Netti Dynamic System User manual

UM0116 UK 2021-03
III HD
Patent EP 2836184
DYNAMIC SYSTEM
This product conforms to
2017/745/EU for medical products.
User Manual and
mounting description

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CONTENTS
1.INTRODUCTION 4
ABOUT THIS MANUAL 4
INTENDED USE 6
IMPORTANT BENEFITS 6
NETTI DYNAMIC SYSTEM 7
NETTI DYNAMIC SYSTEM 8
EXPLODED VIEW OF NETTI DYNAMIC SYSTEM 9
2. ADJUSTING
THE WHEELCHAIR TO THE USER 10
INITIAL ADJUSTMENTS 10
SEAT DEPTH ADJUSTMENTS IN THE BACK: 11
SEAT DEPTH ADJUSTMENTS IN THE FRONT: 11
SEAT ANGLE ADJUSTMENT: 12
SEAT PLATE ADJUSTMENT: 12
SEAT PLATE LOCK 12
ASSESSMENT AND CHOICE OF NETTI DYNAMIC
BACK SUPPORT GAS CYLINDER 13
OPTION 1: NETTI DYNAMIC 15° MOVEMENT 13
OPTION 2:NETTI DYNAMIC FREE MOVEMENT 14
OVERVIEW OF AVAILABLE DYNAMIC RECLINE CYLINDERS AND SEAT WIDTHS 16
TECHNICAL SPECIFICATION AND OPTIONS OF NETTI DYNAMIC BACK SUPPORT GAS CYLINDERS 16
CHAIR BACK HEIGHT 18
NETTI DYNAMIC HEAD SUPPORT 18
ARM SUPPORT POSITION 19
MOUNTING, POSITIONING AND ADJUSTMENTS OF PELVIC SUPPORTS AND SUPPORTIVE HARNESSES
19
ANKLE HUGGERS AND SHOE SHELLS 20
LEG SUPPORT HEIGHT AND ANGLE 20
TABLE 20

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3. EVERYDAY USE OF THE NETTI DYNAMIC SYSTEM 21
TRANSFER TO / FROM THE CHAIR 21
USING A PATIENT HOIST 21
ATTENDANT USE 22
PUSH BOWS AND PUSH HANDLES 22
ANTITIPS 22
BRAKES 22
ARM SUPPORT 23
LEG SUPPORTS 23
FOOT BOARD LOCK 23
THE LEG SUPPORT ANGLE 24
HARNESSES 24
OPERATING TILT HANDLE: TILTING THE SEATING UNIT 26
OPERATING RECLINE HANDLE: RECLINING THE CHAIR BACK 27
SAFETY GUIDELINES WHEN LEAVING A USER IN THE WHEELCHAIR 28
WHEELCHAIR USED AS SEAT IN A CAR 28
LIFTING THE WHEELCHAIR 28
DRIVING A WHEELCHAIR WITH NETTI DYNAMIC SYSTEM 28
4. MOUNTING DESCRIPTION 29
CHANGING THE BACK GAS CYLINDER 29
5. NETTI DYNAMIC COMPONENTS AND ACCESSORIES 32
6. TRANSPORT 35
7. MAINTENANCE 35
8. TROUBLESHOOTING 35
9. TESTS & WARRANTY 36
10. APPENDIX 37

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Next page you can see a matrix based on dierent
diagnosis and suggestions of Netti Dynamic System
parts that could be used. We emphasize that this is
an overview of possible applications and possible
product options / suggestions of Netti Dynamic
System or components. The nal solutions should
be based on the ndings of an individual seating
assessment, conducted by a trained professional.
ABOUT THIS MANUAL
In order to avoid damages while using the Netti
Dynamic System wheelchair, please study this
manual carefully before starting to use the chair. A
wheelchair with dynamic system must be adjusted
and operated dierent than static wheelchairs.
Please also pay careful attendtion to the user manual
for the wheelchair where the dynamic system has
been mounted.
The following symbols are used to point out
important points:
Symbol of forbidden actions.
No warranty can be claimed whenever
these actions are implemented.
Symbol of warning.
Whenever this symbol is used,
caution has to be taken.
Symbol for important information.
Symbol for useful tips.
Symbol for tools.
1. INTRODUCTION
The Netti Dynamic System Concept:
What is Netti Dynamic Seating?
Netti Dynamic System is a tilt and recline wheelchair
which allows controlled Open Kinetic Chain (OK-C)
movements of the user. Static comfort wheelchairs
can be accommodated to support the user’s distal
segments. The controlled OK-C movement has an
extra impact: The distal segments can move, with
a moderate resistance. OK-C helps to gain control
of the proximal segments, especially when the user
cannot inhibit muscle movements due to their
medical condition.
Netti Dynamic System is a modular system that can
be customized and adjusted according to the user’s
need.
Typically Netti Dynamic System or its components
may be used for wheelchair users with involuntary
movements.
EXAMPLES OF INVOLUNTARY MOVEMENTS ARE:
• Dystonia – involuntary, sustained or intermittent
muscle contractions that can cause twisting and
repetitive movements, abnormal posture or both.
Muscle tone varies from normal or hypotonia to
hypertonia.
• Athetosis – slow, involuntary writhing movement.
• Chorea – brief, irregular jerking movements.
• Tremor – this is a rhythmic movement of part of
the body.
• Hemiballism – these are wild inging / throwing
movements of one arm or leg, usually occurring as
a result of a cerebrovascular event.
• Clonus – rapid muscle jerks that are frequently
repetitive.
Before using Netti Dynamic System (NDS)
or any of its components, a seating
assessment should be carried out
by a trained professional.

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WHAT TYPE OF INVOLUNTARY MOVEMENTS CAN YOU EXPECT WITH THE FOLLOWING DIAGNOSES?
CP ALS CVA Intel
Disorder Parkinson’s MS TBI SCI Huntington
Dystonia
Athetosis
Chorea
Tremor
Hemiballism
Clonus
Stereotypic
Movement
Disorder
WHICH TYPE OF NETTI DYNAMIC SYSTEM CONFIGURATION COULD BE INDICATED?
Before any product selection a seating evaluation should be conducted by a trained professional.
1. If your client exhibits involuntary movements of the lower extremities only, the Netti Dynamic leg
support system only could be considered, this will be a dynamic component added to a Netti III HD,
Netti 4U CED/S or Netti 4U BASE.
2. If your client exhibits involuntary movements of the trunk only, the Netti Dynamic recline system only
could be considered, this will be a dynamic component added to a Netti III HD, Netti 4U CED/S or Netti
4U BASE..
3. If your client exhibits involuntary movements of the head only, the Netti Dynamic head support system
only could be considered, this will be a dynamic component added to a Netti III HD, Netti 4U CED/S or
Netti 4U BASE.
4. If your client exhibits involuntary movements of the head and trunk only, the Netti Dynamic recline
system in combination with the Netti Dynamic head support could be considered, these will be two
dynamic components added to a Netti III HD, Netti 4U CED/S or Netti 4U BASE.
5. If your client exhibits involuntary movements of the head and trunk and lower extremities, the full Netti
Dynamic System are to be considered, these dynamic components will be added to a Netti III HD, Netti
4U CED/S or Netti 4U BASE.
Denitions of the above-mentioned movement patterns are listed on previous page.
Denitions of the above mentioned diagnosis are listed in 10. Appendix.

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INTENDED USE
Netti Dynamic System is an advanced mobility
aid for users aected by dystonia. It is for users
with extensive movement patterns resulting
in strong spasms and contractions of the
user’s musculoskeletal apparatus causing joint
dislocations, involuntary movements, sliding, loss
of function and also challenging the strength of the
wheelchair.
The patented Netti Dynamic System accommodates
the user’s extension movements letting the
wheelchair work in synergy with the user’s
movements. When accommodating the spastic
extensions pattern, muscle tone and frequency of
spasms could be reduced. The wheelchair is dynamic
and will follow the user’s movements of both upper
and lower body.
NETTI DYNAMIC SYSTEM
allows for Open Kinetic Chain movements (OK-C):
• Leg movements
• Hip movements
• Back movements
• Head movements
• Foot movements
IMPORTANT BENEFITS
• The wheelchair adapts to the movements
of the user.
• The user will have less discomfort during spasm
as the wheelchair supports the movement.
• After a spasm the user returns to the original
sitting position securing a good position and
pressure distribution.
• It prevents unintentional change of position.
• It prevents the user from sliding forward in the
chair and thereby getting a bad sitting position
and inadequate distribution of pressure.
• Extends the lifetime of the wheelchair.
CONTRA INDICATIONS
Limitations of the Netti Dynamic system
• when allowing movements leads to destructive
postures.
• when allowing movements increases extension
tone and spasms.
• when the client may not be able to return to a
neutral position.

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Netti Dynamic III HD with Dynamic System with a
pelvic stabilizer and ankle huggers
Netti Dynamic CED
NETTI DYNAMIC SYSTEM
is a modular system that can be customized and
adjusted according to the user’s need. The Netti
Dynamic System seat and back unit can be ordered
with these chair models:
• Netti Dynamic III and HD (2 models)
• Netti Dynamic 4U CED (S) (2 models)
• Netti Dynamic 4U BASE
USER REQUIREMENTS
* If you choose a Netti III model, we recommend the
reinforced frames Netti III HD due to hard use and
uncontrollable muscle movements of the user. In
order to get the right model, width, heights etc.
a seating evaluation should be performed by a
trained clinician.
Netti Dynamic Components:
The Netti Dynamic head support and leg supports
can be mounted on a wide range of our static
comfort wheelchairs:
Netti III models, Netti 4U CED/S and BASE models,.
HOW TO USE THIS MANUAL
This manual focuses on the adjustments and use
of the Netti Dynamic System seat, back and head
support.
This manual is to be used together with the
user manual of the wheelchair.
The User manual UM0115 for Netti Dynamic
leg supports contains all necessary information
about mounting, adjustments and use of the Netti
Dynamic Leg supports “Dual”.
The user manuals for each relevant Netti static
wheelchairs models contains all necessary
information about mounting, adjustments and use
of the static wheelchair parts and basis frame for the
Netti Dynamic System, and is delivered as a part of
the complete product.

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NETTI DYNAMIC SYSTEM
The dynamic elements moved into max extension applied to a Netti III wheelchair.
Headrest pushed backwards
Back in max recline
Seat lifted
Leg supports lifted
and extended
Tilted foot plate
Frame extender

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EXPLODED VIEW OF NETTI DYNAMIC SYSTEM
Netti Dynamic head support
Netti Dynamic seat plate
Netti Dynamic System
leg support
Long anti-tippers
Netti Dynamic back gas spring
Frame extender
Armrest with nger protection

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2. ADJUSTING
THE WHEELCHAIR
TO THE USER
INITIAL ADJUSTMENTS
Start with normal relaxed seating position.
SEAT ADJUSTMENTS  BALANCING THE CHAIR
It is vital to adjust the seat correct.
Adjustments to the seat change the centre of gravity
which eects the balance of the wheelchair.
Proper adjusted seat provide stability and the ability
to manoeuvre the wheelchair, even during a max
extension of the dynamic parts of the wheelchair.
• Correct seat depth depends on the user’s thigh
length and is measured while seating – see the
red horizontal arrow on the illustration.
• Seat depth can be adjusted on the back of the
chair by moving the back hinge brackets followed
by adjusting the back cylinder head.
• Seat depth can be adjusted in the front by
adjusting the extension pieces where the leg
supports are mounted.
• The relationship between seat angle and backrest
angle should be constant when the tilt function is
used to create variation for the user.
• Seat height is to be seen together with the leg
supports.
• Leg supports need to be adjusted to
accommodate the seat height.
Please note: the Netti Dynamic System leg
support adjustments are described in detail
in a separate mounting description.
Please, see the illustrations on next page
regarding seat depth adjustments.

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SEAT DEPTH ADJUSTMENTS
IN THE BACK:
When the chair is equipped with a main wheel larger
than 12” or 16”, remove the main wheels rst.
Back hinge adjustment
• Remove the screws on each side which are
holding the back hinge.
• Pull the bracket on each side back or push it
forward to desired position before the screws are
xed again.
Recline cylinder head position:
• Remove the bolt holding the
recline cylinder head.
• Reposition it in the corresponding number hole
as the previously adjusted chair back bracket.
• This will also have inuence on the chair back
angle.
By choosing another hole you can change
the angle of the back support which means
that the back angle or hip angle will be more
open or more closed.
See separate table in the chapter:
“Technical specication and options of Netti
Dynamic back support gas cylinders”and
separate mounting description MD0120UK.
SEAT DEPTH ADJUSTMENTS
IN THE FRONT:
The extension pieces are adjusted
by removing the screws holding
them and pulling the extension
pieces out to desired position.
The aim is to have the centre of the
users knee joint aligned with the
center of the leg support rotation
centre – while the user at the same
time is having good back support
of his lower back – also when the
leg support angle is changed.

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SEAT ANGLE ADJUSTMENT:
Can be adjusted at any time by the use of the tilt
handles.
SEAT PLATE ADJUSTMENT:
The Netti Dynamic System seat plate is
pivoted in the front of the seat. This allows the
seat to rise in the rear when doing a hip extension.
The pelvic stabilizer which is xed to the seat
plate, is necessary to make this happen. The pelvis
stabilizer must be used together with the dynamic
seat plate.
The pelvic stabilizer must be rmly
tightened to minimize the risk ofthe user
sliding forwards.
To prevent the seat plate to pivot too high, there
are seat plate limiters – belts – between the seat
plate and the chair frame. The seat plate limiters
can be adjusted to allow for max seat
pivoting. Adjustment of the seat
plate limiter is done by loosening
the screw holding the seat plate
limiter belt under the seat and
sliding it back or forward to nd the
desired movement of the seat plate.
SEAT PLATE LOCK
In some cases it may be necessary for safety reasons
to lock the movement of the seat. This is when the
wheelchair is used as a seat in a car or when driving
the chair on rough surface where a sudden spastic
extension may cause the chair and user to become
unstable.
The seat plate lock is easy to use; remove the QR-
Axcle by pressing the head to release it and move
it from its upper position and push it into the lower
position.
Remember to unlock the seat plate when
you are back in smooth areas, allowing the
Netti Dynamic System to work.

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The chair back position is dened by the chair back
cylinder. There are two dierent type of cylinder
available for the Netti Dynamic System:
OPTION 1:
NETTI DYNAMIC 15° MOVEMENT
BACK SUPPORT CYLINDER 15° is never xed /
locked but allows for a 15° ex at any position where
the chair back has been reclined to. The cylinder
is suitable for users with open kinetic chain (OKC)
movements with max extension less than 15°. If 15°
closes the kinetic chain movement, more forces will
have impact on the leg support.
The leg support might break if it is not
correct adjusted meaning that the user leg
extension reaches the end of the leg support
dynamic area, or if the user has slid forward.
Netti Dynamic System wheelchair with Netti
Dynamic 15° movement back support
cylinder is not approved for being used as a
seat in a vehicle.
Netti Dynamic 15° movement back support
cylinders are available in 80, 120 and 160 N
force.
The recline function is controlled by the
recline handle on the bar behind the back
support. This cylinder is NOT lockable.
ASSESSMENT AND CHOICE OF
NETTI DYNAMIC BACK SUPPORT
GAS CYLINDER

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NETTI DYNAMIC FREE MOVEMENT BACK
SUPPORT CYLINDER  ACTIVATED
The dynamic back solution of Netti Dynamic System
is activated by pulling the recline handle.
The back support cylinder should be assessed.
It can be replaced by another cylinder (more /
less Newton) if needed; either because of new or
changed user needs, or if the weight of the user has
changed.
Please contact your local dealer for advice on which
new cylinder to choose. At the end of this manual
the change of gas cylinder is described.
ASSESSMENT OF DYNAMIC BACK SUPPORT GAS
CYLINDER FORCES, SUITING USER STRENGTH
AND MOVEMENT PATTERNS
An assessment of the user is needed to nd the right
power of the cylinder.
Correct solution:
The back cylinder gives full support on a full, open
kinetic chain movement during the user’s extension
pattern. When the user starts to relax, the cylinder
move the back support to its original position.
OPTION 2:
NETTI DYNAMIC FREE MOVEMENT
BACK SUPPORT CYLINDER allows the back support
to move backwards to full recline, giving full support
during extension movement. When the user starts
to relax the cylinder move the back support to its
original position.
The strength of the full free cylinder has to
be tted individually according to body
weight. A cylinder that is too strong will not
allow the back support to move. A cylinder
that is too weak will not be strong enough to
lift the back support to its original position.
Standard cylinder forces are: 600, 800, 1000
and 1200 N.
NETTI DYNAMIC FREE MOVEMENT BACK
SUPPORT CYLINDER  LOCKING
The free cylinder is lockable in any reclined angle
– when the recline handle on the back is in neutral
position. This may be necessary / required, when
the chair is used as seat in a car or driven on rough
ground where a sudden spastic extension may make
the chair unstable. Or when the user needs to lay
back for a rest.
If you recline the chair back on a wheelchair
with free cylinder, locking it in reclined
position, it is only the Netti Dynamic Leg
supports, seat plate and head support that
will respond to spastic movements.
If you lock the free cylinder, it is important
that the user is correct positioned and not
sliding forward, to prevent skin damage and
damage on the leg support.

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HOW TO ASSESS AND CHOOSE THE RIGHT POWER
OF THE DYNAMIC BACK SUPPORT CYLINDER?
Main factors to be considered by a trained
professional:
• The user’s weight, width and height
• The character and strength, extent of the
movements and movement patterns.
• Goals and improvement regarding the user’s
“Activity daily life”and health condition.
The user’s movement pattern and muscle
tone may also change over time. It is relevant
to assess and monitor the tting of the
wheelchair and the power of gas cylinders
according to the development of the user’s
movement pattern and muscle tone over
time. If the gas spring is too strong, the user
will not be able to make an extension. It will
be a“closed kinetic chain”, or a static position
for the user.
If the gas spring is too weak, the user will not
be lifted back to his / hers original seating
position after an extension of the upper
body part.

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OVERVIEW OF AVAILABLE DYNAMIC RECLINE CYLINDERS AND SEAT WIDTHS
The user’s width is an indicator to assess regarding the choice of minimum gas spring force.
The user’s weight is an indicator to assess regarding the choice of minimum gas spring force:
FREE MOVEMENT
BACK SUPPORT
CYLINDER MODELS 
LOCKABLE
USER
WEIGHT SEAT WIDTHS
Newton (N) Minimum
kg 250 mm 300 mm 350 mm 380 mm 400 mm 430 mm 450 mm 500 mm
200 N 20 kg
300 N 30 kg
400 N 40 kg
500 N 50 kg
600 N 60 kg
700 N 70 kg
800 N 80 kg
900 N 90 kg
1000 N 100 kg
1100 N 110 kg
1200 N 120 kg
1300 N 130 kg
15° FREE CYLINDER
80 N –15° back
support cylinder 82408 KIT
120 N –15° cylinder 82409 KIT
160 N –15° cylinder 82410 KIT
TECHNICAL SPECIFICATION AND OPTIONS OF NETTI DYNAMIC BACK SUPPORT
GAS CYLINDERS
FREE MOVEMENT BACK SUPPORT CYLINDER:
Combination of seat depths, front bracket hole and cylinder head – short and long.
The recline angle range is approximately 40° and valid for all wheelchair-models with
free movement cylinder locking.
Netti Dynamic recline solutions have a starting angle of app. 90°.
Please note: The separate Mounting Description MD0120UK NDS-Free solution – Back angle Matrix for Netti
III, CED, BASE gives a detailed description of how to adjust the cylinders and possible combinations.

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RECOMMENDED COMBINATIONS FOR NETTI III MODELS
SEAT DEPTH
IN MM
FRONT BRACKET HOLE
ABC
A IS UPPER HOLE
CYLINDER HEAD
SHORT
38 MM
CYLINDER HEAD LONG
96 MM STARTING ANGLE IN DEGREES º
500 A X 98
475 A X 87
475 B X 97
450 B X 85
450 C X 95
425 A X 92
425 B X 101
425 C X 85
400 B X 91
* Orange colour is the standard adjustment for the chosen seat depth.
* Grey colour could be an option. Other combinations of seat depths, front bracket holes and cylinder
head sizes are not recommended.
RECOMMENDED COMBINATIONS FOR NETTI III HD MODELS
SEAT DEPTH
IN MM
FRONT BRACKET HOLE
ABC
A IS UPPER HOLE
CYLINDER HEAD
SHORT
38 MM
CYLINDER HEAD
LONG
96 MM
STARTING ANGLE
IN DEGREES º
400 B X 91
425 A X 92
450 C X 95
475 A X 87
500 A X 98
STARTING RECLINE ANGLE FOR NETTI DYNAMIC CEDS
FRONT CYLINDER BRACKET HOLE ABC.
A IS UPPER HOLE. B IS THE POSSIBLE
OPTION. A AND C WILL NOT WORK.
SEAT DEPTH SD
375 MM SEAT DEPTH SD 400 MM SEAT DEPTH SD 425 MM SEAT DEPTH SD 450 MM
B: with rst hole on cylinder hinge 92 104 N/A N/A
B: with second hole on cylinder hinge 83 92 104 N/A
B: with third hole on cylinder hinge N/A 83 92 104
B: with fourth hole on cylinder hinge N/A N/A 83 92
STARTING RECLINE ANGLE FOR NETTI DYNAMIC CED / BASE
FRONT CYLINDER BRACKET HOLE ABC.
A IS UPPER HOLE. B IS THE POSSIBLE
OPTION.
SEAT DEPTH SD
425 MM SEAT DEPTH SD 450 MM SEAT DEPTH SD 475 MM SEAT DEPTH SD 500 MM
B: with rst hole on cylinder hinge 92 104 N/A N/A
B: with second hole on cylinder hinge 83 92 104 N/A
B: with third hole on cylinder hinge N/A 83 92 104
B: with fourth hole on cylinder hinge N/A N/A 83 92

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CHAIR BACK HEIGHT
It can be extended by mounting a back
extension.
NETTI DYNAMIC HEAD SUPPORT
The Netti Dynamic System
is equipped with a dynamic head support.
The head support follows the extension
movement of the neck.
The depth of the head support should be
adjusted to barely touch the back of the
user’s head when sitting relaxed.
For head support depth adjustment simply:
• Unlock the 2 two levers, one on each side
of the head support holder.
• Move the head support forwards or
backwards to desired position.
• Fix rmly the two levers.
The height of the head support needs to be
adjusted to t directly behind the head:
• Open the screw on the bracket holding
the vertical pole of the head support.
• Pull the head support to desired height
and x the crew rmly.

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Remember to shorten the stabilizer beneath
the last used hole to avoid any conict with
chair frame.
ARM SUPPORT POSITION
Depending on the wheelchair model the arm
support may vary.
The arm supports are static and adjustable
(no “Open Kinetic Chain movement concept”).
The adjustments of arm support are described
in the user manual of each type of static
comfort wheelchair:
Netti III (Netti Dynamic III),
Netti 4U CED (Netti Dynamic CED),
Netti BASE (Netti Dynamic BASE) etc.
Arrow Apoints to depth adjustment knob on the
arm support on a wheelchair with swing away arm
support (Netti Dynamic CED). Height adjustment
is done once loosening the screw Band xing it in
correct height.
MOUNTING, POSITIONING AND
ADJUSTMENTS OF PELVIC
SUPPORTS AND SUPPORTIVE
HARNESSES
Netti Dynamic System can be equipped with
several dierent types of pelvic stabilizer and
supportive harnesses each type developed
to give the user the best stabilization support
depending on the conditions:
• Pelvic stabilizer –
(included in Netti Dynamic System)
• Upper body harnesses
• Ankle huggers
• Shoe shells
• Pelvic stabilizer, mounted to the seat plate, helps
the user to keep his position on the seat even
under full spastic extension.
See separate Mounting Description for upper body
harnesses.
HOW TO ADJUST THE PELVIC STABILIZER
The pelvic stabilizer is mounted on the guide-rail
under the seating plate as shown on the illustration.
• Slide the pelvic stabilizer to a position where it
crosses the upper thighs, angle: 70 – 90 degrees.
• Adjust the harness mounting point so that the
harness can be tightened.

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ANKLE HUGGERS AND SHOE SHELLS
helps to keep the feet on the foot board not letting
them slide of during an extension spasm.
The ankle huggers are mounted by threading
them through the slots in the foot board on the
leg support and xing the belt on the underside of
the foot plate, threading shown in the illustration –
follow the numbers.
LEG SUPPORT HEIGHT AND ANGLE
Please see separate user manual for
Netti Dynamic System Leg support.
TABLE
Please do a user assessment to determine
if a table is suitably. By special or extensive
movement patterns a table may brake or
cause danger to the user or 3rd parties
because the table is statically xed to the
armrests while the movements of the user
are dynamic.