHAN, E

A COMPARISON OF A DYNAMIC BALANCE SYSTEM TO A STATIC FORCE PLAST SYSTEM

FOR ORTHOPEDIC AND MUSCULOSKELETAL REHABILITATION

Biodex Medical Systems

Biodex #91-113

BLACKBURN, JT, et al.

BALANCE AND JOINT STABILITY:

THE RELATIVE CONTRIBUTIONS OF PROPRIOCEPTION AND MUSCULAR STRENGTH

J of Athletic Training, Vol. 34(2):S-30 / April-June 1999

Biodex #91-104

BLACKBURN, TA, et al.

REHABILITATION AFTER LIGAMENTOUS AND LABRAL SURGERY OF THE SHOULDER:

GUIDING CONCEPTS

J of Athletic Training 2000;35(3):373-381

Biodex #93-111

BLACKBURN, TA, et al.

SINGLE LEG STANCE: DEVELOPMENT OF RELIABLE TESTING PROCEDURE

Berkshire Institute of Orthopedic & Sports Physical Therapy, Wyomissing, PA

Biodex #93-207

— 14-1 — BIBLIOGRAPHY

APPENDIX A

CACHUPE, WJC, et al.

RELIABILITY OF BIODEX BALANCE SYSTEM MEASURES

Human Performance Dept. / San Jose State University / June 2000

Biodex #91-198

CAGGIANO, NA, et al.

THE RELATIONSHIP BETWEEN ANKLE KINESTHESIA AND PEAK TORQUE WITH

SINGLE LEG MULTIAXIAL PLATFORM STABILITY

J of Athletic Training, Vol. 34(2):S-31 / April-June 1999

Biodex #91-106

CAMPBELL, MH, et al.

THE CORRELATION BETWEEN ISOKINETIC STRENGTH MEASURES AND FUNCTIONAL

PERFORMANCE IN AN ELDERLY POPULATION

Biodex #93-293

CAVANAUGH, JT, et al.

BALANCE AND POSTOPERATIVE LOWER EXTREMITY JOINT RECONSTRUCTION

Orthopaedic Phys Therapy Clinics of No America; Vol.11:1, 75-99 - March 2002

Biodex #92-244

CLARK, S, et al.

GENERALIZABILITY OF THE LIMITS OF STABILITY TEST IN THE EVALUATION OF

DYNAMIC BALANCE AMONG OLDER ADULTS

Arch Phys Med Rehabil Vol 78:1078-1084, October 1997

Biodex #92-269

DiCOSTANZA, K, et al.

EFFECT OF ADHESIVE MEDIAL LONGITUDINAL ARCH SUPPORT ON POSTURAL SWAY

J of Athletic Training / Vol. 36(2) (suppl) S66, April-June 2001

Biodex #92-227

DOVER, G, et al.

RELIABILITY OF INVERSION AND EVERSION PEAK TORQUE MEASUREMENTS FROM

THE BIODEX SYSTEM 3 ISOKINETIC DYNAMOMETER

J of Athletic Training / Vol. 35 (2) (suppl) / S-91 / April-June 2000

Biodex #91-185

FERRIS, CM, et al.

A COMPARISON OF STRENGTH, PROPRIOCEPTION, LAXITY, FLEXIBILITY, AND BALANCE

BETWEEN BASKETBALL AND NON-BASKETBALL COLLEGIATE FEMALE ATHLETES

J of Athletic Training / Vol. 35 No. 2 (suppl) / S38 / April-June 2000

Biodex #91-189

FINN, JA, et al.

STABILITY PERFORMANCE ASSESSMENT AMONG SUBJECTS OF DISPARATE

BALANCING ABILITIES

Southern Connecticut State University, 501 Crescent St.,

New Haven, CT 06515 Phone: 203-392-6036

Biodex #93-286

FLYNN, WL, et al.

CHANGES IN DYNAMIC POSTURAL STABILITY FOLLOWING CRYOTHERAPY

J of Athletic Training, Vol. 32(2):S-6 / April-June 1997

Biodex #91-110

BIBLIOGRAPHY — 14-2 —

APPENDIX A

FREIDHOFF, G, et al.

PILOT ASSESSMENT OF THE BIODEX STABILITY SYSTEM WITH NORMALS:

TEST/RETEST AND DAY TO DAY RELIABILITY

University of Kentucky, Div. of P.T.,

(Med. Center Annex I, Lexington, KY)

Biodex #93-206

HINMAN, MR

FACTOS AFFECTING RELIABILITY OF THE BIODEX BALANCE SYSTEM:

A SUMMARY OF FOUR STUDIES

J of Sport Rehab, Vol. 9 (3):240-52, August 2000

Biodex #91-194

HORNYIK, ML, et al.

RELIABILITY OF LIMITS OF STABILITY TESTING: A COMPARISON OF TWO DYNAMIC

POSTURAL STABILITY EVALUATION DEVICES

J of Athletic Training, Vol. 36(2) (suppl) S78, April-June 2001

Biodex #92-229

HORODYSKI, MB, et al.

MEASUREMENTS OF DYNAMIC POSTURAL STABILITY, VISUAL SCANNING, AND MEN-

TAL FLEXIBILITY IN COLLEGIATE FOOTBALL PLAYERS

J of Athletic Training, Vol. 34(2):S85 / April-June 1999

Biodex #91-108

JORDEN, RA, et al.

THE INFLUENCE OF ANKLE ORTHOSES AND EXERCISE ON POSTURAL STABILITY

J of Athletic Training, Vol. 36(2) (suppl):S-78, April-June 2001

Biodex #92-228

LEONARD, K, et al.

CHANGES IN DYNAMIC POSTURAL STABILITY FOLLOWING CRYOTHERAPY TO THE

ANKLE AND KNEE

J of Athletic Training, Vol. 34(2):S-68 / April-June 1999

Biodex #91-107

LEPHART, S, et al.

LEARNING EFFECTS AND RELIABILITY OF THE BIODEX STABILITY SYSTEM

Sports Medicine & Neuromuscular Laboratory,

Univ. of Pittsburgh / Pittsburgh, PA

Biodex #93-208

LINDEMANN, U, et al.

IMPROVING BALANCE BY IMPROVING MOTOR SKILLS

Z Gerontol Geriat 37:20-26 (2004)

Biodex #93-205

MAGILL, J, et al.

CHANGES IN DYNAMIC POSTURAL STABILITY WITH THE USE OF NEOPRENE SLEEVES

J of Athletic Training, Vol. 34(2), S-30 / April-June 1999

Biodex #91-103

MALLEY, C, et al.

THE EFFECTS OF THREE DIFFERENT ANKLE TRAINING PROGRAMS ON FUNCTIONAL

STABILITY AND SINGLE-LIMB STANCE

J of Athletic Training, Vol. 34(2), S-30 / April-June 1999

Biodex #91-105

— 14-3 — BIBLIOGRAPHY

CONTENTS

MATTACOLA, CG, et al.

STRENGTH, FUNCTIONAL OUTCOME, AND POSTURAL STABILITY CRUCITATE LIGA-

MENT RECONSTRUCTION

J of Athletic Training, Vol. 37(3): 262-268 / July-Sept 2002

Biodex #92-241

MYER, GD, et al.

REHABILITATION AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: CRITE-

RIA-BASED PROGRESSION THROUGH THE RETURN-T0-SPORT PHASE

J of Orthop & Sports Phy Ther, 36;6:385-402, June 2006

Biodex #93-117

NELSON, AJ, et al.

USING THE BIODEX UNWEIGHING SYSTEM, BALANCE SYSTEM AND GAIT TRAINER IN

AN INTEGRATED REHABILITATION PROGRAM

Abstract, May 2001

Biodex #92-217

PATERNO, MV, et al.

THE RETURN OF NEUROMUSCULAR COORDINATION AFTER ANTERIOR CRUCIATE

LIGAMENT RECONSTRUCTION

Biodex Medical Systems

Biodex #91-112

PATERNO, MV, et al.

NEUROMUSCULAR TRAINING IMPROVES SINGLE-LIMB STABILITY IN YOUNG FEMALE

ATHLETES

JOSPT, Vol. 34 (6):305-316, June 2004

Biodex #92-245

PINTO, KK, et al.

THE EFFECTS OF ANKLE TAPING AND BALANCE ACTIVITIES ON BIODEX STABILITY

MEASUREMENTS

J of Athletic Training, Vol. 34(2), S-30 / April-June 1999

Biodex #91-102

RIEMANN, BL, et al.

COMPARISON OF THE ANKLE, KNEE, HIP, AND TRUNK CORRECTIVE ACTION SHOWN

DURING SINGLE-LEG STANCE ON FIRM, FOAM, AND MULTIAXIAL SURFACES

Arch Phys Med Rehabil, Vol. 84: 90-95, January 2003

Biodex #92-237

ROZZI, SL, et al.

KNEE JOINT LAXITY AND NEUROMUSCULAR CHARACTERISTICS OF MALE AND

FEMALE SOCCER AND BASETBALL PLAYERS

American J Sports Med, Vol. 27(3):312-319 / May-June 1999

Biodex #91-101

SCHMITZ, RJ, et al.

INTERTESTER AND INTRATESTER RELIABILITY OF A DYNAMIC BALANCE PROTOCOL

USING THE BIODEX STABILITY SYSTEM

J of Sports Rehab 7:95-101, 1998

Biodex #93-271

BIBLIOGRAPHY — 14-4 —

CONTENTS

SIERI, T and BERETTA, G.

FALL RISK ASSESSMENT IN VERY OLD MALES AND FEMALES LIVING IN NURSING HOMES

Disability and Rehabilitation:

2004, Vol. 26, No. 12:718-723

Biodex #93-106

SIUDMAK, PG, et al.

CORRELATIONS BETWEEN DYNAMIC BALANCE PERFORMANCE AND ISOKINETIC

FUNCTIONS OF KNEE FLEXOR/EXTENSOR MUSCLES IN THE ELDERLY

Biodex #93-295

TESTERMAN, C, et al.

EVALUATION OF ANKLE INSTABILITY USING THE BIODEX STABILITY SYSTEM

Foot Ankle Int 1999 May, 20(5):317-21 (ISSN: 1071-1007)

Biodex #91-116

UUSI-RASI, K, et al.

ASSOCIATIONS OF CALCIUM INTAKE AND PHYSICAL ACTIVITY WITH BONE DENSITY

AND SIZE IN PREMENOPAUSAL AND POSTMENOPAUSAL WOMEN: A PERIPHERAL

QUANTITATIVE COMPUTED TOMOGRAPHY STUDY

J of Bone and Mineral Research, Vol 17, No. 3, 2002: 544-552

Biodex #92-281

WILKERSON, GB

DYNAMIC JOINT STABILITY: MECHANICAL AND NEUROMUSCULAR

INTER-RELATIONSHIPS

Biodex Medical Systems

Biodex #91-109

WINTERS, KM, et al.

DETRAINING REVERSES POSITIVE EFFECTS OF EXERCISE ON THE MUSCULOSKELETAL

SYSTEM IN PREMENOPAUSAL WOMEN

J of Bone and Mineral Research, Vol 15, No. 12, 2000: 2495-2503

Biodex #92-280

REV: March 12, 2008

— 14-5 — BIBLIOGRAPHY

APPENDIX A

CALCULATION OF LIMITS OF STABILITY DIRECTION CONTROL

DIRECTION CONTROL SCORE % =

Straight Line Distance to Target

Actual Distance Traveled

X 100

WHERE:

Actual

Distance

Traveled

(trace)

Straight Line Distance to

Target

CENTER

TARGET

OVERALL DIRECTION CONTROL SCORE = i

=8 i

=1

(DLOS Scores)

8 or the Average of all the eight Targets

— A-1 — APPENDIX A

APPENDIX B

NORMATIVE DATA REFERENCED IN FALL RISK

The following pertains to the Predictive Values noted on the Balance System Predictive Values

Report.

Testing Parameters

• Level eight

• Bilateral stance

• Eyes open

• 20 seconds

• Five Trial reps

• 30-second rest period between sets

Subjects

• 106 males and 84 females were tested

• Ages ranged from 17-89 years

Results

Group 1 (N=31)

17-35 yrs.

X=1.54

s.d.=0.72

Group 2 (N=44)

36-53 yrs.

X=2.13

s.d.=0.90

Group 3 (N=78)

54-71 yrs.

X=2.57

s.d.=0.78

Group 4 (N=47)

72-89 yrs.

X=2.70

s.d.=0.80

NOTE: Young subjects were more stable than older subjects.

Reference:

This information was presented in abstract form at the New England Chapter of the American College of Sports

Medicine Thursday October 1, 1998. It is titled Stability Performance Assessment Among Subject of Disparate

Balancing Abilities. J.A. Finn, M.M. Alvarez, R.E. Jett, D.S. Axtell, D.D. Kemler, Exercise Science Department,

Southern Connecticut State University, New Haven, CT.

— B-1 — APPENDIX B

REPLACEMENT

— R-1 — REPLACEMENT

REPLACEMENT

REPLACEMENT — R-2 —

REPLACEMENT PARTS

— R-3 — REPLACEMENT

REPLACEMENT PARTS

REPLACEMENT — R-4 —

REPLACEMENT PARTS

— R-5 — REPLACEMENT

REPLACEMENT PARTS

REPLACEMENT — R-6 —

REPLACEMENT PARTS

— R-7 — REPLACEMENT

REPLACEMENT PARTS

REPLACEMENT — R-8 —

Certified Quality Management System

B

IODEX

Biodex Medical Systems, Inc.

20 Ramsay Road, Shirley, New York, 11967-4704, Tel: 800-224-6339 (Int’l 631-924-9000), Fax: 631-924-9338, Email: [email protected], www.biodex.com