HybridKnee
Contents
1. 81 SSO00076 Instruction Manual NI C3 Series Introduction Thank you for purchasing Nabtesco s Hybrid Knee Hybrid Knee is a totally new intelligent prosthetic knee joint to provide safe and pleasant walking through integration of hydraulic and pneumatic control and computer control For safe use be sure to read this manual and familiarize yourself with the Hybrid Knee Carefully keep this manual conveniently available for future reference Also read through the User s Manual and give the amputee safety information contained therein before handing it to him her Table of Contents Safety Prec alllONS aietecudvasdulesteneminesancnuaaieoemancananieeiekenenas 2 1 1 Definition OF SY MIDONS ccccaiesacccrnecatinestacnieraiminaneniiuanteracaiacsine 2 1 2 Must Items for Safety ssccxccassesssacecscossssssssvsezecescecteasasssnsazvscadesnonssvensaseacanstaseveusecveesniiiens 3 Basic Construction and Operational Principle sescsssseeesssssscessnescessneeeeseeceessneeesses 5 2l Basic COMSTIUCTION vsssenstussotcassesscsonssozsegassscsonsocectaxarlcnonseschoqsat bsnasssscroattecoossavbchostopsoouseunsd 5 2 2 Operational Principle esssssscsssseccsssssecsssnseccsssncesssnscsessueecesssnscessssescessnsceessneeeessnees 6 223 Stance Phas CON ancnacinowienunaninannanunaunwunauatane ai 6 2 4 Swing Phase Control icn cmaconuusmiahaananaaainannnwusnentaas amen 7 Before Use ates ccttccicesscerceenseaectaceisss staiceiteicead oe E RUER2. 4 Flexing and extending the knee confirm that no abnormality is detected Clevis bolt Trunnion pin Trunnion pin Proximity switch connector behind the substrate Fig 24 Removing Installing the Cylinder Module 28 Outline of the Product Specifications Max 140 125kg 100kg for High Active User Compliance with ISO 10328 P6 A 125kg Approx 2 years These specifications are subject to changes without prior notice Features ay Excellent stance phase stability and yielding function The hydraulic rotary damper and the unique MRS system serve to accurately create hydraulic resistance and to avoid knee buckling In addition the yielding function helps achieve safe descending on a slope and stairs Note Hybrid Knee is intended to assist capability of an amputee who uses a prosthesis Please note that no one can easily descend a steep slope and stairs without gait training EJ Wide range of speed follow up performance and tireless walking The microprocessor controlled intelligent mechanism has realized walking in a wide range of cadence In addition air pressure control can provide easy swing of a prosthesis and can reduce fatigue ej User friendliness Stance phase control can be easily adjusted with a hex wrench The adjust ment method for the stance phase control is the same as that for the conven tional intelligent knee joint Battery life time is approximately 2 yea
3. YBomnt 4 How to land on the prosthesis when descending stairs Instruct the amputee to put the mid foot on the edge of the O x 20 4 4 Precautions When Sitting in and Standing up from a Chair e When sitting in a chair never place the hand behind the knee The hand A can be caught in the swaying part of the hydraulic cylinder causing serious WARNING Y When standing up from a chair never place the hand on the knee Fingers can be caught between the knee plate and the hydraulic unit causing serious injury For ease of standing up from a chair placing hands on the armrests or on the seating face is recommended In addition to the above placing a hand on the socket or placing both hands on the sound leg also facilitate standing up from a chair Provide instructions on the safe method according to the amputee s circumstances Fig 18 Recommended Posture When Standing up from a Chair Even if hydraulic resistance is adjusted to a higher level yielding strength is not increased In the stance phase during walking on a level floor minor wobbling motions occur on the knee joint Hydraulic resistance becomes effective when it is not supposed to Sticking occurs during transition from stance to swing phase Troubleshooting Check if the way to apply body weight is proper Check if alignment is proper Check if the foot is appropriate The above measures can not resolve the problem Check i
4. damper has two kinds of adjusting plugs as shown in Fig 10 and Table 1 A Hydraulic resistance adjusting plug B Hydraulic sensitivity adjusting plug Fig 10 Location of the Adjusting Plugs Table 1 How to Select Adjusting Plugs Increasing effectiveness and sustainability OFF timing of yielding function Sensitivity OFF timing PEREP Strength Hydraulic resistance Time At the time when sticking occurs during transiting to stance phase At the time when the yield duration is insufficient OFF timing Hydraulic resistance Time MPORTANT The adjusting plugs have been set to the positions which are common to most people in the factory default setting When you can not find suitable positions turn the plugs to their original position Hydraulic resistance adjusting plug Set to the scale 10 Hydraulic sensitivity adjusting plug Set to the scale 15 4 1 1 Adjusting the Hydraulic Resistance Inserting a hex wrench obliquely upward into the hydraulic resistance adjusting plug turn it to change hydraulic resistance Clockwise Scale readings become small Hydraulic resistance becomes higher at the stance phase e Counterclockwise Scale readings become large Hydraulic resistance becomes lower at the stance phase Adjust by using scale readings as a guide Read the scale at the mark on the window Hex wrench 3 mm Adjusting scale as viewed through the windo
5. CAUTION 1 Remove the battery connector from the circuit board Fig 20 Battery connector Circuit board connector Fig 20 Removing the Battery Connector 2 Loosening the outer clamp bolts pull out the tube 3 Removing the outer clamp from the frame remove the retaining screw and pull out the inner clamp together with the battery case Fig 21 Battery case Retaining screw Ne Note See next page 8 Inner clamp Outer clamp Fig 21 Removing the Clamps 25 Q 4 Turning the cap on the battery case using a coin remove the battery Figs 22 and 23 Lithium battery Cap Inner clamp Battery case ee Fig 22 Removing the Battery Cap Fig 23 Removing the Battery 5 Insert a new battery into the battery case Note When inserting a battery align the battery wire with the slit of an inner clamp If the battery is placed in the reverse side the battery can not be inserted fully Fig 23 6 Putting back the cap on the battery case fix it properly 7 Install the inner clamp on the frame Note When installing the inner clamp place the battery connector on the upper surface of the circuit board as shown in Fig 21 8 Set the retaining screw Tighten the screw until its head reaches slightly below the frame surface and insert the outer clamp Overtightening may press the battery case and CAUTION damage the battery 9 Insert the battery connector into the circuit board connec
6. ERA Ra 9 3 1 Scope of Delivery sssri mamnintunioncanenennteumnes 9 3 2 Assembly PrO Ce CNG sssini sinini 9 32l Static PAST T cassanssscazscscxcesssasescauvensdivnsecsnevanessncqoonesosvsaznensveninaunssssemnssaretaneudsite 9 3 2 2 Assemblingthe MIDE a camcmancanarrsenenanmentnbnanmsonnmeuenanis 10 3 2 3 inserting the Battery COnMeCtOn scssecawaresencenanmanancmneneutse 10 3 2 4 Precautions on Socket FORMING iarcssesavnaveeresstetennnecternmunnernnneniese 11 AdjUStMENT xt escsssactsaseSaeceasesccshacaaansecondons kccoseaasnsosara amararsnatveamyueancaeinnecaaneanenen 12 4 1 Adjusting the Stance Phase Control sccscuaumiicimanninacianenanmauasn 12 4 1 1 Adjusting the Hydraulic REStStAance s ccsscsscscscssassasccossasssssesnesosesnscanaveseseesensies 13 4 1 2 Walking on a Level FIOOF ca cacicauecauasauninnudaaicuuiemuanivanens 15 4 1 3 Adjusting Sensitivity OFF tiMINg sss ssssssssssssssrsserssesrssserssersssserssersssserssess 16 4 2 Adjusting the Swing Phase Control ss sssssssssssssssssssssesrsssressersssseesserssnserssersserssss 17 4 3 Adjusting Yielding for Descending a Slope or Stairs sssssessccccsssseeeeeeee 19 4 4 Precautions When Sitting in and Standing up from a Chair 21 TroubleshootiN Oinin eini ia ani 22 Maintenan C Esnsscnninnunssannnn n RAAR 24 6 1 Replacing the Extension Stopper Rubber s sssssssssssssssssesssseseeesssesesssseeesssesessse 24 6 2 Replacing the RULE IY css scsssasccasacesaeseconeadsasvesonsava
7. be sustainable YBomnt 2 Guide for Intensity of Hydraulic Resistance Although hydraulic resistance varies by weight and activity the standard level is generally between 5 and 15 If you are not S sure set it to 10 e Hydraulic resistance may be felt weaker due to insufficient heel load Provide sufficient gait training for LBOINT 1 Fig 13 DO NOT use readings of 19 and above When the plug is loosened one full turn or more from the fully closed position reading 0 a risk of oil leakage is created Oil resistance does not change even if further loosening is added Walking on a Level Floor 1 2 3 Let the amputee walk within the parallel bars Provide practice so that the amputee fully extends the knee joint in the initial stance phase in normal walking on a level floor Confirm that there is no sticking caused by yielding function at the time of transition from stance phase to swing phase When the amputee becomes familiar with walking perform gait training outside the parallel bars When sticking occurs make an adjustment according to the troubleshooting method see pages 22 and 23 413 CAUTION Adjusting Sensitivity OFF timing Referring to Table 1 see page 12 perform sensitivity adjustment Sensitivity is set to the standard condition at the factory When no problem exists adjustment is unnecessary Referring to the figure below turn the sensitivity adjusting plug on the right hand side
8. by using a hex wrench When the plug is turned hydraulic resistance will change as follows Clockwise forward Yielding function becomes more effective and more sustainable Counterclockwise rearward Yielding function becomes less effective and less sustainable Hex wrench 3 mm Adjusting scale as viewed through the window for 15 Fig 14 Adjusting Sensitivity ln lt MPORTANT The maximum adjustable range of the sensitivity adjusting plug is one loosening turn from the fully closed position The factory default is set to the scale 15 When you can not find an appropriate position it is recommended that the prosthesis is used in the factory default setting Never loosen the sensitivity adjusting plug more than one turn from the fully closed position The plug is designed for anti dropping If the plug is loosened more than one turn the parts may be damaged Mo 4 4 2 Adjusting the Swing Phase Control Programming for swing phase Enter walking data into the microprocessor to enable changes in cadence As for adjustment procedure refer to the separate adjustment instruction manual Adjusting terminal impact When undesiable terminal impact occurs adjust the cushion valve located above the pneumatic cylinder in the following procedure 1 As shown in Fig 15 turn the cushion valve with a hex wrench 2 mm Clockwise Cushion effect is enhanced and impact is reduced Counterclockwise Cushion effec
9. 9 WARNING 23 Maintenance 6 1 Replacing the Extension Stopper Rubber 1 While flexing the knee joint approximately 90 remove the extension stopper rubber As a double sided tape is attached on the back of the extension stopper rubber it is recommended to use a sharp pointed stick to remove the rubber 2 Remove dirt and dust from the inside of the groove Completely remove the double sided tape without any residual piece Finally remove oil or grease using aerosol Be sure to remove oil and grease If they are not fully removed the double sided tape may not be properly attached and the extension CAUTION Stopper rubber may peel off DO NOT use thinner or acetone to remove oil or grease These degreasing agents may dissolve paint Contact with the hydraulic seal may cause damage to the rubber resulting in oil leakage 3 First remove the protective cover of a new double sided tape for the extension stopper rubber Then turning the surface with projections upward and placing the thicker side forward insert it into the groove After that press it with sufficient force Place the Extension stopper rubber thicker side forward Remove the Double tecti protective cover 4 sided tape cx Fig 19b Fig 19a 24 6 2 Replacing the Battery Replace the battery in the following procedure A Be sure to eliminate static electricity by for example touching a desk before starting this work
10. ccbeanaassscspccansuseoduactavseacanecabsvncconccupacse 25 6 3 Replacing the Cylinder Mod lesssssssssosissssesinnssniiansssisssnsiss 27 Outline OF th PrOdUCt sssisssrisosennissoninissnensisiki as 29 Periodic Inspection and WarraNty sssssssoscssosinnissnumiannisenmionina 30 Safety Precautions 1 1 Definition of Symbols JN an Indicates a potentially hazardous situation caused by nonobservance of this symbol which if not avoided could result in serious injury Aart Indicates a potentially hazardous situation caused by nonobservance of this symbol which if not avoided may result in minor or moderate injury or property damage A Indicates a general caution to be observed Indicates prohibition of a specific action Mandatory Action S Prohibition Indicates obligation of a specific action 1 2 Must Items for Safety ZN Q Mandatory Action Improper use can cause falling or injury Prohibition If used to a person who weighs over 100 kg damage of parts may occur leading to falling This however does not preclude loading and unloading of baggage etc occurring in daily life Prohibition Failure to observe this warning can cause breakage of parts leading to falling Q Mandatory Action Continued use despite a detected abnormality may cause damage of parts leading to falling Prohibition The hand can be caught causing injury Prohibition Failure to
11. dence responsive swing control Hydraulic rotary damper 1 Pneumatic As cylinder Fig 2 Level Floor Stance Phase Control When a knee is flexed the hydraulic rotary damper produces hydraulic resistance thus preventing abrupt buckling to occur The MRS Mechanism of Reaction Force Sensing system mechanically detects floor reaction force and sets ON OFF of hydraulic resistance When floor reaction force exists at the heel side from the sensing point hydraulic resistance is turned on When it exists at the toe side the hydraulic resistance is turned off Sensing point Hydraulic resistance is ON Hydraulic resistance is OFF Fig 3 MRS System A WARNING 2 4 Yielding function By having the heel land first an amputee can slowly flex the knee while applying body weight to the knee After getting familiar with the yielding function he or she can perform various acts such as descending a slope and stairs In order to make yielding function effective be sure to strike the floor with the heel first If you strike the floor with the toe first hydraulic resistance is turned off and the body weight cannot be supported There is a risk that knee buckling may take place causing falling down For safe use fully understand the operational principle and proper walking method and provide the amputee with instructions gt See POINT 1 page 15 Note Hybrid Knee is intended to assist capability of a pers
12. e POINT 1 page 14 Check if alignment is proper Adjust so that body weight can be fully applied to the heel Check if the prosthetic foot Select a prosthetic foot with has adequate heel stiffness medium heel stiffness not too soft The above measures can not Contact your local sales resolve the problem representative dealer When the amputee descends Check if the floor contact Put the mid foot on the edge stairs yielding does not position of the foot is of stairs function appropriate gt See Bont 4 page 20 Check if the toe touches the By swinging the prosthesis floor first due to insufficient fully extend the knee joint Be knee extension sure to put the mid foot on the edge of the stairs Even if the knee is fully Repeat gait training of how to extended it is flexed by its shift the body weight forward self weight before the foot and to obtain the best timing contacts the floor of swing and landing Even after gait training the Select a pneumatic cylinder amputee cannot fully extend with a strong spring to assist the knee joint extension During its use however the amputee may feel heaviness during swing motion in the swing phase The above measures can not Use of yielding for stairs resolve the problem should be prohibited A Make sure that the amputee always holds a handrail during gait training There is a risk that amputee loses balance and falls down gt See 4 3 page 1
13. f alignment is proper Check if the knee joint is flexed at the heel contact Check if the pneumatic cylinder cushion is adjusted too strong Check if hydraulic sensitivity is adjusted too strong Check if the pneumatic cylinder cushion is adjusted too strong Check if smooth heel to toe weight shift is achieved while walking The above measures can not resolve the problem Practice how to fully apply body weight to the heel gt See POINT 1 page 14 Adjust so that body weight can be fully applied to the heel Select a foot with which body weight can be fully applied to the heel Contact your local sales representative dealer Adjust alignment to the stable side Practice how to walk with the knee fully extended in the stance phase Loosen the cushion valve Loosen the sensitivity adjusting plug DO NOT make 3 turns or more from the fully closed position gt See 4 1 3 page 16 Loosen the cushion valve Provide gait training so that body weight is fully applied to the toe of the prosthetic foot at time of toeing off Insufficient toe load at the time of push off is suspected Proper alignment foot selection adjustment and gait training are essential to take full advantage of this knee joint Yielding function is not Check if the way to apply Practice how to fully apply sustainable when the body weight is proper body weight to the heel amputee descends a slope gt Se
14. observe this warning can cause an explosion or firing Incorrect adjustment can never provide pleasant walking It will lead to damage of the pneu matic cylinder impeding normal walking Failure to observe this caution will CAUTION If the Hybrid Knee is used without inspection parts abrasion can be accelerated Continued use after any part is dropped will cause damage of a pneumatic cylinder impeding normal walking cause rust on parts resulting in failure of the unit Basic Construction and 4 Operational Principle Basic Construction Hybrid Knee has accomplished sophisticated integration of the hydraulic rotary damper to control the stance phase the MRS system and the microprocessor controlled pneumatic cylinder for the swing phase Knee plate ae J U Hydraulic rotary Rotary axis fy OAS damper Knee axis P HO 4 Jy Z gt Adjusting plug Proximity sensor K See page 12 Cushion valve M AES Pneumatic y cylinder Swing phase control section wh Wes Printed 48 5 circuit board Stepping motor Battery Fig 1 Main Components Stance phase control section 2 3 Mo Operational Principle The hydraulic rotary damper reliably functions while the prosthesis is in contact with the floor thus preventing abrupt buckling When the prosthesis leaves the floor the microprocessor controlled pneumatic cylinder functions providing ca
15. on who uses a prosthesis Without proper gait training nobody is able to descend a steep slope or stairs Swing Phase Control The microprocessor ase A a ee eee calculates time for Q Q Q Q Q QQ QQ Q one walking cycle by using data on knee joint O O gt AdRO a flexion as detected by the proximity sensor Also this microproces sor memorizes for each Stance phase Swing phase amputee the adjusting data on the maximum j __Timeforonecycle gt 10 stages which consist of cadence and reaction force of the pneumatic cylinder When cadence changes the microprocessor commands the step ping motor to activate the needle valve immediately so that a swing speed of the prosthesis is selected High Valve opening Cylinder reaction force Low 30 a a ee Eo ST MT FT B9 B83 B7 B6 B5 B4 B3 B2 BI Slow Walking Speed Fast OOO eee SS saa gt Fig 6 10 Stage Setting When walking stops When an amputee stops walking for 8 seconds or more the needle valve is automatically set to the his her normal cadence When the battery is running low When remaining battery power is reduced the needle valve is automatically set to the his her normal cadence After that it can not respond to a cadence change but an amputee can walk at a constant speed Data store As adjustment data is stored in the memory it will not be deleted even if the battery connector is pulled out In other wo
16. rds readjustment is not required even when the battery is replaced 3 1 Scope of Delivery Please confirm that the following items are included Hybrid knee ee es 1 e Dedicated lithium battery 1 already set User s manual ee ee ee ed 1 After explaining the content hand it directly to the amputee Instruction manual this book 1 3 2 Assembly Procedure 3 2 1 Static Alignment Perform static alignment according to the following procedure Alignment of frontal plane Complete alignment so that the load line passes through the center of the knee joint and falls in the heel center of the foot section As shown in Fig 7 complete alignment so that the weight load line passes the range of O to 10 mm in front of the center of the knee axis of the knee joint When the recommended alignment is out A of line excess load is imposed to the parts CAUTION accelerating wear For a hip prosthesis use of a torsion adapter is recommended fer Alignment of sagittal plane i z CAUTION 3 2 3 A CAUTION A CAUTION clamp with that of the inner clamp 3 Tighten the bolts to a torque of Battery connector 4 5 to 5 0 Nem Outer K A Assembling the Tube 1 Loosening the outer clamp bolts insert the tube into the inner clamp and push the tube until it hits the stopper of the inner clamp 2 When assembling the tube be
17. rs Note Battery life time varies according to walking pattern of each amputee The battery life time of 2 years is based on a general walking pattern 29 A CAUTION Periodic Inspection and Warranty Periodic Inspection e Receive a periodic inspection every 2 years Inspections for the 2nd year are free of charge and inspections for the 3rd year and following years are offered on a charged basis Consumable parts extension stopper rubber battery are available for purchase Be sure to receive a periodic inspection every 2 years Failure in receiving a periodic inspection cannot satisfy the requirements of the warranty period Should the Hybrid Knee be used without a periodic inspection abrasion of parts may be accelerated Warranty The warranty period is 2 years from the date of sale by your local sales representative dealer on the condition that periodic inspections for the 1st year are implemented 30 Nablesco Corporation Manufacturer Authorized representative for EU countries Nabtesco Corporation NABMIC B V Accessibility Innovations Company Assistive Practices Department Brouwerstraat 34 2984 AR Ridderkerk The Netherlands Phone 31 180 530 590 35 Vozalohama machi Higashinada ku Fax 31 180 530 591 KOBE 658 0024 JAPAN Phone 81 78 413 2724 Fax 81 78 413 2725 http welfare nabtesco com
18. sure to align the split groove of the outer For safe use you are recom Inner clamp mended to use the tube made by Nabtesco When using one made by any other manufac turer due to unavoidable circum stances be sure to use one whose DN outside dimension tolerance is Tube within 0 05 mm Fig 8a Assembling the Tube Inserting the Battery Connector Before inserting the battery Battery connector connector be sure to elimi nate static electricity by for example touching a desk The battery connector has been disconnected for ship ment To use the Hybrid Knee be sure to insert the battery connector into the circuit Fig 8b Inserting the Battery Connector board connector Circuit board connector Connecting the adjustment unit perform reset e Confirm that motor sound is normal When the motor continues to run perform the reset operation There is a risk that battery electricity may be abnormally consumed 3 2 4 A CAUTION Precautions on Socket Forming A Avoid f interference At the time of socket forming make sure that neither the socket nor parts touch the pneumatic cylinder when the knee joint is flexed to the fullest extent Failure to do so may cause damage to the pneumatic cylinder adversely affecting the function Pneumatic cylinder Adjustment Adjusting the Stance Phase Control First adjust the stance phase control As the hydraulic
19. t is weakened and impact is increased Fig 15 Fixing Procedure of the Cushion Valve 2 Let the amputee walk slowly by securing safety with parallel bars and confirm that the knee extends fully If the knee does not fully extend turn the cushion valve to the left to weaken cushion effect 3 Let the amputee gradually increase his or her cadence Confirming sound level of terminal impact select an appropriate valve position A CAUTION Never use the prosthesis with excessively strong cushion effect Failure to observe this caution can cause falling as the knee does not extend fully Also it may cause yielding function to work unintentionally resulting in sticking Bont 3 Guide to Cushion Adjustment e Cushion adjustment should be made in consideration of swing strength of each amputee As a general rule however set to the value in 360 the marked range Factory g default The factory default setting setting is 1 turn to the left from the Fig 16 fully closed position Mandatory Action A WARNING Adjusting Yielding for Descending a Slope or Stairs Before descending a slope or stairs perform fine adjustments of hydraulic resistance and sensitivity Before using the prosthesis for walking on a slope or stairs perform gait training If appropriate use of yielding is judged difficult after gait training use of yielding function should be prohibited Failure to observe this instruction ma
20. ter Fig 20 e Connecting the adjusting unit perform reset A e Confirm proper resetting by hearing the motor operating sound With CAUTION proper resetting the motor will stop in a short time Note If the motor does not stop perform reset again There is a risk that battery electricity may be abnormally consumed _ 2 C 6 3 Disposal of Batteries Dispose used batteries strictly in accordance with regulations of the local government concerned This product uses a lithium battery Replacing the Cylinder Module Removing the cylinder module 1 Pull out the battery connector from the substrate 2 Remove the clevis bolt and the trunnion pin Fig 24 3 Retracting the cylinder rod and creating a space by flexing the knee slowly pull out the cylinder module from the frame Pull it out until the substrate comes above the frame A Remove the proximity switch connector which is fitted behind the substrate Installing the cylinder module 1 Insert the proximity switch connector which exists behind the substrate 2 Retracting the cylinder rod and creating space by flexing the knee slowly insert the cylinder module into the frame 3 Fix the trunnion pin and the clevis bolt Fig 24 Note 1 In order to prevent the clevis bolt from getting loose apply an appropriate amount of adhesive equivalent to Loctite 242 to the threads Note 2 Apply an appropriate amount of grease to the O ring of the trunnion
21. w for 10 Fig 11 How to Adjust Hydraulic Resistance Procedure 1 Make sure that the scale reads 10 at the projection on the window Then let the amputee stand within parallel bars Fig 12 2 Have the amputee place his or her weight on the prosthesis and confirm that yielding function works properly gt See Bont 1 3 Have the amputee feel two different levels of yielding strength by adjusting the scale as follows 1 Scale reading 0 strongest 2 Scale reading 15 weak The reading 0 is where the plug is fully closed by turning clockwise 4 Taking the reading 10 as the benchmark finely adjust the adjusting plug and choose a desirable level of strength gt See POINT 2 YBomnt 1 How to Obtain Yielding Function Three methods are available according to application of body weight LJ When body weight is applied to the heel yielding function can work EJ When body weight is applied to the toe yielding function can not work After fully applying body weight to the heel when an amputee shifts body weight toward the toe while yielding function is retained hydraulic resistance is sustainable Body weight shift A B u gt 4 W A gt ON Sustainable ON A CAUTION A CAUTION 4 1 2 Provide appropriate alignment foot selection and gait training so that an amputee can fully apply his or her body weight to the heel When heel load is insufficient yielding function may not
22. y cause a serious accident such as falling down Concerning use for walking on a slope or stairs an amputee should be fully instructed to secure safety by holding a handrail As floor conditions are not good there is a risk that the amputee may lose balance resulting in falling down In order to make the yielding function effective be sure to touch the floor with the heel first If the toe touches the floor first there is a risk of occurrence of knee buckling resulting in falling down il Fig 17a Descending a Slope Fig 17b Descending Stairs 19 C Procedure Adjustment for descending a slope e Adjustment of hydraulic resistance Select an appropriate strength of hydraulic resistance suitable for the angle of the downslope where the amputee walks in his or her daily life gt See 4 1 1 page 13 e Adjustment of the sensitivity adjusting screw When a sticking occurs at the toe off during descending a slope or when the yielding function is not sustainable make fine adjustment of the sensitivity adjusting screw gt See 4 1 3 page 16 Adjustment for descending stairs if applicable Adjustment of hydraulic resistance Select an appropriate strength of hydraulic resistance suitable for the stairsteps where the amputee walks in his or her daily life gt See 4 1 1 page 13 Fine adjustment of sensitivity Make fine adjustment of the sensitivity adjusting screw as needed gt See 4 1 3 page 16
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