GripAble Pro User manual

GripAble. User Manual Pro
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PRO
USER
MANUAL

GripAble. User Manual Pro
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GripAble is an assessment and treatment instrument for people with upper
limb needs. It is intended for use by people with a wide variety of clinical
presentations and aims to:
• provide assessment of grip and release
• provide assessment of wrist and forearm movements
• optimise dose and intensity of upper limb training
• provide real time feedback during use
• track and monitor all training
GripAble is an adjunct to other instruments and rehabilitation modalities and
can be used in many different clinical and community settings. The therapist
will need to use clinical reasoning for each user and apply the instrument
appropriately. The therapist is responsible for the assessments and treatment
prescription selected.
For home use, it is recommended that the user consults an occupational
therapist or physiotherapist, who can assess the suitability of GripAble as part
of their home rehabilitation programme, set goals and advise on the appropriate
activities for the individual.
THERAPEUTIC
GUIDE TO THE
DEVICE

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• Assessment
•Training
Updating software
Positioning during use
Strapping
Locked and unlocked mode
GripAble rehabilitation goal setting and tracking
• Repetition calculations
• Time calculations
• Tracking and monitoring training
• Cleaning the device
Main menu – app navigation
Initial set up instructions for user
New user set up
GripAble activities
Grip test menu
Extra help
FAQs and troubleshooting
CONTENTS
Therapeutic guide to the device
Contents
What does GripAble do?

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GripAble enables the therapist to set up users (patients/clients) with a unique
log in, assess their ability in grip/release and movement to set a baseline,
set treatment goals and review progress. GripAble is also able to assess
various aspects of grip strength in a separate part of the App. See later in this
document for more details on how to set up a new user, use the grip tests and
other functionalities.
ASSESSMENT
GripAble assesses:
• Grip strength
• Release of grip
• Wrist extension and flexion
• Wrist radial and ulnar deviation
• Pronation and supination
The assessment of strength is sensitive to 0.1 Kg and is therefore able to detect
flickers of movement. The minimum and maximum strengths recordable are 0.3
Kg to 90 Kg.
Assessment of ability to release is valuable for neurological disorders. GripAble gives
an objective assessment of the ability to actively release, even at low strength levels.
This is represented as a percentage of total release.
TRAINING
The therapist can use GripAble to address training goals as appropriate
including to:
• gain control of grip and release
• strengthen forearm and hand muscles
• improve concentration
• improve coordination
• improve intentional release of grip
• strengthen pinch grips
• encourage movements of the wrist and forearm
• encourage grip and pinch strength endurance
• provide motivating and engaging activities
GripAble is developing fast and therefore software upgrades
will be regularly applied to the GripAble App. Awareness
of the updates and training will be provided for therapists
both online on the GripAble website and via newsletters.
Should you need any further help, please contact the
customer team.
WHAT DOES
GRIPABLE DO?

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U PDATI N G
SO F T WA RE
Occasionally your tablet will tell you it needs an update. Follow the
instructions to update at the time or schedule an update at a later time.
The GripAble software will also be updated regularly providing further
functionality. When you click into the GripAble app, the following screen will
appear:
Now when you enter the activity carousel, all those activities which need to
be installed or updated will be indicated. Click on each one and follow the
instructions as follows:
Follow the instructions. By
pressing “OK” you will be taken
automatically to the Play Store.
Install activity.
Click “Update”
When the update has completed:
Click “Open”
Activity being updated. If you already have the
activity but there is an update you will see
“update required”. The update will need to be
applied before play can commence.

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For all use, the recommended
user position is seated in
an upright posture with the
shoulder adducted, elbow at
90 degrees, forearm
horizontal to the ground and
unsupported as shown here.
In some clinical situations this will not be possible. The therapist will need to
adapt to the physical capacity of the user. For example, in the presence of
altered tone, the arm may need to be supported and/or resting in the lap. For
users with specific movement disorders, GripAble may need to be placed on
a table. It is for the therapist to design and advise advantageous treatment
positions. Place the black wrist lanyard around the wrist to prevent accidental
dropping of GripAble.
Grip and release activities are designed with
the GripAble placed in the hand with the
forearm in mid pro/supination (with the thumb
uppermost).
Wrist flexion/extension activities are designed
with the GripAble placed in the hand with the
forearm in full pronation (palm down). Where
possible, the starting position is in neutral.
Wrist radial/ulnar deviation activities are
designed with the GripAble placed in the hand
with the forearm in mid pro/supination (thumb
uppermost). Where possible, the starting
position is in neutral.
Supination/pronation activities are designed
to have the GripAble in the hand with the
forearm starting in mid pro/supination (thumb
uppermost) and move into further pronation
and supination range from this position.
POSITIONING
DURING USE

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The straps have a small element of stretch in them to aid fixation but it is
important that the straps are not fixed too tight. Consider the route of the
superficial branch of the radial nerve and be sure not to compress in this area.
Wherever possible, use the hooks that are on the main body of GripAble rather
than the two on the moveable fingerplate. If the latter hooks are needed, GripAble
should be used in the isometric mode (see below).
STRAPPING
GripAble is supplied with one black lanyard strap which
fixes to the base of the device. This should be placed around
the wrist during use to prevent accidental dropping.
GripAble is also supplied with several white silicone straps.
These are intended for use with users who need extra help to
retain a hold of GripAble. They have multiple holes along their
length and three hooks / attachment points each end of
GripAble to enable the therapist to design the best position
for the straps for each individual user. Some examples are
shown below:

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UNLOCK MODE:
The fingerplate moves as GripAble is squeezed and provides a small amount of
resistance.
LOCK MODE:
The fingerplate does not move when GripAble is squeezed. Locked mode is to
allow GripAble to be used isometrically (similar to a hand dynamometer).
• To lock: Squeeze GripAble and press the locking button completely in.
• To unlock: Squeeze GripAble and press the locking button completely in,
let go, and the button will pop back out to be flush with the top of the device.
Should you be in locked mode at a time when it is not usually used, the GripAble
software will give you a warning that it is in locked mode.
LOCKED AND
UNLOCKED MODE

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The therapist can select grip and release repetitions and/or wrist and forearm
movements and set daily targets for each. The target can be number of
repetitions of the desired action or number of minutes spent training a specific action.
After each level on each activity, a summary of the repetitions performed, and
minutes trained that day will be displayed with the number that were added
during that level of that activity as a “+”. See below.
On the Level menu you will see one, two or three stars. This represents how well
the user has performed at the activity.
Advise your user which activities are the best to meet their goals.
Grip/release added during the
level just completed
Daily repetitions of grip/release
Minutes added during the level just
completed
Daily minutes of grip/release
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GRIPABLE
REHABILITATION
GOAL SETTING
AND TRACKING
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REPETITION CALCULATIONS:
TIME CALCULATIONS:
TRACKING AND MONITORING TRAINING:
CLEANING THE DEVICE:
Grip and release:
All squeezes and releases performed during the day will be recorded by the
software and a cumulative score achieved. Each squeeze and release sequence is
one repetition. This can be benchmarked against a daily goal set by the therapist.
Wrist flexion/extension:
Each cycle of movement from neutral to wrist flexion through to wrist extension and
back to neutral (or vice versa) will count as one. Each full cycle performed during
the day will be recorded by the software and a cumulative score achieved. This can
be benchmarked against a daily goal set by the therapist for movement of the wrist
in this plane.
Wrist radial/ulnar deviation:
Each cycle of movement from neutral to wrist radial deviation through to wrist
ulnar deviation and back to neutral (or vice versa) will count as one. Each full cycle
performed during the day will be recorded by the software and a cumulative score
achieved. This can be benchmarked against a daily goal set by the therapist for
movement of the wrist in this plane.
Pronation/supination:
Each cycle of movement from neutral to pronation through to supination and back
to neutral (vice versa) will count as one. Each full revolution performed during the
day will be recorded by the software and a cumulative score achieved. This can be
benchmarked against a daily goal set by the therapist for movement of the wrist
in this plane. Neutral (mid pro- supination) is the starting position. Neutral is the
starting position.
The GripAble software will record all time spent on each specific movement each
day in minutes. Total time spent will be shown between each level of each activity.
Detail can be tracked in “Achievements” (see below).
Considerable data is available for review of training by looking under
“Achievements” on the menu bar as listed below.
Any alcohol-based wipe can be used to clean the device. The antiseptic products
in the wipe will not affect the device. Alternatively, use soap on a damp piece
of dressing gauze / J-cloth or equivalent. The device is splash proof but not
waterproof. Do not immerse in water.

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CALIBRATING THE DEVICE:
You can calibrate your device whenever you wish. This ensures it remains accurate
and stable. Watch this 20 second video to find out more.
See:
•Mutaib et al (2022) Modernising grip dynamometry: Inter-instrument reliability
between
GripAble and Jamar.BMC Musculoskeletal Disorders 23:1,23(1), 1-10
•Mace et al (2022) GripAble: an accurate, sensitive and robust digital device for
measuring grip strength. J Rehabil Assist Technol Eng.
PRECAUTIONS:
If you have epilepsy, vestibular or visual changes please discuss with a clinician, prior
to use, to assess your suitability to use any of the activities as the activity might initiate
symptoms. The only 3D moving activity is Plume.

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Click on the three-line button top left corner of the app
Activities
To access the activities carousel. See separate appendix for a
summary of each activity.
Achievements
To review daily progress. Data is available on eight screens:
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Daily overview minutes trained, repetitions completed and total work
accumulated.
Minutes spent on each activity.
Minutes trained today and comparison to daily goal.
a. Goals can be set and reset here.
Repetitions trained today and comparison to daily goal.
a. Goals can be set and reset here.
MAIN MENU –
APP NAVIGATION

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Grip and Release trained today and comparison to daily goal.
a. History of grip and release activities over 7, 30, 60 and 90 days
can be tracked here
b. History can be tracked with and without the goal line included.
Pronation / Supination trained today and comparison to daily goal.
a. History of pronation / supination activities over 7, 30,
60 and 90 days can be tracked here
b. History can be tracked with and without the goal line included.
Wrist Radial/Ulnar Deviation trained today and comparison to daily
goal.
a. History of wrist radial / ulnar deviation activities over 7, 30, 60 and
90 days can be tracked here
b. History can be tracked with and without the goal line included.
Wrist Extension/Flexion trained today and comparison to daily goal.
a. History of wrist extension / flexion activities over 7, 30, 60 and 90
days can be tracked here
b. History can be tracked with and without the goal line included
MAIN MENU –
APP NAVIGATION
Assessment
For review and reassessment of grip strength and release and all movements
used as calibration for the activities.
On this screen you can also change the Reminder Period.
Reports
Select between two reports:

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Support
Activity Purpose: Quick guide to the purpose of our current activities
GripAble Device: This leads to a menu
a. Instructions – diagram showing all the parts of the device
b. Pair New GripAble
c. Unpair GripAble
Daily Activity ReportGripAble Device: This leads to a menu
a. Select the date you wish to see (those when training occurred will be
highlighted)
b. Report will include results from calibration assessments, overview of
training, minutes and repetitions for each motion and which activities
were used. If you have done the Single Maximum Grip Test on that
day, this result will also carry through.
c. This report can be emailed to any account you choose
Grip Tests Report
a. Select the date you wish to see (those when assessment occurred
will be highlighted)
b. Results from all the grip tests completed on that day will be listed
including all the parameters you chose for the test and any associated
results and graphs
c. This report can be emailed to any account you choose
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Grip Tests
See below for full explanation of Grip Tests
MAIN MENU –
APP NAVIGATION

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Support
FAQ s
Your Profile: a summary of the users’ personal settings
Terms & Conditions
Contact Us
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Log Out
Log out to enable others to log in and register new users
MAIN MENU –
APP NAVIGATION
SWITCHING GRIPABLE OFF
To preserve the battery it is vital that when the activity session has
been completed, the app is swiped away on the tablet otherwise the
app is constantly searching for the device and the device battery will
drain quickly. See online video if further instructions are needed.

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INITIAL SET UP
INSTRUCTIONS
FOR USER
Sit the user in an upright position - ideally in a comfortable
and supportive chair.
Place the tablet on a tabletop or on a tablet stand in front of the user. It is
important (for Bluetooth functionality) for the tablet to be facing the user.
Turn on the Tablet. Click into the GripAble app on the screen.
Ensure GripAble is in the unlocked isotonic mode
(where the front fingerplate moves as GripAble is
squeezed).
Turn on GripAble:
GripAble is turned on by squeezing the fingerplate on the device for
three seconds. The device will vibrate and the blue light will come
on when you have correctly turned it on.
Make sure the device and tablet are sufficiently charged.
GripAble shows its connective status via the blue LED light at the
top end of the device. If this light is off, the device is asleep. When
flashing blue, it is in pairing mode to allow you to connect the
GripAble App. When solid blue, the connection is established.
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• Off: Device is asleep
• Blue (flashing): Pairing mode, device is ready to connect
• Blue (solid): Connection established
GripAble shows its battery status via the LED light at the base of
the device. This light will display when in pairing mode.
Connection indicator
• Red: Battery is critically low
• Yellow: Battery is low
• Green: Battery is okay
Battery indicator (Charging LED)
• Orange: Battery is charging
• Green: Battery is fully charged, remove charging cable

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If it is the first time use of GripAble for this patient/user, set them up as
a new user by navigating to Add User. Follow the process described
below to set their baseline measurements for their activities.
Only use this profile for the patient’s affected side (hand/arm). If you
wish to swap hands or if a relative/friend/carer wishes to use GripAble,
please use the DEMO USER profiles. Please select DEMO USER right
or DEMO USER left.
If you have a patient needing bilateral training, currently they will need
to set up two separate profiles. This will require a single use of a
second mobile phone number (or use the skip option).
The mobile phone number is only used at the initial set up and and if
you want to log in on a new tablet as part of a two factor
authenticafication method. If setting up dual profiles, ensure you add
“left” and “right” for ease of identification and ensure the patient logs into
the correct account for the hand to be trained.
Returning Users: select the correct profile by navigating through the
carousel. The user will need to enter their PIN number.
Plug in GripAble and the tablet to charge when charging is required.
Both the tablet and GripAble device are supplied with power cables
which connect into a USB plug. The GripAble device charger can be
managed with one hand using the magnetic connector.
When training has finished remember to shut down the GripAble App.
Swipe up on the bottom of your tablet screen (on the icon) and swipe
the GripAble App closed. This will automatically disconnect the
GripAble device which will go into sleep mode after one minute and
deep sleep after ten minutes.
When you wish to change the movement being trained, click “Change
movement” in the bottom right of the activities page.
Pick a movement (grip/release, wrist extension/flexion, pronation/
supination or wrist radial/ulnar deviation) to train. Only the activities with
this movement as the primary movement will be displayed and this
movement will be remembered for the next training session. If a
movement has not been selected (first time), when you enter the activity
carousel, all activities will be displayed. Pick an activity from the carousel
and begin training. Use clinical reasoning to select therapeutic activities for
each user.

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NEW USER
SET UP
Enter the mobile phone number of the user
(therapists - never use your own number).
Use the correct country code (e.g. +44).
Click “Next”.
If the user wishes to review the terms of
use, they can read them here. Entering the
mobile number ensures a unique identifier so
the data for each user is never mistaken for
another.
This stage can be skipped but it is not
recommended.
If your user requires training for their right and
left hands, they will need to build themselves
as two user profiles and use a second mobile
phone number at this stage (or use the mobile
number of a friend or relative).
Select “Add User” from the carousel
When the mobile phone number is used,
an SMS (text) six digit code will be sent to
the mobile phone for verification. Enter this
six digit code here.
GripAble will confirm to you that this
number code is correct.
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Enter a unique “username”. This needs to
be easily remembered but does not need
to be your actual name. Such as “Super
Sarah” or “Fred A Left”.
If you are training both left and right hands
or grip and pinch, set up two user profiles
with clear indication in the name as to
which is which.
Or not…
Select a user image from the origami
emojis
To keep your account safe, use a unique six
number pin that you can remember for when
you log into your account.
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NEW USER
SET UP

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Select all the diagnostic groups that apply.
There are three pages of conditions to
scroll through, namely:
• neurological
• musculo-skeletal
• miscellaneous
There is an “other” option on each page
where you can enter other diagnoses.
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NEW USER
SET UP
Add your personal information:
• Select gender
• Input date of birth
• Select the hand to be trained
• Select your dominant hand
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