biodex 830-450 User manual

DUAL POSITION BACK EX/FLEX ATTACHMENT
INSTRUCTIONS FOR USE
830-450
FN: 08-261-CLR Rev B 8/19

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This Instructions For Use document covers safe operation of the Dual Position Back Ex/Flex
Attachment for the Multi-Joint System – 830-450.
Additional information and resources are available upon request or directly from the Biodex
website, http://www.biodex.com.
If the desired information is not found, contact a local distributor or Biodex directly at
[e-mail]
Thank you,
Biodex Medical Systems, Inc.
Contact information
Manufactured by:
Biodex Medical Systems, Inc.
20 Ramsey Road, Shirley, New York, 11967-4704
Tel: [phone] (Int’l 631-924-9000)
Fax: [phone]
email: [email protected]
www.biodex.com

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Table of Contents
Definition of Symbols................................................................................................................ 4!
1.!Introduction ........................................................................................................................ 5!
Intended Use ................................................................................................................. 5!
Indications for Use......................................................................................................... 5!
2.!Parts and Adjustments ........................................................................................................ 7!
3.!Setup and Installation.......................................................................................................... 8!
Attaching the Ex/Flex Mounting Bars ............................................................................. 8!
Connecting the Back Attachment to the Biodex Multi-Joint System ................................. 9!
Releasing the Back Attachment from the Dynamometer ............................................... 12!
4.!Patient Positioning and Stabilization .................................................................................. 13!
Semi-Standing (Functional Position) ............................................................................. 13!
Seated Compressed (Isolated Lumbar Position) ............................................................ 15!
5.!Clinical Applications .......................................................................................................... 18!
Passive Mode ............................................................................................................... 18!
Isokinetic Mode ........................................................................................................... 18!
Eccentric Mode ............................................................................................................ 18!
Isometric Mode............................................................................................................ 19!
6.!Maintenance...................................................................................................................... 20!
Cleaning Instructions................................................................................................... 20!
Disposal ...................................................................................................................... 20!

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Definition of Symbols
The following symbols and their associated definitions are used and implied throughout this
manual.

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1. Introduction
Figure 1.1. The Multi-Joint System with Dual Position Back Ex/Flex Attachment. The
Patient is Exercising in the semi-standing (functional) position. For exercise
or testing in the seated compressed position, remove the lumbar pad, raise
the seat to the inclined position, and insert both the Sacral Pad and the
Lower Extremity Compression Device.
Intended Use
The Dual Position Back Ex/Flex Attachment is intended to objectively measure Back muscle
extension/flexion and rehabilitation in the semi-standing and seated-compressed lumbar
positions.
The attachment is easily connected or disconnected from the dynamometer and conveniently
rolled aside for storage when not in use.
Indications for Use
The Dual Position Back Ex/Flex Attachment is used to identify, treat and document physical
impairments that cause functional limitations typical of sports injuries and orthopedics.

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Contraindications
Below are the contraindications to isokinetic testing or exercising.
Absolute Contraindications
•Acute strain (musculotendinous unit) or sprain (non-contractile tissue)
•Soft-tissue healing constraints (such as immediately after surgery)
•Severe pain
•Extremely limited range of motion (ROM)
•Severe effusion
•Joint instability
Relative Contraindications
•Subacute strain or chronic third-degree sprain
•Pain
•Partially limited ROM
•Joint laxity
•Effusion

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2. Parts and Adjustments
Figure 2.1. The Biodex Dual Position Back Ex/Flex Attachment Major Components and
Adjustment Mechanisms
1. Headrest Adjust Lock Knob
2. Cervical Headrest
3. Scapula Roll
4. Back Attachment Support
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)

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3. Setup and Installation
Attaching the Ex/Flex Mounting Bars
Figure 3.1. The Ex/Flex Mounting Bars Installed on the Dynamometer Base.
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.

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Connecting the Back Attachment to the Biodex Multi-Joint
System
Figure 3.2. The Dual Position Back Ex/Flex Attachment Secured to the 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 Setup mode.
4. Rotate the dynamometer shaft so that the red dot is at the nine o’clock position.
5. 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 and 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 the knob is tightened. 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.
9. Lock all four casters on the back attachment.
10. Tighten the dynamometer height, tilt and rotation locking knobs. The system is ready for
use.

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Figure 3.3. Align the Connecting Hub Red Dot with the Dynamometer Shaft Red Dot.
Figure 3.4. Tighten the Connecting Hub Lock Knob to Draw the Back Attachment
Securely to the Dynamometer.

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Figure 3.5. Secure the Docking Clamp at the Base of the Back Attachment to the Bars at
the Base of the Dynamometer. Push the Bracket Down as the knob is Being
Tightened.
Figure 3.6. The Docking Clamp Fully Secured to the Dynamometer Base.

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Releasing 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.

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4. Patient Positioning and Stabilization
Semi-Standing (Functional Position)
Figure 4.1. The Dual Position Back Ex/Flex Attachment and Multi-Joint System with a
Patient in the Semi-Standing (Functional) Position.
NOTE: It is recommended that patients remove their glasses during testing or exercise with this
attachment.
1. Place controller in Setup mode and press <Standby>.
2. Holding back attachment firmly with one hand, press <ON>, press <Start> to allow rotation
of the dynamometer shaft. Use the dynamometer Balance Adjustment dial to balance the

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attachment in the vertical position. Move the support attachment to 50 degrees on
attachment goniometer. Press <Stop> on controller or dynamometer to lock the support
attachment in place.
3. Ensure seat is in down position (front of seat tilted down approximately 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.
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 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.
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 position 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 maximum patient restraint
and comfort. Secure tethering strap across the patient’s chest.
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 shoulder pads up or down the strap to position for patient comfort.
NOTE: Because different body types require different torso strap angles for maximal
patient comfort, the straps may be positioned above or below the strap peg located where
the straps are secured to the back attachment frame. It is also acceptable to wrap the strap
around the frame itself in order to accommodate large 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.

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NOTE: Instruct patient to maintain proper posture or support patient manually while in
Setup mode or during mode changes. When changing modes, place the patient in flexion
with manual assist (if necessary) to reduce the possibility of undesired movement into
extension from gravitational effects. Always secure the support attachment when turning
the mode switch on the controller past Setup mode.
14. Set ROM 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 the Advantage Software Operations Manual.)
The system is ready for patient testing or exercise.
NOTE: Use the Back ex/flex goniometer to establish anatomical reference. Flexion is
towards, extension is away. Begin the test/exercise with the patient in the flexed position.
The initial movement is extension (away).
Seated Compressed (Isolated Lumbar Position)
Figure 4.2. The Biodex Dual Position Back Ex/Flex Attachment and Biodex Multi-Joint
System with the Patient Seated in the Compressed (Isolated Lumbar)
Position.

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NOTE: It is recommended that patients remove their glasses during testing or exercise with this
attachment.
1. Place controller in Setup mode and press <Standby>.
2. Holding back attachment support attachment firmly with one hand, press <ON>, press
<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
attachment to about 50 degrees on attachment goniometer. Press <Stop> on the controller
or dynamometer to lock the support attachment in place.
3. Remove Lumbar Pad and insert Sacral Pad, with scale facing up, into Sacral Pad Receiving
Tube.
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 proper 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 subject’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 scapular 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 the Cervical Headrest to
below the occipital protuberance, or to patient comfort.
12. Apply torso straps firmly and adjust clavicle pads on straps for maximum patient restraint
and comfort. Secure tethering strap across the patient’s chest.
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. 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

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the base of the back attachment frame and doubled back to be secured via the Velcro®
patches. Slide the shoulder pads up or down the strap to position for patient comfort.
NOTE: Because different body types require different torso strap angles for maximal
patient comfort, the straps may be positioned above or below the strap peg located where
the straps are secured to the back attachment frame. It is also acceptable to wrap the strap
around the frame itself in order to accommodate large body types.
13. Provide speed to the dynamometer and manually assist patient through range of motion
while still in Setup mode to determine if axis of rotation is properly set.
NOTE: Instruct the patient to maintain posture, or support the patient manually, while in
the Setup mode or during mode changes. When changing modes, place the patient in flexion
with manual assist (if necessary) to reduce the possibility of undesired movement into
extension from gravitational effects. Always secure the support attachment when turning
the mode switch on the controller past Setup mode.
14. Set ROM 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 <Back Velocity Spectrum> from the
Advantage Software Operations/Test menu <Spectrum> from the Advantage Software
Operations/Test menu (refer to Advantage Software Operations Manual.) The system is
ready for patient testing or exercise.
NOTE: Use the Back ex/flex goniometer to establish anatomical reference. Flexion is
towards, extension is away. Begin the test/exercise with the patient in the flexed position.
The initial movement is extension (away).

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5. Clinical Applications
Passive Mode
1. The passive mode may be used to assist patients through a range that they cannot actively
move through, thereby helping to increase range of motion.
2. Non-reciprocal contraction types (Concentric/Eccentric, Eccentric/Concentric) or eccentric
contractions types may be performed in a passive mode. Although research on eccentrics
involving the back is scarce, the functional importance is well known. Submaximal
eccentrics are commonly performed during activities of daily living.
3. Placing the patient in the Passive mode may help overcome the apprehension some patients
experience when using isokinetic equipment. Patients may feel more comfortable knowing
that they do not have to move the equipment, but that the equipment will assist them.
4. Using the Percent Range dials, a patient may be worked through a limited portion of the
range of motion to limit apprehension or work in an area where a deficit has been detected.
5. In patients who are experiencing pain and/or weakness at specific positions, the passive
motion can aid them through these points while they are able to relax the involved muscles.
Isokinetic Mode
1. Loading is concentric/concentric.
2. Recommended for:
•Healthy athletes
•End-stage rehabilitation
•Pre-employment screening
•High-speed testing
3. Not recommended for acute mechanical pain. Patients with acute inflammation may first be
rehabilitated in the passive or isometric mode.
Eccentric Mode
1. Eccentrics emphasize the elastic nature of muscle and therefore a patient can work
eccentrically at a greater physiological efficiency. This translates to greater patient
compliance in many cases since the exercises are subjectively not as hard to perform.
2. There is evidence that eccentric contractions can result in similar strength gains as
concentric contractions. In early stages of rehab, this may be attractive to the clinician and
patient.
3. Mark Rowinski, PhD, PT, (Biodex Clinical Protocol Manual, 1988) states,
"The therapist must focus on the motor control mechanism, and since bending is assisted
by gravity, the eccentric activity of the trunk extensors should be the prime focus early in
the rehabilitation process. Therapy should progress slowly from eccentrics of the trunk
extensors to concentrics of the flexors and, finally, to concentrics of the trunk extensors.
This progression makes sense in relation to the sensitivity of the structures involved and
the capabilities of the muscles, since the extensors are about two to three times stronger
than the trunk flexors."

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Isometric Mode
1. Since no movement is involved, patients can safely exercise muscle flexors or extensors at
specific angles while placing only minimal stress on the trunk and back.
2. In the acute stages of rehab, submaximal exercise can be utilized to maintain or increase
strength at specific ranges in the ROM.

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6. Maintenance
Cleaning Instructions
With the system turned OFF, wipe down all surfaces with a damp cloth. Mild soap and water can
be used to remove stains and scuff marks. Pay particular attention to the upholstery that can be
damaged by exposure to perspiration and other body fluids.
NOTE: DO NOT use cleaning solutions containing ammonia or alcohol to clean upholstery. Mild
soap and water should be sufficient. Allow the system to dry thoroughly before resuming
testing, rehab or activity sessions.
A leather cleaner/conditioner can be used monthly on all upholstery.
Hardware
As needed, inspect all locking and adjustment mechanisms for signs of wear or damage.
If there are any questions or if further assistance is required, contact the Customer Service
Department.
Disposal
An appropriate waste disposal company is to be contacted (i.e., the local collection point for
waste separation). Properly dispose of the device at the end of its service life:
•The device packaging is disposed of through resource recycling.
•The metal parts of the machine go to scrap metal disposal.
•Plastic parts are disposed of as hazardous waste.
The disposal of equipment must be in accordance with the respective
national regulations.
Wear parts are considered hazardous waste! After being replaced, wear
parts must be disposed of according to country-specific waste laws.