Biodex Dual position back ex User manual

FN: 06-326 10/06

BIODEX

Biode Medical Systems, Inc.

20 Ra say Road, Shirley, New York, 11967-4704

Tel: 800-224-6339 (In NY and Int’l. call 631-924-9000),

Fax: 631-924-9241 E ail: [email protected] , www.biodex.co

DUAL POSITION BACK EX/FLEX

ATTACHMENT

OPERATION MANUAL

830-450

10. HANGER FOR ACCESSORY CART

This manual contains instructions for the following

Biodex product:

#830-450 D al Position Back Ex/Flex Attachment

Figure 1: The Biodex Multi-Joint System 3 with Du l Position B ck Ex/Flex

Att chment. The p tient is exercising in the semi-st nding (function l) posi-

tion. For exercise or testing in the se ted-compressed position, remove the lum-

b r p d, r ise the se t to the inclined position, nd insert both the s cr l p d

nd lower extremity compression device.

The Dual Position Back Ex/Flex Attachment was created to provide clini-

cians with greater versatility in back testing and rehabilitation. With this

system, patients can perform both semi-standing and seated-compressed

lumbar back extension/flexion. This allows the clinician to objectively

measure muscle performance in both functional and isolated capacities.

The attachment is easily connected or disconnected from the dynamome-

ter and conveniently rolled aside for storage when not in use.

INTRODUCTION

— 3— INTRODUCTION

The ability to test or exercise in a functional pattern is important because,

in real life activities, musculature other than the abdominals and erector

spinae are used to perform such tasks as lifting. The semi-standing posi-

tion, in which the seat is slightly reclined from horizontal, allows for hip

involvement and a range of motion comprising both lumbar and sacral

movement. This position simulates an upright standing position with

respect to the musculature that contributes to this posture but reduces

some of the compressive forces acting at the low back. Past history has

demonstrated that this position is comfortable for the patient and results

in greater compliance to the rehabilitation program. Many clinicians con-

sider the semi-standing position effective for functional assessment of

lower back extension/flexion motion. A necessary degree of stabilization

is achieved through the use of a cervical support, thoracic support, chest

harness, scapula pad, pelvic support, thigh strap, and foot cuffs.

Effective lumbar isolation, on the other hand, is achieved by placing the

patient in the "seated compressed" position and using the femurs to

immobilize the pelvis. This fixation is accomplished by positioning the

patient in the seat against a specially designed sacral pad and securing

him/her into this surface with the lower extremity compression pad.

Laterally, the patient is secured by the contour of the pad. f course, all

the stabilization features noted for the semi-standing position are also

incorporated to ensure maximal stabilization. Range of motion should

be limited to that which is produced from the lumbar area.

When placed in the seated-compressed position with the seat slightly

inclined from horizontal, the patient maintains some degree of lordosis,

resulting in less deformation of the discs and reduced loads on the lum-

bar region. The sacral pad also helps to maintain this lordotic position

and reduced compression. Because of these factors, isolated lumbar test-

ing is very safe — especially when performed isometrically.

Numerous reasons for isolated lumbar testing have been recognized.

ne important factor stems from a research standpoint. As with joint

testing, the more isolated the motion and the better the stabilization, the

more reproducible the task. Because the movement is isolated the clini-

cian may be sure that the abdominals and erector spinae are being exer-

cised to full capacity with minimal contributions of hip, gluteal, and

other lower extremity musculature.

1. PARTS AND COMPONENTS

INTRODUCTION — 4—

Figure 2: The Biodex Du l Position B ck Ex/Flex Att chment m jor

components nd djustment mech nisms.

1. Headrest Adjust Lock Knob

2. Cervical Headrest

3. Scapula Roll

4. Back Attachment Support Arm

5. Scapula Roll Adjustment Knob

6. Torso Straps with Clavicle Pads

7. Goniometer

8. Lower Extremity Compression Device

9. Sacral Pad

10. Seat Tilt Lever

11. Height Foot Pedal

12. Positive-Lock Casters (all four wheels)

13. Footrest Adjust Lock Knob

14. Footrest

15. Docking Clamp with Lock Knob

16. Femur Strap

17. Pelvic Strap

18. Connecting Hub

19. Connecting Hub Lock Knob

20. Lumbar Pad

21. Torso Strap Buckles

22. Ex/Flex Mounting Bars (inset)

PARTS AND ADJUSTMENTS

— 5— PARTS AND ADJUSTMENTS

123

Attaching the Ex/F ex Mounting Bars

(See Figure 3.)

Figure 3. The Ex/Flex Mounting B rs inst lled on the dyn mometer b se.

1. Using a 5/16" Allen wrench, remove the three bolts each on the left

and right side of the dynamometer pedestal base that secure the

base to the dynamometer travel. Discard the bolts.

2. Position the ex/flex mounting bars over the dynamometer pedestal

base and install with the two new bolts supplied.

SETUP AND INSTALLATION

SETUP AND INSTALLATIONS — 6—

Connecting the Back Attachment to the Biodex System 3

(See Figures 4 - 8.)

Figure 4. The Biodex Du l Position B ck Ex/Flex Att chment secured to the

Biodex Multi-Joint System.

1. Position the dynamometer facing out from the chair at the center of

the top of the T-base (0-degrees rotation).

2. Loosen the dynamometer height, tilt and rotation locking knobs.

3. Set the controller to Set-Up mode.

4. Rotate the dynamometer shaft so that the red dot is up.

5. Lift up on the back attachment support arm to align the red dot on

the connecting hub with the red dot on the dynamometer shaft.

6. Push the back attachment connecting hub onto the dynamometer

shaft until it is fully seated, adjust the dynamometer height, tilt and

rotation as required for a proper fit.

7. Fully tighten the back attachment connecting hub lock knob.

8. Secure the docking clamp at the base of the back attachment to the

ex/flex mounting bars at the base of the dynamometer. Push the

bracket down as you tighten the knob. The lip of the bracket will be

drawn into the grooves on the bars. Fully tighten the knob to draw

the back attachment against the bars.

3. SETUP PROCEDURE

— 7— SETUP AND INSTALLATIONS

9. Lock all four casters on the back attachment.

10. Tighten the dynamometer height, tilt and rotation locking knobs.

The system is now ready for use.

3. SETUP PROCEDURE

SETUP AND INSTALLATIONS — 8—

Figure 5. Align the connecting

hub red dot with the dyn mometer

sh ft red dot.

Figure 6. Tighten the connecting

hub lock knob to dr w the b ck

tt chment securely to the

dyn mometer.

Figure 7. Secure the docking

cl mp t the b se of the b ck

tt chment to the b rs t the b se

of the dyn mometer. Push the

br cket down s you tighten the

knob.

Figure 8. The docking cl mp fully

secured to the dyn mometer b se.

Re easing The Back Attachment From the Dynamometer

1. Loosen the back attachment docking clamp knob until the bracket

pops out of the grooves in the dynamometer bars.

2. Unlock all four back attachment locking casters.

3. Loosen dynamometer height, tilt and rotation locking knobs.

4. Fully loosen the back attachment hub locking knob and pull the

back attachment off the dynamometer.

4. UPPER EXTREMITY EXERCISE

— 9— SETUP AND INSTALLATIONS

Semi-Standing (Functiona Position)

(See Figure 9.)

Figure 9. The Biodex Du l Position B ck Ex/Flex

Att chment nd Biodex Multi-Joint System with

p tient in the semi-st nding (function l) position.

NOTE: It is recommended th t p tients remove their gl sses during testing or

exercise with this tt chment.

1. Place controller in Setup mode and press Standby.

2. Holding back attachment support arm firmly with one hand, press

N, then Start to allow rotation of the dynamometer shaft. Use the

dynamometer Balance Adjustment dial to balance the attachment in

the vertical position. Move the support arm to 50 degrees on attach-

ment goniometer. Press Stop on controller or dynamometer to lock

the support arm in place.

3. Ensure seat is in down position (front of seat tilted down approxi-

mately 15°. If not, lift up on seat, flip up seat adjustment lever and

lower seat appropriately.

4. Ensure that lumbar pad is installed and that both the sacral pad and

lower extremity compression device are removed and stored in their

respective holders.

PATIENT POSITIONING & STABILI ATION

PATIENT POSITIONING & STABILIZATION — 10 —

5. Seat patient. Move patient anteriorly or posteriorly to approximate

longitudinal spinal axis with the fixed axis of the Back Ex/Flex

Attachment.

6. Position footrest so that femur is nearly parallel to seat. Knee angle

will be approximately 15 degrees. Note the value indicated on the

footrest position scale so that it may be entered under subject setting.

7. Adjust patient axis height by pumping seat up or down using Seat

Height Foot Pedal located at back of chair base. Align the fixed axis of

the machine with the subject’s anterior superior ileac spines (ASIS).

Half-strokes move seat up. Full strokes held down lower seat.

8. Stabilize lower extremity firmly with pelvic and femur straps. With

the lower torso properly stabilized the patient assumes a posterior

pelvic tilt with a slight degree of knee flexion. Maintenance of poste-

rior pelvic tilt throughout the range of motion places the extensor

muscles in an elongated position which, when moving into a flexion

posture, allows exercise of a broader range of extensors.

9. Adjust Lumbar Pad to provide desired firmness or maximum

patient comfort. To do this, tighten or loosen the Lumbar Pad’s

Velcro® strap.

10. Adjust Scapula Roll to rest between the level of the scapular spines

and inferior angles. To do this, press in simultaneously on the

Scapular Pad Adjustment Knobs and slide the pad up or down into

any of the notches provided. Affirm that this is a comfortable posi-

tion for the patient.

11. If necessary, loosen the Headrest Adjusting Knobs and adjust

Cervical Headrest to below the occipital protuberance, or to patient

comfort.

12. Apply torso straps firmly and adjust clavicle pads on straps for max-

imum patient restraint and comfort. Secure tethering strap across the

patient’s chest.

5. LOWER EXTREMITY EXERCISE

— 11 — PATIENT POSITIONING & STABILIZATION

The torso straps can also be crisscrossed over the chest by sliding

one strap through the slot of the cervical pad on the second strap.

This is generally the most comfortable strap arrangement for most

patients. The torso straps can also be used independently on each

side. In either case, each strap is guided through the D-Ring on the

appropriate side near the base of the back attachment frame and

doubled back to be secured via the Velcro® patches. Slide the shoul-

der pads up or down the strap to position for patient comfort.

NOTE: Bec use different body types require different torso str p ngles for

m xim l p tient comfort, the str ps m y be positioned bove or below the

str p peg loc ted where the str ps re secured to the b ck tt chment fr me.

It is lso ccept ble to wr p the str p round the fr me itself in order to

ccommod te l rge body types.

13. Provide speed to the dynamometer. Manually assist patient through

range of motion while still in Setup mode to determine if axis of

rotation is properly set.

NOTE: Instruct p tient to m int in proper posture, or support p tient

m nu lly, while in Setup mode or during mode ch nges. When ch nging

modes, pl ce p tient in flexion with m nu l ssist (if necess ry) to reduce

possibility of undesired movement into extension from gr vit tion l effects.

Alw ys secure the support rm when turning mode switch on controller

p st Setup mode.

14. Set R M Limits 1 and 2 in Setup mode. Set Percent Range dials 1

and 2 if required by patient protocol.

15. Proceed to the desired test/exercise mode. Select "Lumbar" as the

joint to be tested and "semi-standing" as the test pattern (refer to

your Advantage Software perations Manual.) The system is now

ready for patient testing or exercise.

NOTE: Use the B ck Ex/Flex goniometer to est blish n tomic l reference.

Flexion is "tow rds," extension is " w y." Begin the test/exercise with the

p tient in the flexed position. The initi l movement is extension ( w y.)

6. APPLICATIONS

PATIENT POSITIONING & STABILIZATION — 12 —

Seated-Compressed (Iso ated Lumbar Position)

(See Figure 10.)

Figure 10. The Biodex Du l Position B ck

Ex/Flex Att chment nd Biodex Multi-Joint

System with the p tient in the se ted-

compressed (isol ted lumb r) position.

NOTE: It is recommended th t p tients remove their gl sses during testing or

exercise with this tt chment.

1. Place controller in Setup mode and press Standby.

2. Holding back attachment support arm firmly with one hand, press

N, then Start to allow rotation of the dynamometer shaft. Use the

dynamometer Balance Adjustment Dial to balance the attachment in

the vertical position. Move the support arm to about 50 degrees on

attachment goniometer. Press Stop on the controller or dynamometer

to lock the support arm in place.

3. Remove Lumbar Pad and insert Sacral Pad, with scale facing up,

into Sacral Pad Receiving Tube.

6. APPLICATIONS

— 13 — PATIENT POSITIONING & STABILIZATION

4. Ensure seat is in inclined position (front of seat tilted upward

approximately 15°). If not, lift up on seat until it locks into the prop-

er position.

5. Seat patient. Move patient anteriorly or posteriorly to approximate

longitudinal spinal axis with the fixed axis of the Back Ex/Flex

Attachment.

6. Position footrest so that it will not interfere with patient positioning.

7. Adjust patient axis height by pumping seat up or down using Seat

Height Foot Pedal. Align the fixed axis of the machine with the sub-

ject’s anterior superior ileac spines (ASIS’s). Half-strokes move seat

up. Full strokes held down lower seat. Note the value indicated on

the seat height scale so that it may be entered under subject settings.

8. Adjust Sacral Pad to provide desired firmness or maximum patient

comfort. To do this, loosen the Sacral Pad locking knob and slide the

pad to that it is flush against the patient’s sacrum.

9. Insert the Lower Extremity Compression Device into the receiving tube

directly beneath the center of the seat. The Compression Device Locking

Knob should be on bottom with the pads pointing up. Place the patient’s

legs between the anterior and posterior pads and slide the device in

toward the chair until there is firm contact with the femur and the lower

leg is perpendicular to the supporting surface. Tighten the locking knob

for the compression device. Secure pelvic and femur straps.

10. Adjust Scapula Roll to rest between the level of the scapular spines

and inferior angles. To do this, press in simultaneously on the scapu-

lar pad adjustment knobs and slide the pad up or down. Affirm that

this is a comfortable position for the patient.

With the lower torso properly stabilized the patient assumes a

posterior pelvic tilt with a slight degree of knee flexion. Maintenance

of posterior pelvic tilt throughout the range of motion places the

extensor muscles in an elongated position which, when moving into

a flexion posture, allows exercise of a broader range of extensors.

11. If necessary, loosen the Headrest Adjustment Knobs and adjust

Cervical Headrest to below the occipital protuberance, or to patient

comfort.

12. Apply torso straps firmly and adjust clavicle pads on straps for max-

imum patient restraint and comfort. Secure tethering strap across the

patient’s chest.

6. APPLICATIONS

PATIENT POSITIONING & STABILIZATION — 14 —

The torso straps can also be crisscrossed over the chest by sliding

one strap through the slot on the cervical pad of the second strap.