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User Guide - Quantitative Muscle Assessment

1. 1 QMA v1 1 QMA v 3 4 used short file names These file names must be converted to long file names to be able to be used in qma42 see 3 7 2 QMA v1 1 qma 4 1 file format must be converted to consistent tab delimited file format used in qma42 see 3 8 3 It is necessary to complete these actions sequentially to complete them correctly 14 3 7 To Update short file names to Long file Names QMA v1 1 v3 4 Previous versions of the QMA system used short DOS file names QMA 4 0 and forward uses long file names for muscle or test names The conversion utility located in QMA will change the short file names to long file name This is the first of two steps to use older files with QMA 42 x Data files acquired with QMA v 1 1 QMA 3 4 requires both 3 7 AND 3 8 X Data files acquired with QMA 4 0 or QMA 4 1 requires only 3 8 6 XK Illustrations of each step may be found on the CD or in C UPDATE X You may be requested to provide missing information during the conversion process prior to proceeding to 3 7 1 Open EXPLORER right click START In the older QMA Directory Open double left click sysinfo txt and write down the following information 1 SITE example OSU 2 UNITS of measurement 0 Ibs 1 kgs and 2 newtons 3 PATINFO 0 is US ENGLISH 1 is INTERNATIONAL format for entry day mo year 4 PROTOCOL Not from sysinfo txt This is the protocol to convert example CREATINE gt
2. Andrew Goodman Shree Pandya Michael McDermott William Martens and Barbara Herr and QMA Systems personnel The developers of the QMA System acknowledge and express their appreciation to the National Institutes of Health NIH which has been contributory to the continuing work of QMA v 4 0 with the award of grant 1R41AR45530 01A2 dated 26 July 2000 Individuals making timely suggestions and critiquing the system include Wendy King Neurology Department Ohio State University Columbus Ohio Laura Herbelin Neurology Department Univ of Texas Dallas Univ of Kansas KS Brian Kotajarvi Neurology Department Mayo Clinic Rochester MN Lois Finch Neurology Department McGill Univ Montreal Canada Benjamin Brooks and Mohammed Sanjak Neurology Department University of Wisconsin Madison Wisconsin Barbara Polkinghorn David Tierney and Dave Mason Elan Pharmaceutical Elan Holdings Gainesville Georgia 1 Introduction Quantitative Muscle Assessment QMA is an accurate PC based MS Windows compliant maximal voluntary isometric contraction mvic fixed and hand held myometry testing system developed to objectively assess muscle strength and fatigue 1 1 Types of users In a typical setup the QMA system will have two different types of users Administrators Admin and Physical Therapists PT The Administrator has the primary responsibility of protocol setup compliance This area is password protected in th
3. The following is a recommend method to minimize difficulties 3 7 1 Install a second copy of QMA42 change the default directory to C qma42TEMP 3 7 2 Copy the protocols from the older qma to update into the qma42TEMP directory 3 7 2 1 Using EXPLORER in the older QMA version Copy each of the protocols to convert to QMA42TEMP CTRLC CTRLV EXIT out of Explorer X X If the protocols to change are in C qma42 the 3 8 conversion will attempt to overwrite the files and the conversion will fail 3 7 3 Start QMA42TEMP 3 73 1 In Explorer locate QMA42TEMP and then locate and double left click QMA EXE 3 7 3 2 In the QMA proram Go to SETUP cursor down to ADVANCE and over to UPDATE FILE MUSCLE NAMES and SELECT X The Instructions and prompts on the use of this utility are detailed on the screen 3 7 3 On the lower left ALL protocols available to the qma system will be displayed XK If the protocols to change are not present then you may be in the wrong QMA42 see 3 7 1 3 7 3 Protocols using long names will be checked Protocols to update will be unchecked Select a protocol to update by highlighting and press 1 The short names are displayed on the left suggested long names are displayed on the right 3 7 4 If the names on the right are correct then press 4 The file is now written with the long file names Proceed to 3 7 5 3 7 4 1 If they are incorrect do not depress 4 and follow the process of obtaining
4. NOTE If the patient information display is not correct the patient display screen needs to be changed Sec 2 1 2 5 2 Patients are displayed but no patient is selected Select the patient you wish to test by Double Clicking on the patient s information X HINT You can sort on the patients Name Identifier or Initials 3 Patient is shown in the Patient Identifier large rectangle area and is the correct patient to begin testing A Go to Begin Visit and begin tests 4 Patient is shown in the Patient Identifier but is NOT the correct patient to test A Go to View Patient Screen then Logout the incorrect patient Return to Begin Visit and select the patient to test by double clicking on the patient information 17 4 2 2 Finishing a previous visit If a patient s visit must be interrupted or the therapist finishes a visit prematurely it may be necessary to go back and finish a previous visit To do this select Finish Previous Visit from the File pull down menu in the Main Menu screen Please refer to 4 1 1 to select the patient to test After selecting a patient you will be prompted with a menu of previously recorded visits for that screen number Select the visit you want to finish and then press OK See section 4 1 2 about stepping through the no load calibration check before a visit After the accuracy of the calibration is confirmed the tests that were already performed during the previous visit will be di
5. OTHER This would permit keyboard entry for each test and may simplify data retrieval by the statistician These tests are not muscle specific 21 4 7 Special Testing Features 4 7 1 Rejection Annotation During testing a trial can be rejected and comments attached to that rejection these become part of the test data Comments made be made in addition to the following reasons chosen 1 Improper Test Position 2 Subject unable to maintain test position 3 Unable to test due to pain 4 Equipment malfunction 5 User Button trace started in error 6 Other with comment 4 7 2 POP UP NOTES Pop UP Notes are now available throughout the tests to make comment These comments are made a part of the acquired data the patient the visit and the specific test These are separate from rejection annotations 4 7 3 Disable Auto Stop A choice is now available in each particular test to disconnect auto stop This permits a single test to continue past maximum and continue to zero This can be used for multiple traces or to acquire data for analysis on the back slope of a particular test a HINT Myatonic Dystrophy use NOTES to indicate the release point 4 7 4 Set Zero Check Zero In a test the weight of an extremity may now be excluded from the effort exerted by the patient Example Hip Extension Place the extremity into a testing cuff Request the patient to let th
6. QMA keeps track of a patient s test data and background information based on the patient s Patient Identifier screen number 3 1 1 View Patients From the Main Menu screen select View Patients from the File pull down menu Patients may be sorted and accessed by Patient Identifier Name and Initials Double Click on the Patient s Identifier to begin a task Personal identification including the Name identifier 1s stripped from the data for viewing and printouts 3 1 2 Adding a new patient From the Main Menu screen select New Patient from the File pull down menu A new screen entitled New Patient Information appears Simply enter the patient s identifier or screen number up to 16 alphanumeric characters and background information in the data fields Move to the next field by either pressing lt Tab gt or clicking with the mouse You must enter a unique patient identifier for each patient Additionally most of the fields are checked for errata data such as numeric characters in the INITIALS field or characters other than L or R in the HAND DOMINANCE field The new patient is created and the background information stored on disk when the OK button is pressed a Hint A combination of hospital number and last name may be used for the patient s identifier in internal or referral work XX NOTE The patient s Name or identifying variation may not be used as the patient identifier in drug trials or wher
7. The Interface SM250 250 Ibf capacity may be safely overloaded to 150 of capacity 2 Physical Wiring Problems have been encountered with the transfer wiring at the head of the load cell The wiring may be flexed and have effort extended against it during normal use The continuing flexing action will cause the wiring to fatigue and break inside the wirings sheathing See NOTE X NOTE It is recommended to move the flex and pull point from the head of the load cell with use of a plastic tie to a neutral point on the body of the load cell This will dramatically reduce wiring fatigue and breakage Because this breakage is contained within the sheathing it is not apparent and may only be detected by confirming the output accuracy of the load cell Therefore we recommend using measure to confirm accuracy and inspect the wiring of the load cell for spikes or movement in measurement integrity before the testing for a day begins Once this is accomplished there may be no need to repeat the process between patients tested on the same day unless a problem is observed SS NOTE It may be advisable to have a second or replacement load cell available for testing if the primary unit is found to have a problem so the testing process is not interrupted and patients are not inconvenienced 5 8 Reverting back to the default calibration In the event entries have been made that are totally erroneous the original settings of the system can
8. an optional list etc buttons 2 amp 3 3 7 5 You will now be requested to confirm or enter the protocol information SITE PROTOCOL UNITS and PATIENT INFO enter or confirm each and OK 3 7 6 This concludes this portion of the update on this protocol select the next protocol 3 7 7 When all of the protocols to convert are completed depress DONE and LOGOUT of SETUP Go to FILE and LOGOUT and then QUIT the QMA program at this time XX HINT Do not open the new file at this time until section 3 8 is read amp completed satisfactorily 15 X NOTE QMA 42 has a more consistent file structure to permit the exporting of files to MS EXCEL Data acquired with previous versions of QMA do not have the improved file structure In the event you wish to utilize the Export to Excel function of QMA 42 with previously acquired data then that data must be updated to the qma42 format The following instructions located in Sections 3 7 and 8 8 are written to expedite the conversion Please follow these instructions to avoid encountering undo difficulties Previously acquired data qma 1 1 3 4 short name files must be converted to long file names use section 3 7 PRIOR to using section 3 8 Data files acquired with QMA 4 0 and 4 1 may use this conversion utility only to permit use of the qma compiler and query in QMA42 see 3 8 5 3 8 Change format of previously acquired qma data to work with current qma 3 8 1 On th
9. are now ready to begin a new trial or end the test You should see a red X to the right of the trial indicator denoting a rejection for that trial Single click to continue to test this muscle or hold the button down for a count of seven to move to the next muscle in the testing sequence See Sec 1 6 4 4 4 Displaying all trial measurements Normally only the measurements for the current trial are displayed on the test screen Measurements for all trials can be displayed by pressing the ALL button to the right of the READY button A new window appears with the measurements for all trials displayed If there are more than three measurements for the fatigue tests you can scroll through the list by pressing the on screen left and right arrow buttons immediately above the numeric displays If there are more than seven trials you can scroll through the trials by pressing the on screen up and down arrow buttons to the left of the numeric displays Press OK to close the window After displaying all the trial measurements you cannot enter ready mode by simply pressing lt Enter gt you must either press the hand held button or press the on screen READY button 4 4 5 Ending the test After accepting or rejecting a trial or before starting the first trial you can either start another trial or end the test There are three ways to end the current test 1 Begin the next test in the sequence This is done by either holding down the
10. menu in the Main Menu screen A screen entitled Test Parameters appears 2 4 1 Strength measurements Strength tests report the following three measurements 1 Maximum The maximum force attained 2 Rise time The time it takes for rising edge of the data to go from 10 to 90 of the maximum You can change both the lower default 10 and upper default 90 threshold values 3 Sustain time The amount of time the force remains above 70 by default of the maximum You can change the 70 default value 4 Coefficient of effort Peak rate of force development Observing the slope rising from a resting point to peak force interatively and determine the fastest rate of force increase in the slope the steepest slope It is the point on the curve where the greatest number for the change in force newtons change in time sec may be observed 2 4 2 Static fatigue measurements Static fatigue measurements operate on five different time regions of the acquired data waveform For each time region the maximum value average value and area under the waveform curve can be calculated To define a time region click the numeric control underneath the MEASUREMENT PARAMETERS label in the STATIC FATIGUE section of the Configure Tests screen This control should only display a number one through five to indicate which interval you are modifying The controls under the INTERVAL label define the region in time The checkboxes indicate whi
11. visit number are correct E Begin Test Manually select the test sequence by highlighting category test amp side A manually selected test example Strength Elbow Extension Left or F Begin Sequence Pre selected test sequence described in 4 2 2 G USING THE REMOTE SWITCH Click on Ready press button notice ready flashing then when you are ready to test press button again and the test will begin SS NOTE DEMO use the ENTER key H To Accept the trial effort or trace Click the button To test the same muscle Repeat G l Following acceptance of the final test of this muscle HOLD DOWN the remote switch to a count of seven 7 this will advance the test to the next test in the sequence Repeat G amp H to test this muscle To end this test repeat K or after accepting the final trace select END TEST A manual selection of the next test can be made Choose the category test and side When a trial is not acceptable HOLD DOWN the remote switch to a count of seven 7 and a rejection screen will appear Select the correct reason and annotate NOTE A note can be made at any time and is included in the acquired data To end the testing and the visit END TEST then select File then End Visit 3X ETAT O To conclude this tour and exit the system select File then Logout This takes you back to the Login Screen R Select QUIT this returns you to the desktop of Windows 9x or ME 1 7 Y2K Statemen
12. visits After selecting the appropriate visit and recording a comment as to why this visit is being deleted press the OK button Any data recorded in the deleted visit is NOT removed from the hard drive and WILL be copied to floppy disk with the remaining valid visits but is NOT accessed for analytical evaluation If you delete the most recent visit QMA will retest that visit the next time the patient comes in If you delete a visit other than the most recent one the deleted visit must be manually enumerated to test Testing sequence will resume 3 3 Print amp View Results QMA provides the option of viewing results and or printing acquired data in individual tests and printing visit summaries When printing QMA uses the printer driver setup under MS Windows Other MS products including EXCEL are available to print and plot raw data when needed See section 3 4 USING the qma compiler query engine and export to EXCEL 10 X NOTE Do not attempt to print while a patient is being tested 3 3 1 PRINT TESTS Printing and Viewing individual tests graphically Printing or Viewing in this manner will present the results of a single test much as it appears on the test screen When PRINT TESTS is selected you have the option to view the test cancel or print You may view longitudinal testing of one muscle without printing If you select the option to print many tests at the same time please be aware that each test of a p
13. 3 Disconnect Auto Stop A choice is now available in each particular test to disconnect auto stop This permits a single test to continue past maximum and continue to zero This can be used for multiple traces or to acquire data for analysis on the back slope of a particular test X lt HINT Myatonic Dystrophy use NOTES to indicate the release point so measurement of the back slope may be analyzed 2 6 Other setup parameters The administrator also must specify other setup parameters such as the data acquisition rate 2 6 1 Data acquisition rate The data acquisition rate may be set at your discretion Admin or in accordance with parameters established by a protocol A range of 10 to 50 points per second may be set for the acquisition of data These will be seen as data points in the protocol file For example a fatigue test set to run for 30 seconds at 30 points per second would have 900 data points acquired when run to anticipated completion An increment of time is displayed to the left of each data point Timing is now an integral part of the acquisition function Algorithms and programming method have changed to provide more accuracy and co relation of the data points to the time and effort expended 3 Database Management Database management involves updating accessing and printing patient information and data files 3 1 Entering patient information XX HINT Make certain you are in the correct PROTOCOL
14. 6 2 3 CHANGING THE TEST SEQUENCE csssssscccececsesssececececsessnaececeescsessaaeceeececsessaaecesececsensaaeaecececeesenssaeeeeeens 6 2 4 DEFINING THE MEASUREMENTS einen a a a r a NE e ESENE 6 24 1 Strength measurements ieie Eeee SE E aE EE EEO NeVeR EE ENNEN 6 2 4 2 Static fatigumeasurements sn 6 2 4 3 Static Fatigue Analysis Models 7 2 4 4 Dynamic fatigue measurements ss 8 2 5 SETTING OTHER PARAMETERS cccsssesssceeececsesnsaececececeesssaececececsensauscecececseneaueaeseeeceesenneaeeeeseeesensaaeees 8 2 5 1 Time out 00 en x ARR De RTS E AAEE nn TS R D PRE 2 8 2 52 AUO STOP SEINE EE 8 2 5 3 Disconnect Auto Stop irere nie hae iia ein i ip E r 8 2 6 OTHER SETUP PARAMETERS suisses a a a a E R a O ES 8 CO NR E Ee 8 3 DATABASE MANAGEMENT 9 3 1 ENTERING PATIENT INFORMATION 9 31 1 Mea enee ts A EAEE E nn nt nee ST et em E 9 3 1 2 Adding a new patent egen 9 3 1 3 Editing an existing patient s information cece eceesecseesecseeeeceseeecsaecaeesecnersecsaeecesaecateseeneaes 9 3 1 4 Referring Physician amp Diagnosis 9 3 2 KEEPING TRACK OF VISITS AND PATIENT 10 3 2 1 Updating and Viewing Patients Visite 10 3 2 2 Chansine the Visit Numbers rites nn Ee SEENEN ER 10 3 23 KEE 10 3 3 VIEWING AND PRINTING RESULTS ccccccesssssscecececsessssececececsesescaesecececsesaaececececsessaaeseeececsenenssaeeeeeens 10 3 3 1 Viewing and Printing gr
15. BMI Information Height Ft In or Kgs amp h Weight Lbs or Kgs Diagnosis Referring Physician Test Date L l Time of Test m Testing Measurement Units LB KG N Dan Er Oo FAT Cu CN 4 9 3 2 The Testing Area is automatically populated with the following Baseline Test designated by user to be the baseline first test or comparison test This Test Test designated by user as the second or comparison test Mean An average of predicted normal based on age gender and BMI Either side of Mean acceptable or designated acceptable deviation from normal Change in Percent Change from one test to the next Last Test Predicted Change An increase or decreased amount to the expected Mean This Test Predicted Change An increase or decreased amount to the expected Mean Total Upper Extremities Total Right amp Left Total Lower Extremities Total Right amp Left QC bh OD D D 4 9 3 3 The Areas for evaluation include the following a Interpretation Area to enter evaluation comments or notes b Physician c Physical Therapist d Place mark x in Header 1 Verify diagnosis 2 Disability Evaluation 3 Evaluate Response to Therapy 4 Research 5 Physician add Name X NOTICE All data and argument fields are protected to maintain data integrity 26 4 9 4 Howto Use the Progress amp Evaluation File X NOTICE Before you begin with the QMA P amp E File please go to Explorer and locate the P
16. HOULDER EXTENSION LEFT To discard any changes you made while in the Test Definitions screen press the CANCEL button SELECT INPUT EQUIPMENT A list of available input equipment may be seen by scrolling down in SELECT Choose the input equipment for this test for each side and OK To accept changes press OK gt NOTE check the test names format before making new files It is your responsibility to make certain filenames are not repeated To view the file format and see which filenames have already been used in explorer examine but do not modify the C QMA protocol TESTINFO TXT file Open with Explorer then Note Pad WordPad or MS Word 2 2 2 Editing a test Use LONG File Names To edit a test first select the desired category and test in the two selection boxes in the Test Definitions screen and then press the EDIT button A box appears with the current definitions for the selected test Consult section 2 1 1 above for information on the entries for this box S NOTE If a test does not have the correct file name delete the test and make a new test Do not change the file name of an existing test at EDIT Edit prior to initializing testing X NOTE To change the filenames from short file names to long file name see section 3 5 2 2 3 Deleting a test X NOTE Deleting a test is important make certain your are in the correct protocol To delete a test first select the desired category and test in the two selection b
17. MEDICAL This manual is written using MS Office 97 amp updated with Office XP amp 2007 With the manual on line a search may be made in MS Word of any topic or word combination Go to EDIT and then FIND type in your word and a search will be made of this manual Organization This manual is compiled as an operationally progressive set of instructions utilizing commonly accepted nomenclature for a user that is experienced with MS Windows operating systems and products Contribution Those contributing to the programming and validation of this system include James Fielding Managing Director Hardware Compliance System Quality Assurance co author User Manual Revisions QMA Report Generator Craig Petrie Senior Programmer co author QMA system co author User Manual Robert Sandage Programmer co author QMA system Revisions Daqtron Inc CEO Matthew Kelton Daqtron Programmer Upgrades Revisions v 3 0 v 3 4 Jason Smith Daqtron Programmer v 4 0 Improvements amp Enhancements Jason Smith Ind Contractor v4 1 v4 2 Query Engine Data converter Multiple Device Matthew Kelton Ind Contractor Upgrades Revisions vXL QMA Report Generator Acknowledgment Many improvements of QMA 4 0 are a direct result of collaborating efforts with Charles Thornton and the personnel of the Neuro Muscular Disease Center at the University of Rochester Rochester New York including Richard Moxley Rabi Tawil
18. Quantitative OMA Muscle Assessment copyright 1997 2010 James Fielding USER GUIDE AEVERL MEDICAL LLC www AEVERL com P O Box 170 Gainesville GA 30503 Quantitative Muscle Assessment QMA Contract 770 983 1369 JRF AEVERL com 2010 James Fielding All Rights Reserved Table of Contents LICENSE AGREEMENT 55325 nn Eee nee Re RL aaah AE ed ns A SOFTWARE LIMITED WARRANTY sise B HARDWARE LIMITED WARRANTN AAA C A ABOUT THIS MANUAL I INTRODUCTION nn nier Ana retenu lh seth inter ee Ee ES 1 Lt E e OB USERS EE en eee 1 Se ba ENEE KEE 1 E E OGGINGIN DEE 1 LAP ABOUT OMA EE 1 1 5 INITIALLY SPEAKING BASIC SITE amp PROTOCOL Sub 2 L QMA SYSTEM TOUR AND TUTORIAL eege sbckaesacthad asa ssascests sek eatin Eege 3 1 7 Y2K COMPLIANCE STATEMENT einen ceccecenenenececeecenenene secs Ee pnrt Near eneee 3 Ds TEST SETUP nn nn as seo ahaa vob den eee ent EOS RRS 4 2 PROTOCOE SITE ER D 4 2 1 1 Protocol Identification en dee SE fades da cada Ee EE SEENEN EE DEEN A 2 12 Setup a EE A E We EE A 2 1 4 Measurement Units cccc cc cccccccsscssccccecsessssscesccscseseesssscecceesssesssssceceessessssscsceesessssseseesesseesseesees 4 2 1 5 Patient Information Display ege ie gieg stets deg deier ain e Eed Eege A 2 2 TEST NAMES TEST DEFINITION ccsscsccccccecsesssececececsessaaececececeensasececececseseaeaesececeeseseaeceeeeeesenseaeees 5 2 21 Adding EE 5 2 22 Fait Sa EE 5 2273 Deleting EE
19. VERL s current standard pricing terms and conditions RESTRICTED USE You may not copy the software except for backup or archival purposes Any such copy made by you shall be subject to this Agreement and shall contain all of AEVERL s notices regarding copyrights trademarks and other proprietary rights as contained in the Software originally provided to you You may not lend rent lease or otherwise transfer the Software TITLE Title ownership right and intellectual property rights in and to the Software and Documentation shall remain in AEVERL and or its suppliers This agreement does not include the right to sublicense the Software and is personal to you and therefore may not be assigned by operation of law or otherwise or transferred without the prior written consent of AEVERL You acknowledge that the Software in source code form remains a confidential trade secret of AEVERL and or its suppliers and therefore you agree not to attempt to decipher decompile disassemble or reverse engineer the Software or allow others to do so except to the extent applicable laws specifically prohibit such restriction You further agree not to modify or create derivative works of the Software U S GOVERNMENT RESTRICTED RIGHTS Use duplication or disclosure by the U S Government is subject to restriction as set forth in subparagraph 1 ii of the Rights in Technical Data and Computer Software clause at DFARS 252 227 7013 or subparagraphs 1 1i o
20. a Archiving data involves copying the QMA data files stored on the system s hard drive to either a floppy disk or other storage media zip drive jazz drive or CRW CD 3 6 1 Saving data To copy the acquired data from the system s hard drive to another medium select Copy Data from the File pull down menu in the Main Menu screen A window appears and you are given three options 1 copying all the data files in the system ALL PATIENTS ALL VISITS 2 copying all the data files for all visits of a particular patient ONE PATIENT ALL VISITS or 3 copying all the data files from one visit of one patient ONE PATIENT ONE VISIT If you select the second or third option you must also specify the patient s screen number If you select the third option you must also specify which visit to print You cannot copy individual data files Visit summary files will also be copied along with raw data files If you select the first or the second option the appropriate files containing patient background information e g name screen number height weight etc will be copied as well Files or Protocols may be copied or archived from a DIRECTORY level using Explorer QMaA is located on the C drive default C QMA QMA42 or QMAXL open that directory and you will find your PROTOCOLS listed The patients and their respective visits reside in those protocols Simply select and copy protocols to your designated media 13 3 6 2 Direc
21. and the visit number of the bad visit and press OK If the deleted visit is the most recent visit for that patient that patients visit number will be properly updated If the deleted visit is not the most recent the visit number may have to be manually corrected 4 8 5 A visit was partially completed with valid data but ended prematurely and needs to be fully completed Select File and then Finish Previous Visit Enter the screen number of the patient in the prompt that appears Then select the visit that needs to be completed in the screen that appears 23 4 8 6 4 8 7 4 8 8 4 8 9 4 8 10 4 8 11 PT wants to move to next test but the button switch is depressed too short a time and the same test is available amp the header is flashing red Start the test short button depress stop the test sbd reject the test long depress 6 7 seconds select TRACE STARTED IN ERROR and OK Move to the next test by selecting NEXT TEST or END TEST and select the test Remote button is depressed too long A new test is available and the desired test was skipped or closed out early Whenever you are in a test you do not want to test select CANCEL At the Main Menu go to FILE and select FIX TESTS Select the category test and side that was missed and DELETE then OK The missed test is now available to continue testing Graph is not displaying effort exerted QMA 42 XL Input equipment may not be selected correctly fo
22. aphical data 11 3 3 2 Viewing and Printing visit SUMMATICS 2 0 0 eee eeeseceeeseceeeecseeeceseeecaecseesecnerecsaeeeceecsaeeeeeaees 11 3 4 EXPORT ACQUIRED DATA TO MS ESCH 12 3 5 CONSTRUCTING EXCEL TEMPLATE amp QMA DATA 13 3 6 ARCHIVING DATA tee hard geesde EES ee 13 3 6 1 Saving data on a floppy disk or other Media 13 3 6 2 Dir ctory and file Structure 2 254230 tata ege Seed ehhh nina eae 14 3 6 3 Importing Data for other QMA Systems 14 3 7 UPDATE FILE AND MUSCLE DEFINITIONS SHORT NAMES TO LONG NAMES QMA V 1 1 V3 4 15 3 8 CONVERTING PREVIOUSLY ACQUIRED DATA TO USE CURRENT QMA VERSION QMA V1 1 4 1 16 e PERFORMING TESTS 555 ne DR ARR PE en eee gee amie eee 17 4 1 NO LOAD LOAD CELL amp HAND DYNAMOMETER E 17 4 2 BEGINNING A VISIT ses ne me tres tree sm nt fe osent etes st annee nt nn en ete 17 4 2 1 Beginning a New Visit cccccccesceesccesecssecnecececaeeenecncesscesscesecseesscescenseeeseesaecaecsnecseeeeneennees 17 4 2 2 Finishing a Previous Visit s a en in tn eh ne ne 18 4 3 SELECTING WHICH TEST TO PERFORM o oreo en eoi nare Enee ENE EEEo EE p EEES EES E E E EEEE E eetos 18 4 3 1 Selecting tests Individually AAA 18 4 3 2 Following the test ROUER genie meet ane E 19 4 4 STRENGTH AND FATIGUE TESTS eebe ed mn sente ne te ne ne E E E EE 19 441 Beginnings atrial ses dE ace ARR ES ate isa ee RER CA eee Eeer 19 4 4 2 Ending a taleko Eees e nn ane ea trier enter ti tt ten ne
23. apist states Ready and presses the hand held button at the same time to start the data acquisition then exclaims GO This will produce a zero starting point for the trace Be consistent on the time between Ready and Go If an exerted effort is desired at the origin of the trace exclaim GO and start the acquisition simultaneously Clicking in the small circle labeled GO in the bottom right corner of the screen or simply pressing lt Enter gt will also start the data acquisition 4 5 2 Ending a trial The test can be ended by either depressing the red button or click on end test 4 5 3 Accepting or rejecting a trial See 4 4 3 on accepting or rejecting options 4 5 4 Displaying trial data Trial data can be observed by selecting the trial number or depressing the scroll bar 4 5 5 Ending the test See 4 4 5 on ending and continuing a test 4 6 Other tests Other tests results or simple data entry that will be associated with the visit can be made by utilizing this area See adding a test 2 2 1 X Hint Record Height and Weight during a longitudinal study Do you want to observe the height and weight of patients during a longitudinal study Then add Height and Weight as two tests in Other Tests Each time the patient is tested these tests will be completed X Hint Data transcribe MMT data MMT data can be transcribed into QMA by setting up a test in the protocol under the fifth test category
24. atient s visit will occupy one page Results from strength and fatigue tests will be printed on a graph with the measurements listed below Results from the stopwatch and other tests will look like the test screens for those tests To print or view a test select Print Tests from the File pull down menu in the Main Menu screen A new screen entitled Print Results appears 3 3 1 1 To print or view a single test from a patient s visit first select the patient s identifier or screen number in the SCREEN menu Then select the desired visit in the VISIT menu Finally select the desired test to view print in the TEST menu Only tests which were completed for the selected visit will be highlighted 3 3 1 2 To print or view all the tests in a particular visit press the ALL button underneath the TEST menu label and make sure the correct visit is selected 3 3 1 3 To print a particular test for every visit press the ALL button underneath the VISIT menu label then select the test to view print A8 Now you may view the progress or degeneration of a particular muscle of a patient longitudinally by selecting several visits and one test X HINT Print Tests generates one page for each test Print Test has the advantage of generating graphs and data but uses more paper Print summary combines the tests does not print graphs but minimizes paper usage 3 3 2 Print Summaries As each test is performed during a particular visit results
25. ations as accessible backup files This will minimize the opportunity for difficulties in the future 27 5 Checking Modifying Confirming Calibration The Unit of measurement can be selected at the time of measuring 5 1 Performing a simple measurement confirm accuracy To make a simple measurement to quickly check the accuracy of an input device or to make certain an input device is functioning prior to testing the following is suggested release any force or weight on the input equipment chosen and select CALIBRATE then NO LOAD scroll through the input equipment and select the input device Then choose PROCEED and OK Now select MEASURE and place the weight or force to measure The unit of measurement may be changed as needed The measured weight or effort exerted will be displayed Select Cancel or Done when completed SS NOTE To confirm the accuracy of the input equipment update the working files with the most recent weight measurement algorithms and append the QMA Calibration Log Directory QMA Cal Log use CHECK amp TWEAK as described in 5 3 5 2 The function of No Load NO LOAD will zero the selected input equipment Remove all force and weights that are not part of the measured effort and select CALIBRATE then NO LOAD scroll through the input equipment and select the input device Then choose PROCEED and OK S NOTE NO LOAD forces a zero measurement on the selected input equipment and does n
26. be retrieved by selecting Back to Default S NOTE Unfortunately this also includes the original dates of calibration 5 8 Full calibration for the strain gauge with authorization only The accuracy of the system has been certified by an agent of the GA Dept of Agriculture Scales and Weight The functionality of this section currently remains and is self explanatory in its method of action X NOTE Itis strongly recommended that Check amp Tweak be utilized by users of the qma System for all calibration confirmations and adjustments Calibration Problem We suggest you call the AEVERL help desk 770 983 1369 or Fax 770 983 4009 or email at support QMASystem com 30 6 File Structure and Format 6 1 File Structure and Format Located within QMA C drive default the PROTOCOL is the parent directory Each Patient has a unique information directory sorted by patient identifier or screen number under the Protocol directory Files are tab delimited and may be accessed through Microsoft Notepad WordPad Word or Excel Each visit of that patient opens a new directory under his patient identifier or screen number with the data of that visit building individual files and a summary file of the requested data of each test All files are stamped with time and date to protect the integrity of the data Unaccepted trials or visits are noted with XXX 6 1 1 PATIENT HIERARCHAL DATA LINKING C QMA PROTOCOL M
27. button to a count of seven or pressing the NEXT TEST button Make sure to hold the button long enough a single click will begin a new trial See section 4 2 2 for more information on following the test sequence 2 End the test and return to the Main Menu screen This is done by pressing the END TEST button This will save all the trial data on the hard disk and close the test screen From the Main Menu screen you can either choose the next test end the visit or perform other QMA tasks 3 Cancel the test and return to the Main Menu screen This is done by pressing the CANCEL button The data will not be saved and the test can be retaken later 20 4 5 Stopwatch tests A stopwatch is integrated into the qma program utilizing the accuracy of the processor of the pc or notebook 4 5 1 Beginning a trial Before beginning a trial it is important to make sure the title of the screen matches the test you intend to perform The current trial number is displayed underneath the TRIAL label at the bottom of the screen Before preparing the patient for the trial press the hand held button once to enter into ready mode You can also press the READY button or simply press lt Enter gt to enter into ready mode Ready button will blink slowly and for all trials except the first the trial indicator will increment by one The patient should be prepared for the test at this time the next push of the remote button will begin the trace The ther
28. ch analyses will be applied to this time region These measurements are named W XXX in the data reports where is the interval number and XXX is either MAX AVG or AREA 6 2 4 3 Static Fatigue Models Excerpt as published by Journal of Rehabilitation Research and Development Volume 39 Number 2 March April 2002 Pages 211 224 Fatigue in multiple sclerosis Current understanding and future directions Steven R Schwid MD Melissa Covington BS Benjamin M Segal MD Andrew D Goodman MD Neuroimmunology Unit Department of Neurology University of Rochester Medical Center Rochester NY http www rehab research va gov jour 02 39 2 schwid htm also Schwid SR Thornton C Pandya S et al American Academy of Neurology 1999 743 750 C 6c Modeling fatigue analysis Three methods have been used to analyze fatigue during sustained maximal contraction The simplest method is to express maximal strength at the end of the contraction as a ratio with the initial strengt model 1 below Alternatively Bigland Ritchie and others found that force generation by small intrinsic hand muscles declines linearly during sustained maximal contraction The slope of the force versus time curve provides an indicator of fatigue However we found that this method was not suitable for larger muscles because the decline in force generation was non linear when we inspected individual and mean normalized for peak strength of eac
29. d To finish a previously started visit consult section 4 1 3 2 2 Changing the Visit Number Qualifying or Pre testing for a particular protocol PRTO0001 or other changes in the visit number may be required and can now be accomplished When beginning a visit continue the sequence if the visit number is correct or change the visit to the correct visit number View Visits if a question exists concerning the correct visit number Visit numbers can lead with 3 alpha characters and follow with up to 5 numeric characters Visit numbering will automatically sequence from the last visit number To Change the Visit Number Choose patient begin visit if the visit number is incorrect Change the visit number highlight the visit number and change then continue the testing sequence 3 2 3 Deleting visits If a user mistakenly begins a visit he or she should immediately end the visit However an extra visit will be added to the screen number that the visit was initiated with In this case the new erroneous visit may be deleted for QMA to correctly keep track of the visit number To accomplish this select Delete Visit from the File pull down menu in the Main Menu screen You are then prompted for the patient s screen number If you have only the patient s name see section 3 2 3 After entering the screen number and pressing OK or just hitting lt Return gt a small window appears with a menu that contains the patient s recorded
30. e Main Menu The Physical Therapist is responsible for the accuracy and consistency of the data collected These responsibilities include verifying the accuracy of the system periodically and testing each muscle group as directed by a protocol 1 2 Types of tests The different tests performed by QMA are categorized by the type of action required by the patient and the measurements associated with each test Currently there are five types of tests that can be performed with QMA 1 Strength The patient exerts the maximum possible force for approximately three to eight seconds Maximum force achieved rise time sustain time and coefficient of effort are calculated See Sec 2 4 1 2 Static Fatigue The patient tries to sustain a maximum possible force over a longer period of time 15 40 seconds Average force maximum force and area are calculated for up to five different time regions See Sec 2 4 2 amp 2 4 3 3 Dynamic Fatigue The patient repeatedly exerts and releases approximately once every second with the maximum possible force Maximums and averages are calculated using the peaks of the exerted force Area is also calculated Only three time regions are analyzed See Sec 2 4 4 4 Stopwatch The patient tries to perform a task such as walking or running a marked distance in the least amount of time possible Time not force is measured 5 Other Other tests allow for keyboard input that is associated with each test and is
31. e desktop Open the QMA converter 3 8 2 Ok to open the converter al converter ico Select protocol to convert 3 8 3 Using the scroll bar locate QMA42TEMP on the C drive 3 8 4 From your list 3 7 locate a protocol to convert in QMA42TEMP 3 8 4 1 Double left click highlight folder amp select Select Cur Dir on lower right The Protocol must be listed in the header to be accepted GO to 3 8 6 gt QMA 4 0 and QMA 4 1 ONLY For data acquired in qma4 0 and 4 1 ONLY 3 8 5 Using the scroll bar locate the qma40 or 41 directory on the C drive 3 8 5 1 locate a protocol to convert 3 8 5 2 Double left click highlight folder and select Select Cur Dir on lower right 3 8 5 3 The Protocol must be listed in the header to be accepted 3 8 5 4 Go to 3 8 6 Select placement of converted folder 3 8 6 Select the C QMA42 Directory 3 8 6 1 Using the scroll bar locate QMA42 on the C drive 3 8 6 2 Double left click QMA42 folder amp select Select Cur Dir on lower right 3 8 6 3 The QMA42 directory must be listed in the header to be accepted 3 8 7 The conversion process is automatic and will end with DONE 3 8 7 1 Start QMA42 change protocol to one of the converted protocols and follow the instructions on exporting data to Excel 4 Performing Tests 4 1 No Load Load Cell and Hand Dynamometer Upon beginning a test a large box listing the different muscle tests should appear You are then step
32. e extremity rest with no effort exerted Select Zero Test and then Ok To check that the weight of the leg is negated depress Check Zero Perform the test on Hip Flexion Set Zero is for a single trial each additional trial trace will require 2 amp 3 to be repeated 7 Upon the conclusion of this test the load cell resumes its normal zero setting O O1 R D 4 7 5 Change Visit Number To Change the Visit Number choose patient begin visit if the visit number is incorrect Change the visit number highlight the visit number and change then continue the testing sequence Sequencing will continue on the last digits 4 7 6 Change the Y Axis Limits In a test the limits of the Y axis or vertical axis may be changed by highlighting the limit and changing as desired This affects the immediate test only and may be made during a test To make a permanent change go to Setup and change the individual test graphing attributes Example of use Ankle Dorsiflexion The upper limit is too high change and continue testing 22 4 8 Correct a Test or a Visit While visits are updated automatically and cannot be tampered with the QMA system is capable of handling or correcting problems encountered in muscle testing and data acquisition In the File menu select Fix Tests Finish Previous Visit or Delete Visit depending on the problem experienced in gathering information and the following examp
33. e the confidentiality of the patient may be compromised 3 1 3 Editing an existing patient s information To change a patients background information to a patient go to View Name Screen ID and select patient to edit select Edit Patient from the File pull down menu in the Main Menu screen You can then edit this information in the same way you would enter a new patient s information as described in the previous section a If the patient is displayed in the current patient box simply choose Edit Patient from the File and proceed with the necessary changes 3 1 4 Referring Physician and Diagnosis Entries for Referring Physician and Diagnosis are now available to add to your patient s information sheet This information when completed and will print on requested Summary test forms 3 2 Keeping track of visits and patients 3 2 1 Updating and viewing visits QMA will automatically keep track of visits The current visit for a patient will be displayed when that patient is being tested To quickly view the number of recorded visits and the date of each for a particular patient select View Visits in the File pull down menu in the Main Menu screen Select the screen number from the provided menu using the mouse You may also use the lt Tab gt key to highlight the menu and then use the up down arrow keys to scroll through the list of screen numbers The date and time displayed is the date and time when the visit was last modifie
34. easurement info Test Names Test Order Patient ID Visit Number testing data and Summary File X Hint In Notepad Under file and format Set the global Font to 10 to correct word wrapping and data carrying forward XX NOTE The current protocol in use by QMA may not be replaced or transferred In QMA select or make a new protocol and select it as the current protocol close QMA amp then copy or replace desired protocols XX NOTE It is strongly advised to NEVER USE NEW PROTOCOL as an active testing protocol NEW PROTOCOL may be overwritten with updates 6 2 Maintaining directory and file structure copy or backup Patient information and the location to copy or backup may be selected 6 2 1 1 In FILE scroll down to COPY 2 Use scroll bar to choose on of the following a All patients all visits b One patient all visits c One patient one visit 3 Use the locator to choose the drive or media and OK 31
35. en 19 4 4 3 Accepting or rejecting mal 20 4 4 4 Displaying trial data 20 AAS Ending EE 20 4 5 STOPWATCH E 21 4 5 1 Begining a tal satis Baines ENEE Sieh he aie AU pe ae eed 21 4 5 2 Ending tal niet EE EE wie ewe eR ee eee 21 4 5 3 Accepting or rejecting a Dal 21 4 54 Displaying trial data inei ne etes nes tent eene bete eurent ay 21 455 Ending the test vecscosce ch seess geed lee dere de E 21 4 0 OTHER TESTS ebe gege eege 21 47 SPECIAL TESTING FEATURES henges dousi ie aose msn nue te cutee ele tn oil edit 22 4 7 1 Trial Rejection Annotatton seen 22 4 7 2 Pop Up EE 22 473 Disable Auto Stop ees ASSEN EES 22 ATA Set Zero Check Zero TEE 22 47 5 Change visit NUMDET y io iE a EES 22 4 7 6 Change Set Y axis Limits eet EE E aE ate EE NEER EKE Ta e 22 4 8 CORRECTA TEST KVISTE eege E A AA E A 23 4 8 1 5 Examples of testing problems ses 23 4 8 6 11 Examples of testing problems ss 24 CR WE EE 25 4 9 1 View Test Results within the qma program 25 4 9 2 View Test Results qma compiler query engine and export to MS Excel 25 Optional 4 9 3 View Test Results QMA Patient Progress amp Evaluation Report 26 amp 27 5 CHECKING PERFORMING CALIBRATION unir snernrerenrenennennesnesse seen 28 30 5 1 Performing a simple measurement ss 28 5 2 The Function of no load sise 28 5 3 Checking and Tweaking the calibration ss 28 5 4 Calibration Weight a product of the load cell 29 5 5 Cal
36. f the Rights in Technical Data and Computer Software clause at DFARS 252 227 7013 and in similar clauses in the NASA FAR Supplement Contractor Manufacturer is AEVERL MEDICAL P O Box 170 Gainesville GA 30503 MISCELLANEOUS This Agreement represents the complete and exclusive statement of the agreements concerning this license between the parties It may be amended only be a writing executed by both parties If any provision of this agreement is held to be unenforceable for any reason such provision shall be reformed only to the extent necessary to make it enforceable and such decision shall not affect the enforceability I of such provision under other circumstances or ii of the remaining provision hereof under all circumstances Headings shall not be considered in interpreting this agreement This Agreement shall be governed by and construed under Georgia law as such law applies to agreements apply to Georgia residents entered into and to be performed entirely within Georgia except as governed by Federal Law This Agreement will not be governed by the United Nations Convention of Contracts for the International Sale of Goods the application of which is hereby expressly excluded Copyright 1996 2010 AEVERL MEDICAL James Fielding P O Box 170 Gainesville GA 30503 USA Sales amp Customer Support 770 983 1369 NOTICE AEVERL MEDICAL reserves the right to make improvements to the product described in this manual at any time and
37. for each test are appended to a summary file for the entire visit The summary file contains the date and time of each test and all the measurements associated with that test for each trial 3 3 2 1 To print a visit summary select Print Summaries from the File menu in the Main Menu Screen A window appears and you are given three options 1 printing all the visit summaries in the system ALL PATIENTS ALL VISITS 2 printing all visit summaries for a particular patient ONE PATIENT ALL VISITS or 3 printing one visit summary for one patient ONE PATIENT ONE VISIT If you select the second or third option you must also specify the patient s screen number If you select the third option you must also specify which visit to print With the proper selection made press OK to start the print job For every summary that will be printed you will see a window of text quickly flash on the screen and then disappear QMA calls C WINDOWS NOTEPAD EXE to call up each visit summary a text file and send the file to the printer XX NOTE You must not resume testing a patient until the printer stops printing 11 3 4 Exporting acquired qma data to MS EXCEL Acquired data from the current protocol or other protocols may be selected for comparative analysis in MS Excel AS NOTE the QMA compiler and query engine exports to MS Office EXCEL XP and 2007 MS Excel must be in place prior to using this function and options set to process macros origina
38. for the trial press the hand held button once to enter into ready mode You can also press the READY button in the bottom left corner of the screen or simply press lt Enter gt on the keyboard to enter into ready mode Ready will blink slowly and for all trials except the first the trial indicator will increment by one The patient should be prepared for the test at this time by placing the patient hand grip and or connectors and strain gauge in the appropriate position The therapist then exclaims GO and presses the hand held button at the same time to start the data acquisition Clicking in the small circle labeled GO in the bottom right corner of the screen or simply pressing lt Enter gt will also start the data acquisition Slight variations to this beginning sequence may be made to begin the test on SET with the patient starting his effort on GO X HINT Beginning the trial on Set and the patient s effort beginning on Go will display a zero baseline prior to the patients efforts being displayed 4 4 2 Ending a trial Under normal circumstances the trial or data acquisition will stop automatically However a trial can end in a variety of ways e when the therapist again presses the red hand held button only try to stop with the button after a few seconds into the trial e when the end of the graph has been reached this is the time out time see section 2 5 1 e when the therapist cl
39. g for an active testing system PCI Analog Digital converter SCSI III to DB25 cable wiring enclosure hand dynamometer strain gauge and remote button Each piece of equipment has unique connectors Make all connections secure The use of power surge protection or Uninterrupted Power Supply UPS is strongly recommended 1 5 3 Site and Protocol Preparation FAST START To begin the basic configuration of your system please LOGIN using your initials amp OK This will take you to the Main Menu Screen Under Setup select GENERAL PROTOCOL A password is requested to enter this function the default password is qma amp OK Protocol Setup Go to SETUP then SITE PROTOCOL SETUP and then GENERAL PROTOCOLS Highlight NEW PROTOCOL and select NEW Enter a name for your protocol Suggest LEARN amp OK To the left Under GENERAL change the following 1 TEST SITE Identify your site example MAYO MN or OSU MND 2 PATIENT INFORMATION English American or International 3 UNIT OF MEASUREMENT Kg Lbs or Newton Select UPDATE RENAME your new protocol LEARN should be displayed Place an x in the area that states Make this the current protocol and OK and DONE X NOTE TEST MUSCLES and TEST ORDER are already setup in your protocol SS NOTE To setup different muscles to test or their testing order refer to section 2 1 and 2 2 G You can now LOGOUT of SETUP H Confirm your site and protocol in the lower par
40. h subject data from MS or healthy subjects To overcome this problem a third approach applicable in non linear situations developed by Djaldetti et al is to integrate the area under the force vs time curve and relate this value to the theoretical area that would be expected in the absence of fatigue calculated as the maximal force x duration of contraction models 3 and 4 below C 6d Multiple sclerosis a paradigm for central fatigue pathologic fatigue due to CNS disease Patients with MS list fatigue as one of their most important sources of disability and they often report that fatigue is present even in limbs that are not overtly weak Pathologic central fatigue presumably occurs in MS because demyelination of CNS axons leads to activity dependent conduction block We studied 20 patients with multiple sclerosis MS and 20 healthy volunteers matched for age and gender to validate four models for analysis of fatigue The bases for selection of an optimal model were 1 optimal test retest reliability and 2 greatest sensitivity for detecting increased fatigue in MS compared to normals Fatigue was assessed in four muscle groups in each subject Maximal isometric contractions were sustained for 30 seconds QMA can partition each force vs time curve into 5 independent overlapping or non overlapping intervals Maximal force P in newtons and area under curve AUC in newtons seconds is automatically determined for each inte
41. ibration Log File nent ten chou Ee ENEE EE ee EE 29 5 6 Frequency of Completing Check amp Tweak AAA 30 5 7 Reverting Back to the default Calibration ss 30 5 8 Full calibration for the strain gauge sise 30 6 FILE STRUCTURE AND FORMAT 4 isccscscniccscosctcesivensscechesseunceceves stone donnee sdonteve cassettes dede ee cheese 31 6 1 File structure and format defined 31 6 2 Maintaining directory and file structure copy or backup 31 ii NOTICE By utilizing this Software QMA you are agreeing with the following terms and conditions End User License Agreement GRANT Subject to the provisions contained herein and payment of applicable license fees AEVERL MEDICAL AEVERL hereby grants to you a non exclusive license to use its accompanying proprietary software product Software including and identified as Quantitative Muscle Assessment QMA for your own use Such Software is protected by the copyright laws of the United States and international copyright treaties SOFTWARE AND DOCUMENTATION AEVERL shall furnish the Software to you preloaded in a system electronically or on media in machine readable object code form If you receive a copy on media it may be used for backup and archive purposes only This license does not grant you any right to enhancement or update to the Software and Documentation Enhancements and updates if available may be obtained by you at AE
42. icks in the circle labeled STOP in the bottom right corner of the screen e when the therapist again presses lt Enter gt or e for strength tests when the falling edge of the acquired data waveform reaches 50 of the maximum the 50 value is changeable by the administrator see section 2 4 2 After the acquisition has ended the measurements for that trial are displayed at the bottom of the screen For definitions of these measurements see section 2 4 Only three values are displayed at one time If there are more than three measurements for the fatigue tests you can scroll through the list by pressing the on screen left and right arrow buttons immediately above the numeric displays At this point you must either accept or reject the trial before proceeding 19 4 4 3 Accepting or rejecting a trial You can accept or reject a trial only immediately after the acquisition for that trial has stopped Click the hand held button once to accept the trial and hold down to a count of seven to reject it Additionally pressing the on screen ACCEPT button or simply pressing lt Return gt will accept the trial and pressing the on screen REJECT button will reject the trial If you accept the trial the trial indicator will increment by one and you are now ready to begin a new trial or end the test If you reject the trial a new window appears requesting the reason for the rejection and any additional comments After pressing OK in this window you
43. in the qma program A Strength Test see Sec 2 4 1 1 Maximum 2 Rise Time 3 Sustained Time Static Fatigue Test for Five distinct areas see Sec 2 4 2 Maximum Average Value Area Under the waveform WN HD Dynamic Fatigue Test for Three distinct areas see Sec 2 4 4 Maximum Average Value Area Under the waveform Press View Data Use the scroll bar to display data not readily available 4 9 2 View Test Results Queried and exported to MS Excel parameters A All of the above sec 4 7 7 B Mean of each test C Coefficient of effort Peak rate of force development Observing the slope rising from a resting point to peak force interatively and determine the fastest rate of force increase in the slope the steepest slope It is the point on the curve where the greatest number for the change in force Newtons change in time sec may be observed D Select the data to view and comparisons to make See sec 3 5 25 4 9 3 QMA Patient Progress amp Evaluation Report Overview The QMA Patient Progress and Evaluation Report is designed to provide the following information in an accurate manner and professional format 4 9 3 1 The header is automatically populated with the following Patient Name Patient ID Today s date Visit or Test number Date of Birth dob and corresponding age in English American mm dd yyyy or International Military dd mm yyyy Gender
44. independent of the electronic data acquisition The first three types are performed with connectors cables or straps and a strain gauge assembly or hand dynamometer The fourth type is performed by using the remote switch or a keyboard Enter to start and stop an on screen timer The fifth is direct data entry 1 3 Log In Screen The screen that appears upon start up is the Login screen The login name or initials of the person conducting the testing entered in this screen will be recorded with the data for each test Most all tasks are initiated from the Main Menu screen which appears after a user presses the OK button on the Login screen 1 4 About QMA About QMA displays the version number and contact information for technical support 1 5 Initially Speaking A Quick Setup guide and Program Tutorial 1 5 1 Setting up the equipment software The setup CD is auto starting and self extracting and will install the QMA program to the destination drive of your choice Default is C QMA C QMA4x 0 1 2 or C QMAXL Follow the instructions found on the CD enclosed with your shipment Setup the National Instrument drivers first Install and connect the hardware Then finish the National Instrument driver setup When that is complete QMA may be installed The Serial Number requested only on the first startup is located on the CD 1 5 2 Setting up the equipment hardware The hardware consists of one of each of the followin
45. ional file sysinfo txt and append files in the CALIBRATION LOG DIRECTORY QMA CAL Log see 5 5 1An error of weight hung at C amp T produces an equal amp inverse amount during testing 28 5 4 Calibration Weight a product of the load cell capacity The Interface SM 250 250 Ibf capacity is the most common load cell utilized with the QMA System The recommended minimum test weight for the SM250 is 20 kg With less capacity load cells or as a method to increase accuracy a test weight equal to or approximating the total capacity of the load cell or the normal expected maximum of measured effort may be recommended i e a 50 Ibf load cell used in hand held myometry would use a 50 Ib or 20 kg test weight X NOTE The examination table Electric Hi Low may be used as a lifting platform to lift the weight to minimize the strain on the PT or testing personnel 5 5 Calibration LOG FILE QMA Cal Log When Check amp Tweak is utilized to confirm or adjust the accuracy of the input equipment utilized in acquiring data with the QMA System an operating file sysinfo txt is updated and a duplicate file written and appended to a CALIBRATION LOG DIRECTORY This process permits the continuing appending of the CALIBRATION LOG DIRECTORY QMA Cal Log directory with the updated information of the C amp T the data algorithm and date and time The QMA Cal Log directory may normally be found on the C drive in the QMA QMA42 direct
46. les See Sec 3 1 to select the correct patient etc 4 8 1 A muscle test was completed erroneously or perhaps no data was collected and you want to discard the data You must be in the visit number containing the bad test In the main menu screen select File and then Fix Tests In the windows that appears select the bad muscle test using the selection box on the left Then press the DELETE button on the right This muscle can now be re tested from the main menu screen 4 8 2 A muscle test was completed with valid data under the wrong muscle name You must be in the visit number containing the misnamed test In the main menu screen select File and then Fix Tests In the windows that appears select the wrong muscle name that the test was completed under using the selection box on the left Then press the MOVE button on the right Then using the selection box on the right select the proper name for the test The second name you select must NOT have been tested already in this visit 4 8 3 Two muscle tests were completed with valid data under the wrong muscle names and the data must be swapped Same as example 2 with the following exception select SWAP instead of MOVE after the first test has been selected 4 8 4 A visit was completed accidentally with erroneous or no data and it needs to be deleted If you are in the visit you want to delete first end the visit Then select File and then Delete Visits Select the screen number
47. n The button and selection boxes are visible only if you have begun a visit as described in section 4 1 QMA then starts the first test in the sequence regardless of what is highlighted in the selection boxes If certain tests in the sequence were completed by hand they are skipped in the sequence Each test screen has a button labeled NEXT TEST For strength fatigue and stopwatch tests holding down the red button on the remote switch to a count of seven at the appropriate time is equivalent to pressing the NEXT TEST button Pressing this button and holding it down for a count of seven will end the current test and initiate the next test in the sequence even if there is an unfinished test that is earlier in the sequence If a test is begun in error simply stop the test single click make a note that the test was started in error select CANCEL and select the test to begin or select begin sequence and the next test in the sequence will start see 4 6 6 for more detail 18 4 4 Strength and fatigue tests The graphical test screen is similar for strength tests static fatigue tests and dynamic fatigue tests See section 4 2 on how to initiate the test screen 4 4 1 Beginning a trial trace Before beginning a trial it is important to make certain the title of the screen matches the test you intend to perform The current trial number is displayed underneath the TRIAL label at the bottom of the screen Before preparing the patient
48. ocol At Setup Site Protocol Select General Protocol Default password is qma Select NEW A new Protocol may be constructed using an existing protocol as a template If you wish to use a protocol for a template that is not highlighted scroll and make your selection Make this the current protocol Click for YES 2 1 2 Setup A Site Now that the Protocol is constructed Update your site and testing preferences Protocols can now be constructed in two ways 1 Site Measuring Unit and Patient display consistent at your location OR 2 Site Measuring Unit and Patient display can be unique as needed The Site Information can be setup as follows A Create or choose a PROTOCOL and indicate it to be the current protocol B To the left Under GENERAL Change the following as needed 1 Test Site 2 Patient Information and 3 Units of Measurement C Select UPDATE RENAME the PROTOCOL should be displayed if not return to 2A Make certain the PROTOCOL to update is highlighted D OK for changes completed Cancel to discard changes 2 1 3 Site Identifies the testing facility university hospital or clinic or designated research study group 2 1 4 Measuring Units Measuring Units may be selected as Pounds Lbf Kilograms KG or Newtons N 2 1 5 Patient Information Display or Profile Patient information display may be selected as English American or International 2 2 TEST NAMES Tests can be renamed added or deleted b
49. ory the appending files are located within that directory and may be accessed using MS Word WordPad or NotePad Please notice that the files within the QMA Cal Log directory are uniquely identified as to the completion of C amp T by date and time an example may be sysinfo 01 19 2007 15 26 09 This file name indicates that a C amp T was completed on January 19 2007 at 3 26 09 PM the internal data and structure of the file will confirm that indication 5 6 Accessing the Calibration Log File At the conclusion of each successful Check and Tweak update files are appended to the Calibration Log directory To access the most recent Calibration Log File 1 Right click on Start and open Window Explorer Left click on the C Drive Default drive Locate QMA QMA42 QMAXL QMAXLU and double left click Locate QMA Log Cal and double left click Each of the files located in the QMA Log Cal are named by date An example sysinfo_06_22 2010 14 20 02 6 22 2010 2 20 02 PM Locate and select the most recent file or the file you wish to print Select Print from the options above or single right click and select print DE ON OUR te 29 5 7 Frequency of Completing Check amp Tweak As a load cell is used several things can happen that may adversely affect accuracy 1 Physical Overload the capacity of a load cell can be exceeded that may cause irreversible damage to the physical integrity of the structures resistance
50. ot recognize or take into account any extraneous force or weights hangers or straps that may be present SS NOTE During a test ZERO TEST may be selected and the input equipment of that test will be forced to a zero measurement This may be of benefit when a TARE a force or weight that is to be deducted from the overall measurement is present see 4 7 4 5 3 Checking and Tweaking confirming and modifying the calibration To confirm or fine tune the accuracy of the system Check amp Tweak C amp T may be selected 1 Select an input device by scrolling through the available list and OK 2 Unload the Load Cell place the load cell in a neutral position See 5 2 3 Select the unit of measurement for the test weights Lb Kg or N 4 Hang an accurate weight stabilize the weight amp enter its value X NOTE Enter the total weight hung hangers etc may add to the total weight S NOTE The recommended test weight for your load cell see 5 4 Select TWEAK The measured weight then can be adjusted to the exact value of the hanging weight When the two sides equal select TWEAK To C amp T another input device Select NEXT and repeat 5 3 1 To End this session of C amp T Select DONE 10 To Cancel any entries but remain in C amp T Select CANCEL 11 To Cancel any entries and exit C amp T Select EXIT CAL A a VD OND UI X NOTE The information of the most recent C amp T will update an operat
51. oxes in the Test Definitions screen and then press the DELETE button Undo deletes and other changes made in the screen by pressing the CANCEL button 2 3 Changing the test sequence QMA can automatically sequence through the list of tests in any order you choose To define the order of tests select Test Order in the Setup pull down menu in the Main Menu Screen screen entitled Test Order Definition appears As you use the selection boxes on the left to select the test you want to move the current place of the highlighted test in the test sequence is displayed The display on the right contains a list of all tests in order Change the position of the selected test by using the keyboard or up down buttons to change the number in the ORDER control or highlight and change to the desired number in the sequence The display on the right is updated as you change the control X Hint Single Left Click in the BLUE after each entry to set the entry when finished click OK this will permit you to exit this function 2 4 Defining the measurements The raw data from the strain gauge or hand dynamometer is written to a file during testing QMA will also take measurements on this data which will be shown on the screen and included in the data files and printouts These measurements allow for some flexibility in their definition To change the measurement definitions select Test Parameters under Protocol Setup from the Setup pull down
52. ped through a no load calibration for the load cell and the hand dynamometer Due to infinitesimal changes in the electronics of the data acquisition equipment the system should undergo a no load calibration check periodically The no load calibration check can also be executed between tests during a visit see section 5 2 First you are prompted to unload the load cell or strain gauge Make sure that the force or no force pulling on the load cell is acceptable and then press OK or hit lt Return gt You are then asked to do the same for the hand dynamometer X lt NOTE The weight of Testing straps or cables may be cancelled by hanging them from the load cell during the No Load process Check the protocol or administrator Once the no load calibration check is finished you are ready to select a test See section 4 2 for information about selecting a test to perform Beginning a visit 4 2 Beginning a visit To start the testing procedure for a patient you can either begin a new visit or finish a previous visit 4 2 1 Beginning a new visit X HINT When all of the patients are missing or look unfamiliar check the protocol When a patient is ready for a new visit select Begin Visit from the File pull down menu in the Main Menu screen Basically four options will be available 1 No patients are available in this protocol add patients Return to File then New Patient and enter the required information Sec 3 1 AS
53. ply to this Visit visit shown select a apply to this visit b apply to checked visits tests shown apply to all tests 3 4 5 Select Export The data will be queried and exported to MS EXCEL 3 4 6 Complete the query DONE skip to 3 4 9 3 4 7 Add data from another protocol ADD PROTOCOL and select the protocol that contains the data desired 3 4 8 repeat 3 4 3 through 3 4 5 complete see 3 4 6 add more see 3 4 7 3 4 9 Name the file notice the location of the file when saved XX HINT Files generated by qma can be located by single right clicking on START and then move up to Explore move to the C drive and the QMA directory QMA QMA42 QMAXL look under the protocol for your Excel files 12 3 5 Setup MS Excel Template for results comparison and analysis X Hint Data placed in Excel is consistent permitting the construction of templates with functions and arguments 3 5 1 Build a Template A Export requested information to Excel B Build arguments based on location of data C Save the arguments as a book as a different Excel file 3 5 2 Use the Template A Export requested information from qma to Excel sec 3 4 B Open both the newly created Excel spreadsheet and the template C Copy requested information as lines to the template D If constructed correctly arguments will be executed as expected for further comparison and analysis 3 6 Archiving dat
54. r test to correct End Visit Select SETUP and TEST NAMES Select Test to correct and Input Equipment Select correct input equipment and OK Correct Input Equipment should now be available for testing Input equipment maximum capacity is too small to Check amp Tweak QMA XL permits input equipment with 1 1 Ibf to be calibrated with Check amp Tweak contact support qmasysgtem com for update information Export to Excel not working QMA 42 XL Depending on the version of Excel that you are using 1 In Excel XP go to TOOLS MACRO and then SECURITY change to MEDIUM and then Click on the Tab Trusted Sources and permit Visual basic from trusted sources 2 In Excel 2007 go to left top corner and select Excel Options Proceed to Trust Center and Trust Center Options and click Permit access to VBA Object Project and close Report Generator not able to load Macros Depending on the version of Excel that you are using 1 In Excel XP go to TOOLS MACRO and then SECURITY change to MEDIUM and then Click on the Tab Trusted Sources and permit Visual basic from trusted sources 2 In Excel 2007 go to left top corner and select Excel Options Proceed to Trust Center and Trust Center Options and click Permit access to VBA Object Project and close 24 4 9 TEST RESULTS 4 9 1 View Test Results QMA parameters The following analytical data of the efforts expended in the current test may be observed with
55. rked on the outside of the package before any shipment will be accepted for warranty work AEVERL MEDICAL will pay the shipping costs of returning to the owner parts that are covered by warranty Except as specified herein AEVERL MEDICAL makes no warranties express or implied and specifically disclaims any warranty of merchantability or fitness for a particular purpose Customer s right to recover damages caused by fault or negligence on the part of AEVERL MEDICAL or their sources for hardware shall be limited to the amount thertofore paid by the customer for the faulty hardware component Any action against AEVERL MEDICAL must be brought within one year after the cause of actions accrues In no event shall AEVERL MEDICAL owners or associates collectively or severally be liable for direct or indirect incidental or consequential damages resulting from any defect in the hardware even if AEVERL MEDICAL owners or associates have been advised of the possibility of such damages The terms DOS and Windows and IBM are registered trademarks of Microsoft Corporation and International Business Machines Corporation respectively Copyright 1996 2010 AEVERL MEDICAL James Fielding P O Box 170 Gainesville GA 30503 USA Sales amp Customer Support 770 983 1369 A About this manual This manual is topically organized includes information for both the administrator amp physical therapist and may be updated at the discretion of AEVERL
56. rotocols and patient information that you wish to access most probably the information will be located in C QMA C QMA42 or C QMAXL X NOTICE The security level of your Excel program may need to be revised to enable Macros for this application Enable Macros See Sec 4 8 11 When opening the QMA Predictor file always ENABLE MACROS On the EXCEL Header to the right of File Edit etc is the Indicator QMA c When you click on QMA you will find the following Import Baseline Data Import Visit Data Clear Baseline Data Clear Visit Data Clear All Data o Oo Ln P OM d An example When you click on Import Baseline Data the program will prompt you for the location of the QMA directory and the protocol If the protocol is located in the QMA42 directory on the C drive then select COMPUTER and then C and then QMA42 A If you wanted to access the first visit of 9988Lopez then double click on 9988Lopez and then the first visit B You will then have the option of requesting the MAX or the MEAN of the tests C To proceed with the second visit click on Import Visit Data follow the same procedure to locate the directory and select the second visit All of the data and information cells should populate automatically Make any necessary comments and other indications SAVE AS rename file and close moO X Recommendation When beginning to utilize the P amp E File please copy the original to several loc
57. rval These intervals were set at 0 30 seconds 0 5 seconds 5 30 seconds 25 30 seconds 2 7 seconds The four fatigue models are Model 1 This is the conventional model for fatigue analysis This model simply analyzes force reduction during the contraction Fmax in the final five seconds of the contraction E 21 is compared to the initial five seconds Fra Fatigue index in 100 x 1 Fiay Ee H Model 2 This modification of model 1 was suggested by Dr Mohamed Sanjak Instead of using E it integrates the AUC in five second epochs at the beginning and end of the contraction in order to smooth out fluctuations in the force vs time curve AUC in the final five seconds AUC is compared to early in the contraction AUC Fatigue index in 100 x 1 AUC AUC Model 3 The model used by Djaldetti et 7 This model derives information from the entire force vs time curve The AUC that would be expected in the absence of fatigue AUC the product of Fna x 30 seconds is compared to the observed AUC over the entire 30 second contraction AU 79 Fatigue index in 100 x 1 IAU IS AUC w Model 4 A slight modification of model 3 in which the upswing or initial 5 seconds of the force vs time curve is neglected This portion of the curve is variable and it does not represent fatigue The AUC that would be expected in the absence of fatigue during the final 25 seconds of the contraction AUC
58. sabled in the test selection boxes See section 4 2 for information about selecting a test to perform 4 3 Selecting which test to perform Once a visit has begun the therapist can perform any of the tests defined by the administrator see section 2 2 The tests can be hand selected in any order or they can be performed in the order sequence defined by the administrator see section 2 3 4 3 1 Selecting Tests Individually Manual Sequence To manually select a test click on the appropriate test category in the CATEGORY selection box in the Main Menu screen Then select the name of the test and the side of the body in the TEST and SIDE selection boxes These selection boxes are visible only if you have begun a visit as described in section 4 1 If a certain test or category has been completed the corresponding text in the selection boxes will turn gray and cannot be selected With the desired test selected press the button labeled BEGIN TEST beneath the selection boxes The Strength and Fatigue Test screen Stopwatch Test screen or Other Test screen will then appear depending on your test selection See sections 4 3 through 4 5 for more information on these screens 4 3 2 Following a Test Sequence Automatic Sequence The administrator can define a test sequence to ensure all visits follow the exact same test procedure To start the test sequence press the button labeled BEGIN SEQUENCE beneath the selection boxes in the Main Menu scree
59. t The Quantitative Muscle Assessment System QMA is a Year 2000 and beyond compliant 32 bit program initiated with QMA version 3 1 1 7 1 Millennium certification requires that the product operate accurately in the manner in which it was intended as it relates to date related operations when given a valid date containing century year month and day 1 7 2 This product uses the following 1 A valid date which contains two digit month two digit day and a four digit year 2 Calculations interfaces and reports using dates execute using a four digit year 3 Successful on line and batch functionality supporting four digit year processing 2 Setup At the main menu Setup opens to the following Protocol selections General Site Protocol Test Parameters Test Names and Test Order Default password for Setup is qma X Hint Always check the site and protocol numbers when considering a change to the system Go to change protocol and select the protocol needed when in doubt 2 1 Protocol and Site The protocol is the underlying foundation of this testing and information system xX NOTE All data including patient data visit numbers and test data test parameters site measuring unit and patient display are unique to the respective protocol identifier ie ALL data is protocol specific Before you begin to test create a new working protocol This will permit you an expendable working copy 2 1 1 Construct a Prot
60. t of the screen X HINT A different Protocol may be selected by going to FILE and then CHANGE PROTOCOL Go to FILE and select NEW PATIENT J Using up to sixteen 16 alpha numeric characters compose a patient or screen I dentifier 1D SS HINT Use the last name in the sequence to quickly identify or hospital number xX NOTE Do not use a personal identifier in the Patient ID if used in a drug trial or if patient confidentiality may be compromised K Finish the New Patient entries oOomtbt mm SS NOTE DO NOT use New Protocol as a testing protocol Programming updates and problem sourcing may change or delete your local copy of New Protocol X lt NOTE If you encounter any problems contact customer support at 770 983 1369 or through the WEB at support AEVERL com We are here to assist you 1 6 QMA System Tour amp Tutorial 1 6 1 Now that a patient is entered you can begin testing A Select Begin Visit B To select a patient DOUBLE CLICK DC the PATIENT S IDENTIFIER ID SS NOTE In DEMO MODE Continue through unload load cell and hand dynamometer Patient s efforts test results and display will be software generated S NOTE In TEST MODE The UNLOAD subroutine constructs a zero baseline C Unload the Load Cell amp the Hand Dynamometer Follow online prompts D You should now be viewing the Category Tests and Side for Muscle Testing Basic patient information is shown to confirm the patient and
61. ted in visual basic VBA Aa To set MS EXCEL XP 2007 to process macros originating with VBA a Open Excel and select the MS Home upper left corner and select EXCEL OPTIONS b Proceed to Trust Center and then Trust Center Settings c Proceed to Macro Settings and then check Trust access to the VBA project object model click OK and OK out of the sequence 3 4 1 In QMA make certain you are in the correct Protocol 3 4 2 Select FILE then EXPORT TO SPREADSHEET 3 4 2 Select specific information to export 3 4 2 1 PREFERENCES amp PATIENT click on area to select each 3 4 2 1 1 PREFERENCES A Renumber Trials B Include Maximum C Include Mean B Apply Query when Exporting B Include Traces C Include Graphs C Information Orientation Rows or Columns 3 4 2 1 2 PATIENT A Screen Number or Patient ID B Last Name C First Name D Gender E Visit Number F Visit Date 3 4 3 Select Compile When compile has completed amp before selecting Export 3 4 4 QUERY DATA Choose sequentially the three tabs for information to Export that will be included in the MS Excel spreadsheet 3 4 4 1 Patients select a apply to checked patient b none c all 3 4 4 2 Visits select a apply to this patient b apply to checked patient visits shown c apply to checked patient all visits 3 4 4 3 Tests patient shown select a this patient b checked patients 3 4 4 4 Ap
62. the product of F x 25 seconds is compared to the observed AUC over final 25 seconds of the contraction AU PL Fatigue index in 100 x 1 AUC AU 7 2 4 4 Dynamic fatigue measurements Dynamic fatigue measurements are similar to static fatigue measurements with two exceptions 1 three time regions are available and 2 the peaks of the waveform are used to calculate the maximum and the average 2 5 Setting the length of tests Stopwatch tests end when the button is pushed Strength and fatigue tests can end in two ways 1 when the button is pushed and 2 after a user specified time out time Additionally strength tests can end automatically after the maximum has been reached All these test time settings are accessed by selecting Test Parameters from the Setup in the Main Menu screen 2 5 1 Time out time Strength static fatigue and dynamic fatigue tests each have a separate time out time The time out time defines the maximum time a trial will run These are changed by using the controls labeled TIME OUT in the different sections of the Test Parameters screen 2 5 2 Auto stop setting The control labeled AUTO STOP in the STRENGTH TESTS section of the Test Parameters screen controls when the testing will stop after a maximum is reached When the falling waveform reaches 50 of the maximum value the trial will end automatically You can change the default value 50 to a range of 1 amp 99 2 5
63. tory and Files Structure By default The QMA program resides on the C drive of your PC in one of the following directories C QMA C QMA4x QMAXL Protocols directories will be seen below the QMA directory Patients directories will be available below the protocol directories Visits directories will be seen below the patients directories Test Data nnn dat where nnn is the name of the test and a summary file will be available for each visit 3 6 3 Importing Data from other QMA Systems Data acquired on other QMA systems QMA v 1 11 v 3 4 may be imported and used by your QMA system up to qma v 3 4 For use with qma42 please see 3 7 amp 3 8 Simply copy the protocol directories into the QMA directory When QMA begins the protocols will be available for testing or analysis If the files are to be kept in their original transferring condition mark them read only and no updating will be possible X NOTE Make certain files duplicating your current files are not being imported If there is a question Make and name a NEW FILE and copy the directories into the newly constructed file Then move them into QMA after reviewing the file names etc AS NOTE The Copy function may alter the visit dates etc AS NOTE QMA 42 and continuing qma versions use a different file format than previous versions this necessitates two different conversion STEPS to permit previous version data to be used in QMA42
64. ven if AEVERL MEDICAL owners or associates have been advised of the possibility of such damages The software and manual are copyrighted All rights are reserved They may not in whole or part be copied photocopied reproduced translated or reduced to any electronic medium or machine readable form with prior consent in writing from AEVERL MEDICAL The user of this product shall be entitled to use the product but shall not be entitled to sell or transfer reproductions of the software or manual to others without the written permission of AEVERL MEDICAL The terms DOS and Windows and IBM are registered trademarks of Microsoft Corporation and International Business Machines Corporation respectively Copyright 1996 2010 AEVERL MEDICAL James Fielding P O Box 170 Gainesville GA 30503 USA Sales amp Customer Support 770 983 1369 NOTICE AEVERL MEDICAL reserves the right to make improvements to the product described in this manual at any time and without notice HARDWARE LIMITED WARRANTY The hardware utilized in the Quantitative Muscle Assessment system QMA is watranted against defects in materials and workmanship for a period of one year from the date of shipment AEVERL MEDICAL will at its option repair or replace equipment that proves to be defective during the warranty period This warranty includes parts and labor A Return Material Authorization RMA number must be obtained from AEVERL MEDICAL and clearly ma
65. without notice SOFTWARE LIMITED WARRANTY The Quantitative Muscle Assessment program executable QMA will perform substantially in accordance with the published specifications the documentation and authorized advertising AEVERL MEDICAL when notified of significant errors within NINETY DAYS from date of shipment will correct demonstrable and significant program or documentation errors within a reasonable period of time The media on which you receive the QMA software are warranted not to fail to execute programming instructions due to defects in materials and workmanship for a period of six months from date of shipment AEVERL MEDICAL will replace the CD or disk with a functionally equivalent media within a reasonable period of time upon receipt of the damaged media AEVERL MEDICAL does not warrant that the functions of the software will meet your requirements or that the software will operate error free or uninterrupted AEVERL MEDICAL has used reasonable efforts to minimize defects or errors in the software You assume the risk of any and all damage or loss from use or inability to use the software AEVERL MEDICAL makes no other warranties expressed or implied with respect to the manual or the software described in this manual In no event shall AEVERL MEDICAL owners or associates collectively or severally be liable for direct or indirect incidental or consequential damages resulting from any defect in the software e
66. y selecting Test Names in the Setup pull down menu in the Main Menu screen A different screen entitled Test Definitions appears 2 2 1 Adding a test LONG FILE NAMES Adding a test is accomplished from the TEST DEFINITION screen First select the desired test category by clicking on the category name in the selection box on the left The selection box on the right lists the currently defined tests Your new test will be added before the highlighted test in the right selection box Your new test will become the last test in the test sequence regardless of what is highlighted in the right selection box With the appropriate selections made press the ADD button The sequence will be corrected in a minute refer to 2 3 A box appears requesting some information Enter a name for the new test If the test will use the hand dynamometer for input strength and fatigue tests only use the word HAND in the name of the test The MAX GRAPH SCALE entry is used as the maximum value for the data graph displayed on the screen during the test X lt NOTE The graph display maximum chosen does not affect the data acquired Next select the desired side of the body in the SUB TESTS pull down menu If you select LEFT amp RIGHT two tests will be created otherwise only one test will be created Finally select an appropriate filename s for the new test s Long File Names are now available An example of a test could be Shoulder Extension Left S

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