Otto Bock Start M4 XXL User manual

Start M4 XXL, Start M6 Junior
Instructions for use (qualified personnel) ................................................................. 3

2 Start M4 XXL, Start M6 Junior

Foreword1 5..............................................................................................................................................................
Intended use2 5........................................................................................................................................................
Indications for use2.1 5................................................................................................................................
Indications, contraindications2.2 5.................................................................................................................
Qualification2.3 5.........................................................................................................................................
Safety3 6....................................................................................................................................................................
Explanation of warning symbols3.1 6..............................................................................................................
General safety instructions3.2 6.....................................................................................................................
Safety Instructions for Assembly3.3 6.............................................................................................................
Nameplate3.4 7...........................................................................................................................................
Start M4 XXL3.4.1 7........................................................................................................................................
Start M6 Junior3.4.2 7.....................................................................................................................................
Delivery4 8.................................................................................................................................................................
Scope of delivery4.1 8..................................................................................................................................
Options4.2 8...............................................................................................................................................
Storage4.3 8...............................................................................................................................................
Preparation for use5 8.............................................................................................................................................
Assembly5.1 8.............................................................................................................................................
Settings6 9................................................................................................................................................................
Prerequisites6.1 9........................................................................................................................................
Adjusting the drive wheels6.2 9.....................................................................................................................
Setting the drive wheels horizontally6.2.1 9........................................................................................................
Adjusting the drive wheels vertically6.2.2 11.......................................................................................................
Adjusting the quick-release axle6.2.3 12............................................................................................................
Adjusting the handrims6.2.4 12........................................................................................................................
Adjusting the caster wheels6.3 13..................................................................................................................
Adjusting the caster journal angle6.3.1 13..........................................................................................................
Changing the installation position of the caster wheels6.3.2 13............................................................................
Adjusting the brakes6.4 14............................................................................................................................
Adjusting the wheel locks6.4.1 14.....................................................................................................................
Adjusting the braking force of the drum brake6.4.2 15.........................................................................................
Adjusting the seat6.5 15...............................................................................................................................
Adjusting the seat depth6.5.1 15......................................................................................................................
Adjusting the back support6.6 16...................................................................................................................
Adjusting the back support height6.6.1 16.........................................................................................................
Adjusting the back support angle6.6.2 16..........................................................................................................
Adjusting the back support upholstery / seat upholstery6.7 16...........................................................................
Adjusting the back support upholstery6.7.1 16...................................................................................................
Adjusting the seat upholstery6.7.2 17................................................................................................................
Adjusting the leg supports6.8 17....................................................................................................................
Adjusting the lower leg length6.8.1 17...............................................................................................................
Adjusting the support angle6.8.2 18..................................................................................................................
Adjusting the posterior lower leg pad of the "elevating" leg support6.8.3 19..........................................................
Adjusting the amputation leg support6.8.4 19.....................................................................................................
Adjusting the side panels6.9 20.....................................................................................................................
Adjusting the anti-tipper6.10 21.......................................................................................................................
Adjusting the swinging anti-tipper6.11 22.........................................................................................................
Adjusting the lap belt6.12 22...........................................................................................................................
Installing and adjusting the head support6.13 23...............................................................................................
Adjusting the transport wheels6.14 23..............................................................................................................
Delivery7 24...............................................................................................................................................................
Final inspection7.1 24..................................................................................................................................
Transport to the customer7.2 24....................................................................................................................
Table of contents
3Start M4 XXL, Start M6 Junior
Table of contents

Handing over the product7.3 24.....................................................................................................................
Maintenance and repair8 24...................................................................................................................................
Disposal9 24.............................................................................................................................................................
Disposal information9.1 24............................................................................................................................
Information on re-use9.2 24...........................................................................................................................
Legal information10 24..............................................................................................................................................
Liability10.1 24..............................................................................................................................................
Warranty10.2 25............................................................................................................................................
Service life10.3 25.........................................................................................................................................
Technical data11 25...................................................................................................................................................
Appendices12 29........................................................................................................................................................
Required tools12.1 29....................................................................................................................................
Torque values of the screw connections12.2 29.................................................................................................
4 Start M4 XXL, Start M6 Junior
Table of contents

1 Foreword
INFORMATION
Last update: 2020-01-08
►Please read this document carefully before using the product.
►Follow the safety instructions to avoid injuries and damage to the product.
►Instruct the user in the proper and safe use of the product.
►Please keep this document in a safe place.
INFORMATION
►New information regarding product safety and product recalls as well as the declaration of conformity can be
obtained at [email protected] or from the manufacturer’s service department (see inside or outside of rear
cover for addresses).
►Report all serious incidents that have occurred in connection with the product, both to the manufacturer (see
rear cover for contact information) and to the relevant authority in your country.
►You can request this document as a PDF file at [email protected] or from the manufacturer’s service depart
ment (see inside or outside of rear cover for addresses). The PDF file can also be displayed in a larger size.
Initial adjustments to the product were made according to the order form. Nevertheless, fine adjustments and set
tings may have to be made depending on the medical situation or the user’s requirements.
These instructions for use provide the information necessary for adjusting the settings. This work should be closely
coordinated with the user.
Please note the following:
• The instructions for use (qualified personnel) are intended only for qualified personnel and remain with them.
• The operation of the product and functionality of the options are described in the instructions for use (user).
These instructions for use must be given to the user.
• The manufacturer recommends checking the product settings regularly in order to assure an optimum fit over
the long term. A review is required every six months for children and youths in particular.
• The installation of all optional components is generally described in the service manual.
• The manufacturer reserves the right to make technical changes to the model described in these instructions for
use.
2 Intended use
2.1 Indications for use
The wheelchair is intended solely for everyday indoor and outdoor use by people who are unable to walk or have a
walking impediment and for operation by the patient or another person.
The product is suitable for users whose anatomy (suchas body dimensions and weight) permits the intended use
of the product.
The wheelchair may only be used with the options listed on the product order form.
Ottobock assumes no liability for combinations with medical devices and/or accessories from other manufacturers
not included in the modular system.
Combinations based on a combination agreement that have been evaluated for effectiveness and safety are an
exception to this.
The safe use of the wheelchair can only be ensured if it is used as intended in accordance with the information
contained in the instructions for use (user). The user is ultimately responsible for accident-free operation.
2.2 Indications, contraindications
See the instructions for use (user) for more information about indications and contraindications.
2.3 Qualification
Installation and adjustment tasks as well as repairs and inspections may only be carried out by qualified personnel.
5Start M4 XXL, Start M6 Junior
Foreword

3 Safety
3.1 Explanation of warning symbols
WARNING Warning regarding possible serious risks of accident or injury.
CAUTION Warning regarding possible risks of accident or injury.
NOTICE Warning regarding possible technical damage.
3.2 General safety instructions
WARNING
Lack of instruction
Tipping over, falling of the user due to lack of knowledge
►Instruct the user or the attendant in the proper use of the product when handing it over.
CAUTION
Use of unsuitable tools
Pinching, crushing or damaging the product due to use of unsuitable tools
►When completing the tasks, only use tools that are suitable for the conditions at the place of work and for
which safety and the protection of health are assured with proper use.
►Observe the specifications in the section "Required Tools".
NOTICE
Tipping or falling of the product
Damage to product due to lack of attachment
►When you work on the product, secure it so that it cannot tip over or fall over.
►Use a clamping fixture to secure the product whenever you work on it at a workbench.
NOTICE
Use of unsuitable packaging
Damage to the product caused by transportation using incorrect packaging
►Use only the original packaging for delivery of the product.
3.3 Safety Instructions for Assembly
WARNING
Changed diameter/installation position of the wheels
Tipping, falling over of the user due to blocked wheels
►Modification of the size and position of the front wheels and of the drive wheel size can lead to wobbling of the
front wheels at higher speeds. If changes are required, verify the horizontal alignment of the wheelchair frame
(see the section "Adjusting the drive wheels", "Adjusting the caster wheels").
WARNING
Incorrect installation of the anti-tipper/missing anti-tipper
Tipping over, falling of the user due to failure to observe the installation instructions and because of incorrect
adjustment
►Depending upon the settings of the chassis, the centre of gravity, the back angle and the experience of the
user, the use of an anti-tipper may be necessary.
►For a small wheelbase and a backrest that is tilted far back, an anti-tipper may need to be installed on both
sides, depending upon the user's experience.
►Verify that the anti-tipper has been installed and adjusted properly. Find the appropriate position with the
assistance of a helper.
6
Safety
Start M4 XXL, Start M6 Junior

WARNING
Improper assembly of removable wheels
Tipping, falling over of the user due to wheels coming off
►After each assembly, verify the proper fit of the removable wheels. The quick-release axles must be firmly
locked in the wheel attachment.
3.4 Nameplate
The nameplates are found on the crossbrace.
3.4.1 Start M4 XXL
Label Meaning
AManufacturer’s product name
BCE marking
CMaximum load (see section “Technical data”)
DManufacturer information/address
ESerial number1)
FManufacturing date2)
GSymbol for medical device
H WARNING! Read the instructions for use before using the
product. Observe important safety-related information
(e.g.warnings, precautions).
IThe product has not been approved by the manufacturer for use
as a seat in vehicles for transporting persons with reduced
mobility
JManufacturer’s reference number for the product variant
KSerial number (PI)3),1)
LGlobal Trade Item Number (DI)4)
1)YYYY = year of manufacture; WW = week of manufacture; PP = production site; XXXX = sequential production
number
2)YYYY = year of manufacture; MM = month of manufacture; DD = day of manufacture
3)UDI-PI to GS1 standard; UDI = Unique Device Identifier, PI = Product Identifier
4)UDI-DI to GS1 standard; UDI = Unique Device Identifier, DI = Device Identifier
3.4.2 Start M6 Junior
Label Meaning
AManufacturer’s product name
BCE marking
CMaximum load (see section “Technical data”)
DManufacturer information/address
ESerial number1)
FManufacturing date2)
GSymbol for medical device
H WARNING! Read the instructions for use before using the
product. Observe important safety-related information
(e.g.warnings, precautions).
IManufacturer’s reference number for the product variant
JSerial number (PI)3),1)
KGlobal Trade Item Number (DI)4)
1)YYYY = year of manufacture; WW = week of manufacture; PP = production site; XXXX = sequential production
number
2)YYYY = year of manufacture; MM = month of manufacture; DD = day of manufacture
3)UDI-PI to GS1 standard; UDI = Unique Device Identifier, PI = Product Identifier
4)UDI-DI to GS1 standard; UDI = Unique Device Identifier, DI = Device Identifier
7Start M4 XXL, Start M6 Junior
Safety

4 Delivery
4.1 Scope of delivery
The scope of delivery includes:
• Preassembled wheelchair
• Two drive wheels (installed or included)
• Options according to the order (installed or included)
• Instructions for use (qualified personnel), instructions for use (user)
The seat cushion is not included in the standard package.
4.2 Options
The functionality and operation of the options are described in more detail in the instructions for use (user).
All of the available options/accessories are listed on the order form.
4.3 Storage
The wheelchair must be stored in a dry place. The ambient temperature must be maintained between -10°C and
+40°C during transportation and storage.
During extended storage, the knee lever wheel lock on wheelchairs with PU tyres must be released since tyre
deformation may otherwise result.
Tyres contain chemical substances that can react with other chemical substances (such as cleaning agents, acids,
etc.).
5 Preparation for use
5.1 Assembly
CAUTION
Exposed pinch points
Crushing, pinching due to incorrect handling
►When folding the wheelchair out or together, only grip by the specified components.
CAUTION
Failure to verify readiness for use before putting into operation
Tipping, falling due to incorrect adjustment or installation
►Before you start using the wheelchair for the first time, check the chosen wheelchair settings with the support
of qualified personnel.
►After every assembly, check for proper mounting of the drive wheels. The quick-release axles must be
securely locked in the receiver bushings.
►Pay particular attention to the stability against tipping, free running of the drive wheels and correct function of
the wheel locks.
►Check the tyre pressure. The correct tyre pressure is printed on the sidewall. Ensure that the pressure is the
same in both tyres.
1) Attach the drive wheels to the quick-release axle housings. The quick-release axles must not be removable after
releasing the push-button.
2) Loosen the safety strap by means of the push button and unfold the wheelchair.
3) If necessary: Insert the leg supports into the attachment device. Fold the foot supports down.
4) If necessary: Pull the flap of the seat upholstery forwards and fasten tightly to the seat upholstery.
5) Fit the seat cushion.
8
Delivery
Start M4 XXL, Start M6 Junior

6 Settings
6.1 Prerequisites
WARNING
Incorrect settings
Tipping over, falling or malposition of the user due to incorrect settings
►Adjustment and installation work may only be completed by instructed, qualified personnel.
►Only the settings described in these instructions for use may be carried out.
►Settings may only be changed within the allowable adjustment ranges; otherwise, the stability of the product
may be impaired (see this section and the "Technical data" section). If you have questions, contact the manu
facturer's service (see back cover for addresses).
►Only conduct tests in the presence of an assistant.
►Unless expressly described, you may not change any settings with a person sitting in the product.
►Secure the user against falling out during all tests.
►Before testing setting changes with the user seated, firmly tighten all screw connections.
►Check for safe function before delivering the product.
CAUTION
Unsecured screw connections
Pinching, crushing, tipping over, falling of user due to assembly errors
►Always firmly re-tighten the mounting screws and nuts after changing settings. Observe the specified torques
in doing so.
►Any time you loosen a screw connection with thread lock, replace it with a new screw connection with thread
lock or secure the old screw connection with medium strength thread locker (e.g.Loctite241).
►Always replace self-locking screws and nuts with new self-locking screws and nuts after disassembly.
Adjustments to match the concrete physical and mental condition of the user should always be made in the user's
presence.
All parts of the product should be cleaned thoroughly before adjustments are made.
The tools required for adjustments and maintenance tasks as well as the torque values for screw connections are
listed in the section "Appendices" (see Page29).
6.2 Adjusting the drive wheels
WARNING
Incorrectly adjusted wheelbase
Tipping over, falling of the user due to unstable settings
►Please note that with the drive wheel in a more forward mounting position and with an unfavourable body pos
ition, the user may tip backwards even on level ground.
►Use an anti-tipper for inexperienced users and with extreme settings of the drive wheel.
►Be sure to position the drive wheels towards the rear for transfemoral amputees. This improves the stability of
the wheelchair.
WARNING
Lack of fine adjustment of the drive wheels
Tipping over, falling of the user due to incorrect adjustment
►Check the standard adjustments of the wheelchair for stability against tipping and function of the drive
wheels. Avoid any extreme settings.
INFORMATION
Changing the drive wheel position can also change the angle between the caster wheel journal and the ground.
However, this must always be approx. 90° and thus readjusted accordingly. The knee lever wheel lock also has
to be readjusted.
6.2.1 Setting the drive wheels horizontally
The horizontal position of the drive wheels can be changed.
9Start M4 XXL, Start M6 Junior
Settings

Changing the drive wheel position has the following effects:
Position of drive wheel Effects
Move backwards (passive setting) • Larger wheelbase
• Larger turning circle
• Greater stability of the wheelchair
• Wheelchair is harder to tip backwards when crossing obstacles
• Position recommended for inexperienced users
Move forwards (active setting) • Smaller wheelbase
• Less load on caster wheels = greater manoeuvrability
• Less stability of the wheelchair
• Wheelchair is easier to tip backwards when crossing obstacles
INFORMATION: An anti-tipper should be installed if necessary.
• Setting recommended only for experienced users
Start M4 XXL
The drive wheel can be installed at three depth positions in the drive wheel adapter.
1) Remove the wheels.
2) Loosen each hexagon nut (see fig.1, item2) from the fitting and remove the fitting towards the inside.
3) Slide the fitting back on in the desired position and tighten the hexagon nut slightly.
4) If necessary: The distance between the drive wheel and the side panel can be continuously adjusted by turn
ing the counter nut on the fitting.
5) Tighten each hexagon nut and the counter nut on both sides of the fitting to 50Nm.
INFORMATION: After adjustment, the distance of the left and right fittings to the side panel must be
the same.
6) Check the depth setting. Both sides must be positioned exactly the same. Readjust if necessary.
7) If necessary: Readjust the height and alignment of the caster attachment device (see Page13) as well as the
brakes (see Page14).
Start M6 Junior
The drive wheel can be installed using the drive wheel adapter at two depth positions.
1) Remove the wheels.
2) Remove both mounting screws on the drive wheel adapter (see fig.2, item1).
3) Turn the drive wheel adapters forwards or backwards to the desired position.
4) Insert the two mounting screws on the drive wheel adapter and tighten to 10Nm.
5) If necessary: The distance between the drive wheel and the side panel can be continuously adjusted by turn
ing the counter nut on the fitting.
6) Tighten each hexagon nut and the counter nut on both sides of the fitting to 50Nm.
INFORMATION: After adjustment, the distance of the left and right fittings to the side panel must be
the same.
7) Check the depth setting. Both sides must be positioned exactly the same. Readjust if necessary.
8) If necessary: Readjust the height and alignment of the caster attachment device (see Page13) as well as the
brakes (see Page14).
1 2
10
Settings
Start M4 XXL, Start M6 Junior

6.2.2 Adjusting the drive wheels vertically
The vertical position of the drive wheels can be changed by vertically moving the drive wheel adapter in the frame.
Combined with adjusting the height of the caster wheels, this also allows the seat height to be optimally adjusted to
individual requirements.
Changing the drive wheel position has the following effects:
Drive wheel position Effects
Move upwards • The higher the drive wheel position, the more the seat surface is tilted to
the rear
• Wheelchair is easier to tip backwards when crossing obstacles
• The change in the centre of gravity results in a lower, more stable seat
position in the wheelchair
• The seat height can be further adjusted in combination with a height
adjustment of the caster wheels.
Move downwards • The lower the drive wheel position, the less the seat surface is tilted to the
rear
• Wheelchair is harder to tip backwards when crossing obstacles
• The seat height can be further adjusted in combination with a height
adjustment of the caster wheels.
The drive wheel can be set to four height positions.
Start M4 XXL
1) Remove the wheels.
2) Remove both mounting screws on the drive wheel adapter (see fig.3, item3).
3) Slide the drive wheel adapter to the desired height position.
4) Reinsert and tighten the mounting screws to 10Nm.
5) Check the height setting. Once changed, the left and right drive wheel adapters must both have the same ver
tical position in the frame. Readjust if necessary.
6) If necessary: Readjust the height and alignment of the caster attachment device (see Page13) as well as the
brakes (see Page14).
Start M6 Junior
1) Remove the wheels.
2) Remove both mounting screws on the drive wheel adapter (see fig.4, item1).
3) Slide the drive wheel adapter to the desired height position.
4) Reinsert and tighten the mounting screws to 10Nm.
5) For fine adjustment: To achieve additional drive wheel positions, the fitting can be moved in the slotted hole
of the drive wheel adapter. Loosen the respective hexagon nuts and counter nuts on both sides of the fitting,
slide the fitting and tighten the hexagon nuts / counter nuts to 50Nm.
INFORMATION: After setting, the left and right fittings must be in exactly the same height position.
6) Check the height setting. Once changed, the left and right drive wheel adapters must both have the same ver
tical position in the frame. Readjust if necessary.
7) If necessary: Readjust the height and alignment of the caster attachment device (see Page13) as well as the
brakes (see Page14).
11Start M4 XXL, Start M6 Junior
Settings

3 4
6.2.3 Adjusting the quick-release axle
The quick-release axle should be set so the wheel is correctly engaged, with no play on the axle.
1) Hold the quick-release axle by the head (wrench size: 19mm) and by the tip (wrench size: 11mm) with a ring
and open-ended wrench respectively.
2) Adjust the play by turning the nut on the end of the quick-release axle (see fig.5, item1) in or out.
5
6.2.4 Adjusting the handrims
INFORMATION
This section does not apply to standard wheels.
All handrims are designed for a spacing from the drive wheel of 15mm (standard setting) and 25mm.
1) Completely remove the tyre.
2) Loosen/remove the handrim screw connection from the rim (see fig.7).
3) Tightly screw the handrims onto the rim in narrow or wide installation position.
4) Completely reinstall the tyre.
6 7
12
Settings
Start M4 XXL, Start M6 Junior

8 9
6.3 Adjusting the caster wheels
6.3.1 Adjusting the caster journal angle
When the drive wheels have been adjusted for the user, the caster journal angle must be readjusted.
The threaded axle in each of the two caster heads should be perpendicular to the ground to ensure optimum
wheelchair driving characteristics. The caster journal bearings permit continuous adjustment of this angle.
1) Remove the caps (see fig.10, item1).
2) Below the caps, slightly loosen the Allen head screws between the caster journal bearing and the frame (see
fig.11, item1).
3) Remove the cap at the top of the caster journal bearing (see fig.11, item2).
4) Place the supplied measuring tool (spirit level) on the top surface of the caster journal bearing in the direction
of travel (see fig.11, item1).
5) Position the continuously variable caster journal bearing perpendicular to the ground (see fig.11, item3).
6) Tighten the Allen head screws to 8Nm.
7) Reinstall the caps (see fig.10, item1).
→The caster axle on each of the two caster journal bearings must be positioned vertically (see fig.10, item2).
10 11
6.3.2 Changing the installation position of the caster wheels
The seat height/angle can be subsequently adjusted by changing the position of the casters in the caster forks or
using different wheel sizes.
Please refer to the installation matrix in the section "Technical data" for permitted positions and combinations of
drive wheels and caster wheels.
1) Loosen the screw connection on the threaded axle (see fig.12, item1).
2) Remove the screw/threaded sleeve, spacers and (if applicable) nuts.
3) Remove the caster wheel.
4) Insert the screw/threaded sleeve with the first spacer bushing offset in one of the 4 holes (see fig.13, item1).
5) Install the caster wheel.
6) Slide on the second spacer bushing (not pictured).
7) Tighten the screw/nut to 8Nm.
13Start M4 XXL, Start M6 Junior
Settings

→Once changed, the left and right caster wheels must have the same vertical position in the caster fork.
→Once the front seat height has been adjusted, the caster journal angle must be checked and if necessary read
justed.
12 13
6.4 Adjusting the brakes
6.4.1 Adjusting the wheel locks
WARNING
Failure to verify brake functionality
Accident, user falls due to incorrect adjustment and improperly inflated tyres
►Check the correct spacing between the wheel lock bolt and tyre (see the following section for details).
►Check the correct position of the wheel lock bolt relative to the tyre. During braking, the wheel lock bolt has to
cover at least half the tyre width.
►Always carry out adjustments to the wheel lock on both sides.
►Ensure that the user can operate the wheel lock without great effort. The force required to do so must not
exceed 60N.
►Check the tyre pressure of the drive wheels. Note the information in the section “Technical data” or on the tyre
sidewall.
►Only use original drive wheels with a verified maximum radial out-of-round of 1mm.
This adjustment must be made after the drive wheel has been repositioned or during fine adjustment.
1) Loosen the Allen head screws on the clamp bracket (see fig.14).
2) The knee lever wheel lock is continuously slidable and adjustable. When the wheel lock is disengaged, the gap
between the tyre and wheel lock bolt must not exceed 5mm (see fig.15).
→The distance between the wheel lock bolt and the drive wheel must be1–5mmin the unbraked condition.
→It must be possible to operate the brake evenly and easily on both sides.
→The wheel lock bolt must lock the drive wheel securely when stationary.
3) Tighten the Allen head screws to 16Nm.
→After adjustment, the left and right knee lever wheel locks must both have the same braking force.
14 15
14
Settings
Start M4 XXL, Start M6 Junior

6.4.2 Adjusting the braking force of the drum brake
INFORMATION
After making adjustments, check that activating the manual brake lever creates a sufficient braking effect.
Note that the drum brake must still be able to produce sufficient braking force even when the manual brake lever
is locked into a ratchet position.
To achieve an optimum braking effect, the braking force is adjusted using the adjustment screw (see fig.16, item
2).
•Increase the braking force: Back off the adjusting screw.
•Reduce the braking force: Screw in the adjustment screw.
1) Loosen the counter nut (see fig.16, item1) and back off the adjustment screw until a scraping noise can be
heard when the rear wheel is rotated.
2) Screw in the adjustment screw (see fig.16, item2) until the scraping noise at the rear wheel disappears and
the wheel runs freely.
3) Tighten the counter nut (see fig.16, item1) until the adjustment screw is fixed.
→The braking force of both rear wheels must be adjusted equally.
16
6.5 Adjusting the seat
6.5.1 Adjusting the seat depth
The seat surface can be moved horizontally by up to 90mm in three steps.
1) Loosen and remove the seat cushion and back support pad from the hook-and-loop fastener.
2) Loosen and remove all Allen head screws between the central unit and frame tubes (see fig.17).
3) Slide the central unit horizontally on the frame tubes. Depending on the design, three different seat depth set
tings are possible in increments of 30mm.
4) Mount all Allen head screws and tighten to 8 Nm.
5) Reattach the back support pad on the seat upholstery with hook-and-loop fasteners.
6) Secure the seat cushion against sliding by pressing it onto the hook-and-loop fastener.
17
15Start M4 XXL, Start M6 Junior
Settings

6.6 Adjusting the back support
6.6.1 Adjusting the back support height
The back support height is adjustable by 75mm. The back support height is set by moving the back support tubes
in the central unit in increments of 25mm.
1) Remove the drive wheels and secure the wheelchair by jacking it up.
2) Remove all Allen head screws from the vertical attachment device of the central unit (see fig.18).
3) Slide both back support tubes to the desired height. Both back support tubes must be set to the same height.
4) Reinsert all Allen head screws on the central unit and tighten them with the following tightening torques:
→Allen head screws at item1: 8Nm
→Allen head screws at item2: 10Nm
5) When adjusting the maximum back support height, an additional screw connection with plastic spacers has to
be mounted in the uppermost bore hole of the central unit (see fig.18, item3). This is part of the
“481D53=ST170 conversion kit for standard back support tube”.
18
6.6.2 Adjusting the back support angle
Adjusting the back angle is described in more detail in the included instructions for use (user).
6.7 Adjusting the back support upholstery / seat upholstery
6.7.1 Adjusting the back support upholstery
INFORMATION
A well-adjusted back support provides lasting comfort for the wheelchair user and reduces the risk of secondary
damage and pressure zones.
INFORMATION
Ensure that the user’s pelvis is positioned as far back in the wheelchair as possible, i.e.between the back sup
port tubes.
The adjustable back support upholstery can be adapted in segments to the needs of the user.
1) Remove the seat cushion.
2) Pull the back support pad up and off the hook-and-loop fastener on the back support upholstery.
3) Loosen the back support straps and use the hook-and-loop fastener to fasten them with the desired tension
(see fig.19).
4) Put on the back support pad and attach it to the hook-and-loop fastener on the back support upholstery.
5) Put on the seat cushion and secure it with the hook-and-loop fastener.
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Settings
Start M4 XXL, Start M6 Junior

19
6.7.2 Adjusting the seat upholstery
The seat upholstery usually does not need to be adjusted during the initial fitting. However, the tension can be
changed.
INFORMATION
You can slightly correct the centre of gravity by making small changes to the sag of the seat upholstery. However,
larger corrections to the centre of gravity must be made by making changes to the settings on the frame, the drive
wheel adapter and the caster wheels.
1) Fold the wheelchair and remove the seat cushion.
2) Remove the protective caps (see fig.20).
3) Remove the seat upholstery from the crossbrace (not illustrated).
4) If necessary, tighten the seat upholstery with the aid of the hook-and-loop fastener on the bottom of the seat
upholstery (see fig.21).
5) Push the seat upholstery onto the crossbrace.
6) Slide on the protective caps.
7) Unfold the wheelchair. In doing so, the crossbrace must be seated fully in the support guides.
20 21
6.8 Adjusting the leg supports
6.8.1 Adjusting the lower leg length
The required legrest height depends on the lower leg length of the user and the thickness of the seat cushion.
“Segmented, angle-adjustable” leg support, “continuous” leg support, “elevating” leg support
1) Loosen the Allen head screw:
→“Segmented, angle-adjustable” leg support: see fig.22
→“Continuous” leg support: see fig.23
→“Elevating” leg support: see fig.24
2) Adjust the foot plate bar to match the user’s lower leg length.
INFORMATION: Ensure that the foot plate bar is inserted into the swivel segment by at least 40mm
(to the marking).
17Start M4 XXL, Start M6 Junior
Settings

3) Tighten the Allen head screw to 6Nm.
Leg support for short lower leg lengths
1) Loosen the clamping screws (see fig.25, item1).
2) Bring the foot support to the desired height and depth position. Readjust the angle if necessary (see fig.25,
item2).
3) Tighten the clamping screws to 9Nm.
22 23
24 25
6.8.2 Adjusting the support angle
The legrest angle setting should be chosen so that the ankle is in a relaxed, comfortable position.
“Segmented, angle-adjustable” leg support
1) Loosen the Allen head screws on the foot plate (see fig.26, item1).
2) Turn the foot support to the desired angle (see fig.26, item2).
3) Tighten the Allen head screws to 6Nm.
“Continuous” leg support
1) Loosen the Allen head screw on the rear suspension of the foot plate by several turns (see fig.27, item 1).
2) Turn the foot support to the desired angle.
3) Tighten the Allen head screw to 10Nm.
Leg support for short lower leg lengths
1) Loosen the upper clamping screw (see fig.25, item1).
2) Turn the foot support to the desired angle (see fig.25, item2).
3) Tighten the clamping screw to 9Nm.
“Elevating” leg support
For additional information, see the instructions for use (user).
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Settings
Start M4 XXL, Start M6 Junior

26 27
6.8.3 Adjusting the posterior lower leg pad of the "elevating" leg support
The posterior lower leg pad on this leg support is height-adjustable.
1) Loosen the clamping unit mounting screw (see fig.28).
2) Slide the posterior lower leg pad to the desired height.
3) Re-tighten the mounting screw.
28
6.8.4 Adjusting the amputation leg support
Adjusting the support angle of the amputation leg support
The angle adjustment is carried out in the same way as for the “elevating” leg support. For additional information,
see the instructions for use (user).
Adjusting the pad
1) Pad angle: Loosen the three Allen head screws and turn the posterior lower leg pad to the desired angle (see
fig.29). Firmly re-tighten the Allen head screws.
2) Pad height: Loosen the Allen head screws on the clamp bracket and adjust the height (see fig.30). Firmly re-
tighten the Allen head screws.
19Start M4 XXL, Start M6 Junior
Settings

29 30
6.9 Adjusting the side panels
“Standard” side panel, “stepped” desk side panel
The forearm support can be adjusted in height by moving the spacers.
1) Remove both Allen head screws (see fig.31).
2) Remove the forearm support and place the spacers as required (see fig.32):
→Both spacers are located below the side panel tube (see fig.31).
→Both spacers are located above the side panel tube (see fig.32).
→A spacer is located above the side panel tube. A spacer is located below the side panel tube (not illus
trated).
3) Place the forearm support on the side panel tube.
INFORMATION: In this step the depth of the forearm support can also be adjusted.
4) Insert and firmly tighten both Allen head screws (see fig.31).
31 32
“Plug-on” side panel
1) Adjusting the height of the forearm support: Use a ballpoint pen or screwdriver to push in the counter-sunk
locking button and slide the side panel to the desired position (see fig.33).
CAUTION! The locking button is intentionally counter-sunk to prevent accidental operation. Always
use an object to press the locking button, never your fingers.
2) Adjusting the depth of the forearm support: Loosen the mounting screws under the forearm support, move
the forearm support and firmly re-tighten the mounting screws (see fig.34, item1).
20
Settings
Start M4 XXL, Start M6 Junior