biodex 950-430 User manual

BIODEX VIBROTACTILE SYSTEM
For use with the Balance System SD and BioSway (Win CE versions)
INSTALLATION AND OPERATING MANUAL
950-430
FN: 15-462 Rev A 5/16

2Biodex Medical Systems, Inc. © 2015
This manual contains operating procedures for the following Biodex products:
950-430 VibroTactile System, 115 VAC
940-440 Balance System SD, 12.1” Display, 115 VAC
950-460 BioSway 12.1” LCD with Tabletop Stand and Case, 115V/230V 50/60V
950-461 BioSway 12.1” LCD with Tabletop Stand, 115V/230V 50/60V
Contact Information
Biodex Medical Systems, Inc.
20 Ramsey Road, Shirley, New York, 11967-4704
Tel: [phone] (Int’l 631-924-9000)
Fax: [phone]
email: [e-mail]
www.biodex.com

VIBROTACTILE SYSTEM FOR WINDOWS CE BALANCE DEVICES 3
Table of Contents
1 OVERVIEW..............................................................................................................................4
2 INSTALLATION .......................................................................................................................5
3 BATTERY AND WIRELESS CONNECTION STATUS......................................................................8
4 COORDINATING LINKBOXES AND TACTILEBELT BOXES..........................................................10
5 CLINICAL APPLICATIONS ......................................................................................................15
6 SUPPORTING RESEARCH AND SUGGESTED READING .............................................................19
APPENDIX A - SPECIFICATIONS .............................................................................................20
APPENDIX B – CONFORMANCE TO STANDARDS ....................................................................21

4Biodex Medical Systems, Inc. © 2015
1. Overview
Vibrotactile Feedback
Biodex has incorporated vibrotactile feedback into our balance products. Vibrotactile
feedback—or “cueing”, as it may be thought of in this application—adds a new element to
postural sway biofeedback. Vibrotactile cueing incorporates a position triggered, localized
vibrating sensation that provides patients with additional sensory enrichment to therapy tasks.
Therapists commonly emphasize their verbal cues to patients by gently tapping them as well.
Tapping contact can be arbitrary and not reproducible. With vibrotactile cueing, vibrations are
activated on various parts of a belt worn by the patient; these vibrations can be either positively
reinforcing or negatively reinforcing, based on the positional feedback.
Real-time biofeedback about one’s performance is an important aid for rehabilitation. Feedback
can be based on visual, audio and/or tactile inputs. Tactile feedback is unique in that it directly
engages the motor learning system. In balance training, to really focus on the vestibular
system, one’s visual system input needs to be temporarily eliminated. When patients close their
eyes during a balance training session, the Biodex VibroTactile System provides biofeedback in
the form of a “buzz” or vibration-cued signal.
The origin for this technology is in the military, where it was used to enhance spatial awareness
for jet pilots. (Sensors embedded into flight suits activate when disoriented pilots steer their
aircraft towards the ground.) Since then, the technology has been adapted to balance
rehabilitation training practices with excellent results. There are several published papers
supporting the technology, application and benefits. Please see the last section of this
document for more information on these studies.

VIBROTACTILE SYSTEM FOR WINDOWS CE BALANCE DEVICES 5
2. Installation
Software Download and Installation
If you purchased your Biodex balance device in late 2015, the VibroTactile System functionality
will be part of the device’s software—you just have to activate it (see below). If you have an
earlier model, you can download the updated software with the VibroTactile System
functionality from the Biodex website.
On the Updates page, find the link for the most recent release of either the Balance System SD
or BioSway software, which will have a version number of 3.04 or higher:
http://biodex.com/physical-medicine/products/software-updates
Save the software .exe file on the root directory of a USB flash drive, and then place the USB
flash drive into one of the USB ports on your Balance System SD or BioSway display.
Figure 2.1 Save the TactileBelt software file within the root directory of a USB flash drive.
Once the USB flash drive has been inserted into the USB port, your device should automatically
recognize the software file and ask you if you want to install it. Follow the on-screen prompts to
install the software on the device.
Once the VibroTactile System software is installed, you need to enable the vibrotactile
functionality on your device. From the Main Screen of the interface, choose the <Utilities>
button, followed by the <Configuration> button. Then touch the <VT> button, which acts as an
on/off toggle.

6Biodex Medical Systems, Inc. © 2015
NOTE: The “VT” button (Fig 2.2) will be a light blue when it is toggled ON and a dark blue when
toggled OFF.
Figure 2.2 The “VT” button acts as a toggle switch for the device’s vibrotactile functionality. When the button is light blue—as
shown here—the vibrotactile functionality is activated.
Installing the LinkBox
The LinkBox mechanism is attached to the back of your device’s display with a fastener strip.
The LinkBox provides for a wireless link between the TactileBelt on the patient’s waist and the
biofeedback seen on the display.
To install the LinkBox, peel off the protective coverings on both parts of the fastener strip, and
position it on back of the display as shown in Figure 2.3. There are two cables: a serial
communication cable and a short USB cable (for power). Once connected, a blue light will come
on indicating the LinkBox is powered.
Figure 2.3 Installing the LinkBox to the back of the display.

VIBROTACTILE SYSTEM FOR WINDOWS CE BALANCE DEVICES 7
Connecting and Applying the TactileBelt
Two belts are provided, sized 28”-36” (71-91 cm) and 36”-48” (91-122 cm). Select for best fit.
The TactileBelt Receiver boxes are the same for both and can be interchanged if needed.
Use the short cable to connect the TactileBelt Receiver box to the connector on the TactileBelt.
NOTE: Be sure to charge the batteries in the TactileBelt Receiver boxes for a minimum of 8
hours before use.
Figure 2.4 Attaching the TactileBelt Receiver box to the belt.
Clip the TactileBelt Receiver box to the belt fabric. Place the belt around the patient’s waist,
arranging it so the red arrow points up and aligns with the patient’s navel.
Press the LINK button to wirelessly connect with the LinkBox. RESET can be used to re-establish
communication with LinkBox should the connection be lost.
Figure 2.5 Align the red arrow on the TactileBelt with the patient’s navel.

8Biodex Medical Systems, Inc. © 2015
3. Battery and Wireless Connection Status
LED Indicator Lights
The LinkBox is powered by the USB connection to the balance device’s display. The TactileBelt
Receiver boxes have rechargeable batteries. The batteries should provide more than enough
service for a full day of clinical usage.
There are two LED indicator lights on the TactileBelt Receiver boxes. The light on the left is for
the battery status. The light on the right is for USB power.
The battery indicator shows various states:
•Solid Green: Battery charged half capacity or greater, trickle or not charging
•Solid Orange: Battery charge less than half but not critical, not charging
•Solid Red: Battery charge is critically low, not charging
•Slow Blink Green: Battery charged half capacity or greater, actively charging
•Slow Blink Orange: Battery charge less than half but not critical, actively charging
•Slow Blink Red: Battery charge is critically low, actively charging
•Fast Blink Red: Temperature out of range (0-40C, 32-104F)
•Fast Blink Orange: Initializing (one second only)
USB power status:
•Solid Blue: USB port powered
•Dark: USB port not powered
LinkBox Indicators (see Fig. 2.3):
LED on Left:
Solid Blue: Receiver Board is/was connected
Slow Blink Blue: Building wireless network (searching)
LED on Right
Solid Blue: Active communications to application software
Dark: No communications to application software
NOTE: When connecting a TactileBelt Receiver box you may see the connection status light
alternating from green to red, but the screen does not display a channel selection. If the belt
has been idle for some time, it is “sleeping” and will not immediately connect. By clicking the
RESET button the belt receiver “wakes up” and should connect correctly.
Figure 3.1 TactileBelt Receiver box LED indicators.

VIBROTACTILE SYSTEM FOR WINDOWS CE BALANCE DEVICES 9
Charging / Power Options for TactileBelt Receiver Boxes
There are two ways to charge the TactileBelt Receiver boxes:
1.) Wall outlet charger (for quickest charge)
2.) USB connection to display
Figure 3.2 TactileBelt Receiver boxes can be charged with a connection to a wall outlet or to the display on the device.
On-Screen Indicators
The wireless reception and battery symbols on the upper left corner of the display indicate
TactileBelt/LinkBox communication and TactileBelt battery status.
Figure 3.3 On-screen indicator showing wireless connection and approximately 75% battery life.
NOTE: Be sure to charge the batteries in the TactileBelt Receiver boxes for a minimum of 8
hours before use.

10 Biodex Medical Systems, Inc. © 2015
4. Coordinating LinkBoxes and TactileBelt Boxes
Configuring Equipment in Facilities with One VibroTactile System
Your Biodex VibroTactile System comes with one LinkBox and two TactileBelt belts and Receiver
boxes. The LinkBox will be labeled with a sticker denoting “A0”, and the two TactileBelt Receiver
boxes will be labeled “A1” and “A2”.
The TactileBelt Receiver boxes will “time out” and power down after 2 minutes of non-usage. If
both are active, however, you will have to select which one the LinkBox should communicate
with.
Figure 4.1 The VibroTactile System will come shipped with labels denoting “A0” for the LinkBox and “A1” and “A2” for the
TactileBelt Receiver boxes.
On the screen shown below, the wireless/battery symbol denotes that no TactileBelt is
communicating with the LinkBox. Touch the wireless/battery symbol once to configure
TactileBelt A1 or A2. In this example, we will proceed with configuring A1.
Figure 4.2 The wireless/battery symbol is in the upper left corner.

VIBROTACTILE SYSTEM FOR WINDOWS CE BALANCE DEVICES 11
Select TactileBelt Receiver (Box) A1.
Figure 4.3 Use the dropdown menu to select a TactileBelt Receiver box.
Check the label to ensure that you are holding TactileBelt Receiver box A1, and then press the
LINK button on that box. The A0 LinkBox should detect and connect with the A1 TactileBelt
Receiver box.
!
Figure 4.4 Press the LINK button to wireless connect the TactileBelt Receiver box.
Once the TactileBelt box has been detected, you should perform a quick test. In a test, each
tactor along the belt will vibrate. In addition to testing the tactors, this allows for the user to
experience what the vibrotactile sensation feels like.
NOTE: Even if you do not need to configure your LinkBox and TactileBelt Receiver boxes, you can
still perform a tactor test by touching the wireless/battery symbol on the main testing/training
screen (Fig 4.2).

12 Biodex Medical Systems, Inc. © 2015
For a tactor test, select <Fast> or <Slow>. In the “Fast” test, each tactor will vibrate for a ½
second. In the “Slow” test, tactors will vibrate for 1 second.
Figure 4.5 Testing the tactors in the TactileBelt.
When finished, a screen will appear noting that test is complete. There is no error message if a
tactor did not vibrate. If a tactor is not vibrating during this test, something is not working
correctly. Try performing the configuration steps again. If there is still a problem, contact
Biodex customer service.
Press the <Back> button to return to the main testing/training screen. You will now note that
the wireless/battery symbol shows wireless connectivity, battery life, and the specific TactileBelt
box that the LinkBox is communicating with. (In this case, TactileBelt Receiver box A1.)
Figure 4.6 A Postural Stability Training screen, showing wireless connectivity and battery life of TactileBelt A1.

VIBROTACTILE SYSTEM FOR WINDOWS CE BALANCE DEVICES 13
Configuring Equipment in Facilities with Multiple VibroTactile
Systems
If your facility has purchased more than one VibroTactile System, you will need to take some
steps to ensure that the various LinkBoxes and TactileBelt boxes do not interfere with each
other.
The process for configuring two VibroTactile Systems to work in the same facility consists
broadly of two major steps: 1) Configuring a VibroTactile System set (one LinkBox and two
TactileBelt boxes), and then, 2) Configuring those boxes on the balance device itself.
Step 1: Configuring VibroTactile System Components on Your Windows 7 or
8 Computer
Begin by downloading the Vibrotactile Configuration Utility from the Biodex Software update
web page:
http://www.biodex.com/physical-medicine/products/software-updates
Follow the prompts to install the software on your Windows 7 or 8 computer.
After you have launched the software, connect the LinkBox you wish to reconfigure to your
computer with a USB cable. Once connected, the connection status indicator in the lower right
of the Vibrotactile Configuration Utility screen will turn green.
!
Figure 4.7 Vibrotactile Configuration Utility main screen.
Select a Wireless Channel other than “A”—for this example, assume <Ch. B> is selected. Press
<Save Settings>. A message will appear indicating that the LinkBox is being updated.

14 Biodex Medical Systems, Inc. © 2015
The LinkBox has now been designated “B0”. Disconnect the LinkBox, and connect one of the
TactileBelt boxes. Press either the RESET or LINK button to activate the box. (This will allow your
computer to “recognize” the device.) Repeat the previous steps, ensuring that you also select
<Ch. B> for both of the TactileBelt boxes, making them “B1” and “B2”.
After all three components have been configured with the Channel B setting, it may be helpful
to replace the “A” sticker labels on each of the boxes with the “B” stickers. The sticker sheet
shown below should be included in the box that your VibroTactile System was shipped in.
!
Figure 4.8 LinkBox / TactileBelt box sticker labels.
Step 2: Coordinating the reconfigured LinkBox and TactileBelt boxes on
your Biodex balance device
Once the three VibroTactile System components (LinkBox and two TactileBelt boxes) have been
reconfigured to the new wireless channel—in this case, Channel B—follow the steps outlined in
the previous section (“Configuring Equipment in Facilities with One VibroTactile System”) for
coordinating the boxes.
Figure 4.9 Coordinating the reconfigured LinkBox and TactileBelt boxes.

VIBROTACTILE SYSTEM FOR WINDOWS CE BALANCE DEVICES 15
5. Clinical Applications
The Biodex VibroTactile System provides augmented feedback and cueing during balance
training when the patient is performing either eyes-open or eyes-closed exercises.
Vibrotactile feedback can be used as an indicator of positive reinforcement to affirm positional
control. It can also indicate negative outcomes in instances where positional control is not
achieved.
Therapists should not limit themselves to the set of clinical applications and training exercises
listed below.
Postural Stability Training
If targets are set, the TactileBelt tactors will vibrate when the target is hit. Location of target will
determine which tactor vibrates. (A target at “3:00” on the screen will activate a tactor on the
patient’s right hip, for example.)
When the therapist touches one of the concentric circles, it will become a “boundary” for the
patient to stay within. As the patient moves the cursor over the screen, the tactor
corresponding with boundary crossing will vibrate.
Figure 5.1 Postural Stability Training mode, with targets set (left) and the most inner concentric circle set as a boundary (right).

16 Biodex Medical Systems, Inc. © 2015
Weight Shift Training
In this exercise, tactors will vibrate when either of the two vertical blue target lines is hit.
Figure 5.2 Weight Shift Training mode.
Limits of Stability Training
In Limits of Stability training, the tactors corresponding with the on-screen targets will vibrate
when the patient moves the cursor accordingly.
Figure 5.3 Limits of Stability Training mode.

VIBROTACTILE SYSTEM FOR WINDOWS CE BALANCE DEVICES 17
Percent Weight Bearing Training
In Percent Weight Bearing training, tactors corresponding with patient movement on direction
planes will vibrate when the boundary is exceeded (on-screen graphic will display a blue color)
and turn off when the patient stays within the boundary (graphic will be green.)
Figure 5.4 Percent Weight Bearing Training mode.
Random Control Training
As the patient moves to maintain the cursor within the randomly roaming circle, tactors will
vibrate if the cursor falls outside of circle. The vibration will stop when the patient is able to
move the cursor back inside the circle.
Figure 5.5 Random Control Training mode.

18 Biodex Medical Systems, Inc. © 2015
Maze Control Training
The objective of this training is for a patient to move the cursor through the maze, hitting
targets. If they hit the maze walls (boundaries), tactors will vibrate until the patient brings the
cursor back onto the maze path.
Figure 5.6 Maze Control Training mode.
Vibrotactile Designation on Training Reports
When vibrotactile feedback is being employed during a training session, this will be denoted at
the top of the training report page (“VT Belt”).
Figure 5.7 Sample of a Postural Stability Training mode report, with denotation that the VibroTactile System was activated
during the training.

VIBROTACTILE SYSTEM FOR WINDOWS CE BALANCE DEVICES 19
6. Supporting Research and Suggested
Reading
Elliott, Linda R., Michael D. Coovert, Matthew Prewett, Ashley G. Walvord, Kristin Saboe, and
Ryan Johnson. 2009. A review and meta analysis of vibrotactile and visual information displays.
Aberdeen Proving Ground, MD: U.S. Army Research Laboratory.
Wall C 3rd. Application of vibrotactile feedback of body motion to improve rehabilitation in
individuals with imbalance. J Neurol Phys Ther. 2010 Jun;34(2):98-104.
K.H. Sienko, M.D. Balkwill, L.I.E. Oddsson and C. Wall. Effects of multi-directional vibrotactile
feedback on vestibular-deficient postural performance during continuous multi-directional
support surface perturbations. Journal of Vestibular Research 18 (2008) 273–285. IOS Press.
Weber, B.; Schatzle, S.; Hulin, T.; Preusche, C.; Deml, B. Evaluation of a vibrotactile feedback
device for spatial guidance. World Haptics Conference (WHC), 2011 IEEE, vol., no., pp.349,354,
21-24 June 2011.
Lee PY, Gadareh K, Naushahi MJ, Gresty M, Bronstein AM. Protective stepping response in
Parkinsonian patients and the effect of vibrotactile feedback. Mov Disord. 2013 Apr;28(4):482-
9. doi: 10.1002/mds.25227. Epub 2012 Oct 31.
Conrad Wall III, PhD, Diane M. Wrisley, PhD, PT, NCS, and Kennyn D. Statler, PhD. Vibrotactile
Tilt Feedback Improves Dynamic Gait Index: a Fall Risk Indicator in Older Adults. Gait Posture.
2009 July ; 30(1): 16–21. doi:10.1016/j.gaitpost.2009.02.019.
Karen L. Atkins, PT, PhD. Vibrotactile Rehabilitation of Adults with Vestibular Dysfunction.
BalanceSense LLC. Whitepaper. June 2014.
Febo Cincotti, Laura Kauhanen, Fabio Aloise, Tapio Palomaki, Nicholas Caporusso,
Pasi Jylanki, Donatella Mattia, Fabio Babiloni, Gerolf Vanacker, Marnix Nuttin,
Maria Grazia Marciani, and Jose del R.Millan. Vibrotactile Feedback for Brain-Computer Interface
Operation. Laboratory of Neuroelectrical Imaging and Brain Computer Interface, Fondazione
Santa Lucia IRCCS, Via Ardeatina 306, 00179 Roma, Italy. Computational Intelligence and
Neuroscience 02/2007; 2007:48937. DOI: 10.1155/2007/48937. Source: PubMed.

20 Biodex Medical Systems, Inc. © 2015
APPENDIX A - SPECIFICATIONS
Belt Dimensions
Small/Medium:28"-36” (71-91 cm)
Large/Extra Large:36"-48” (91-122 cm)
LinkBox Transmitter
Voltage:5v DC
Current: 50 mA
Auxiliary Ports: RS-232, USB
TactileBelt Receiver Box
Voltage:5v DC
Current: 260 mA (when charging)
Auxiliary Ports: USB (wired); LR-WPAN (wireless)
Total Shipping Weight: 5 lb (2.3 kg)
Warranty: One year - parts and labor
For devices running on Windows CE operating systems only.
Field upgrades available.