User Manual - Posture Monitoring Feedback
Contents
1. 02036 02037 02038 EDITION 02 2013 Special contents are combined to this document Wt CHINESPORT Manuals U UFO amp Movies Follow us on L Tube f The positional feedback inclinometer and GONIOMETER dealt with here are part of a larger set of rehabilitation aids named LEONARDO and explained in the Rehabilitation section of Chinesport general catalogue POSTURE MONITORING FEEDBACK Teorema Project User s manual Introduction INCLINOMETER Presentation Three types of Feedback Inclinometer Tilting Adjustment Single parts and their application GONIOMETER Presentation Single parts and their application MOTORIAL LEARNING PHASES APPLICATION EXAMPLES Compensation 1 Elevating the scapula Compensation 2 Counter sideways inclination of the trunk Compensation 3 Homolateral inclination of the trunk Compensation 4 Counter sideways inclination of the trunk Compensation 5 Extension of the trunk Compensation 6 Flexion of the trunk Compensation 7 Flexion of the trunk POSTURE MONITORING FEEDBACK Page 4 Teorema Project INTRODUCTION By means of this exercise the patient must achieve gradual perfecting of movements from the complexity required for shoulder arm forearm and elbow movements to fine movements at the wrist distal hand and fingers To make a stable position possible for2. CK AAA AEREA ERRE AEREA ERA AEREA RAEE RAEE REA ERA AEREA AEREA AEREA AEREA GONIOMETER PRESENTATION This is an elastic structure that follows the patients movements and informs them when they have reached passed a predefined joint angle This aid works on relative angles also monitoring joints that do not have a stable rotation axis such as the thoracic scapula because unlike other joint measuring systems it is not positioned on the fulcrum but is moved away in relation to the movement of the joint segments closing the circuit and activating the sensor The instrument is put in place using velcro strips or double sided tape applied to the skin Adjustment is done by changing the length of a cable laid parallel to the elastic When doing the exercises if elevation tipping or rotation of the thoracic scapula is picked up when it should be stabilised the feedback is very effective Also given the difficulty of correctly perceiving the area application of the vibrating pad on the muscle group to be activated facilitates control NOTE This aid can also be used for other joints and various tasks NOTE Teorema Project AAA EEE TYPE OF FEEDBACK ACOUSTIC FEEDBACK VIBRATORY FEEDBACK VISUAL FEEDBACK When the elastic element is positioned behind the elbow as in the figure a range is determined beyond which the FB is activated By inverting the position one can ask for a certain degree of
3. FB is useful when setting the instrument to determine the angle beyond which the patient will feel the stimulus sound vibration This avoids confusion being created by providing the patient with a signal only when correctly set In the most advanced learning stage self evaluation exercises are provided for summary feedback in which the therapist watches the LED and has an objective parameter to compare with the perception expressed by the patient while executing a series of tests Sound FB is commonly used because it informs the patient timeously and precisely drawing their attention to the motorial behaviour of the area involved It is particularly useful for patients that tend to have limited attentive participation in the treatment Vibrating FB is provided by a vibrating pad 2 cm in diameter which will be positioned near the area of muscle you wish to stimulate block This results in the patient reducing the time lapse between information and response because they do not have to interpret a sound or LED but receive the information at the point monitored Visual acoustic vibratory FB has a warning and alarm meaning in relation to an incorrect gesture negative FB or recognition of correct execution positive FB For the same movements the inclinometer is positioned in opposite directions to implement the two different modes see the images of flexing the trunk and Compensation n 7 below Teorema Proje
4. K Teorema Project MOTORIAL LEARNING PHASES Evaluating the strategy used by the patient in completing the gesture required is of fundamental importance in order to choose the feedback instruments to be used and where they must be positioned Often the patient uses compensation Strategies to complete the task in the most simple economic manner Therefore we want to ensure that by means of the exercised proposed the patient gradually perceives and learns the correct motorial behaviour strategy Motorial learning phases include an initial phase during which feedback is constant and acts on an afferent channel looking for selective monitoring of the movement and posture In the second and third phases the information on details of the mo vement is gradually reduced Here summary feedback is important for getting to an automatism phase with open exercises in variable contexts This is the line taken when seeking to provide the patient with the information required to do a task with the correct Postural alignment reducing compensation to a minimum For explanatory purposes let s analyse the compensations used by patients more often on various planes and how to posi tion the feedback devices to allow them to perceive their error and complete the functional task in the best possible way APPLICATION EXAMPLES 5 T COMPENSATION 1 ELEVATING THE SCAPULA In this task involving reaching the handle there is a need to avoid the patient compensating by us
5. SEH EE EEEE HER EEE HEED EESEH DELO III III C Thoracic indicator strap Alternatively the elastic strap for the thoracic viewer can be positioned at the top of the hips attach the extension 9 to the strap 8 and connect it to the Velcro connector on the goniometer 1 fixing the opposite end 1 close by using the Velcro double sided tape connector B Replace the double Sided tape for each new application D Extension E Velcro strap for the goniometer For elbow exercises position the two Velcro straps E one nearby on the arm just above the bicep venter and the other ata distance on the forearm so that they cannot slip towards the elbow joint Position the Velcro connectors 1 on the male Velcro 10 portion of the two straps AAA AER AEREA AEREA ARA ARE RA AEREA RRE REA EA AAA ERA AAA AER AAA AAA EE RA AEREA ERA AEREA AEREA AAA AE ARA ERE AAA ERA AAA RAE AAA F Additional acoustic signaling device Use the buzzer LED switch 13 to switch from visual mode LED 14 to Acoustic mode buzzer 13 14 To activate the vibrator FB insert the plug 17 in hole 15 and turn the buzzer LED switch 13 to LED When the circuit is S amp S po closed the vibrating pad and LED are activated simultaneously 12 i 15 11 G Vibrating pad 16 x The vibrating pad must be put in contact with the skin 17 keeping it in place using tape or by positioning it under one of the straps Pagmadl0 POSTURE MONITORING FEEDBAC
6. ct CELLLIIIIEEIIIIEIEEIIIEIEEIIIIEEIIIIIEEIIIIEIEIIIEIEIIIIIEIEEIIIIEEEIIIIIEI III TYPE OF FEEDBACK b gt ACOUSTIC FEEDBACK i VIBRATORY FEEDBACK ES VISUAL FEEDBACK Inclinometer Tilting Adjustment To set the range beyond which the feedback is activated simply adjust the antenna changing the tilt on it The closer it is to the horizontal position the more sensitive it will be to movements on that plane The antenna is screwed to a support that is positioned using a velcro strip on the front or back of the thoracic viewer strap In the two images above information is provided on movements in the frontal plane It rt inclination In the images below the reference plane is the saggital flexing extending POSTURE MONITORING FEEDBACK Teorema Project LELLEIIEIEIIIIIIEEEIIILEIEIIIELEIIIIIEIIIIIIEEEIIIIEEIIELEEEIIIEIEIIIIIEEIIIIIEIIIIIEIEIIILIEIIIIEIEIIIIIEIEIIIIIEEILIIIEEIIIIEEIIIIEIIEIIIEIIEEIIIIIEIIIIIEIEIIIIIEIIIIIIEEEIIEIIEEEIIIIIEEIIIEIEIIIEIIEIIIIIEIEIIIIE III SINGLE PARTS AND THEIR APPLICATION 02036 INCLINOMETER ELEMENTS INCLUDED IN THE KIT Inclinometer Electrical connection Inclinometer support Strap for thoracic indicator Thoracic indicator Additional acoustic signaling device G 1 M O ad W gt Vibrating pad A Inclinometer The antenna that houses the inclinometer 3 must be inserted using the threaded screw 2 into the electrical connection hole 4 and scr
7. e is positioned higher up The inclinometer on the trunk makes it possible to precisely determine the point at which the patient begins to have difficulty and use the trunk to compensate to a possible joint deficit of the shoulder Being able to monitor the trunk on the frontal plane and to move the handle to a known height makes it possible to highlight a patient s improvement during a single session or over a number of sessions INCORRECT POSITION CORRECT POSITION Counter inclination sideways of the trunk COMPENSATION 5 o T EXTENSION OF THE TRUNK For this exercise the patients difficulty may be linked to a flexing deficit Frontal Standing turning the handle anticlockwise Inclinometer Negative feedback for the arm Applying the inclinometer to the back immediately indicates any compensation by extending the trunk during the task of positioning an item in the support Below an arm flexion of 120 150 in fact the trunk should not be involved In this case too as in the previous case being able to adjust the support to the required height allows the therapist to work on the specific nature of the functional task As for all the exercises with FB the task can be made easier or more difficult by adjusting the inclination of the antenna Sagittal Standing Putting an item on a shelf Extension of the trunk Inclinometer Negative feedback Page 13 POSTURE MONITORING FEEDBACK Teorema P
8. ewed to the timber support 6 The plug 1 must be inserted into the external connections 12 for the additional signaling device F B Electrical connection The plug 5 must be inserted into the external con f N u nections 12 for the additional signaling device F ry i i f l i I j il YZ id i i 4 wi ee 2 we The Velcro on the side opposite to that of the timber support El can be connected to the back of the inclinometer support gt 10 or to the front of the strap 8 Pagina 6 POSTURE MONITORING FEEDBACK AAA EEE EEE REE EA AAA AAA xxx D Strap for thoracic indicator F Additional acoustic signaling device 15 11 AAA AEREA ARE RAE AEREA REA AEREA AEREA ERE RARE AREA AAA AAA G Vibrating pad 16 17 Teorema Project POPP eee eee eee eee eeeeeEeEEEE EEO LEE HEEL LEH EE EETE ELE LEE EE LOEEEEHEEE EEL ELELEDELELEE ELE LELE EEE OEE EEE OLEH EELS To put on the inclinometer harness first position the elastic Strap at the height of the sternum with the Velcro fixing 7 behind the trunk Rest the Y shaped inclinometer support on the shoulders The two longer ends 9 must be connected to the elastic Velcro strap at the front 8 whereas the shorter part 10 is wedged in at the back between the male Velcro pin 7 and female Velcro slot on the elastic strap The bottom of the box has a female piece of Velcro on it that is used t
9. extension to be reached exceeded positive FB For each of the items described on the previous pages the goniometer can be used if you want to draw the patients attention to the behaviour of the proximal joints The Inclinometer and the Goniometer can pr ovide a visual sound or vibratory signal if incorrect posture occurs when a patient is busy doing some work The feedback device to be positioned on the patient is chosen to suit the type of compensation to be monitored See the description of the individual items contained in these pages and the illustration of the compensations below Page 8 POSTURE MONITORING FEEDBACK Teorema Project AAA AEREA AEREA RAEE AEREA AEREA ERRE RAEE AEREA AEREA EEE AA ERRE RAE ERE RRE SINGLE PARTS AND THEIR APPLICATION 02037 GONIOMETER ELEMENTS INCLUDED IN THE KIT Goniometer Velcro double sided tape connectors Thoracic indicator strap Extension D n I m OO U gt Velcro strap for goniometer Additional acoustic signaling device Vibrating pads A Goniometer The goniometer circuit is closed and the acoustic vibratory signal is activated when the non stretch wire 3 is tensioned The movement arc over which the signal is activated is set by adjusting 4 the length of the wire 3 The FB is switched off by the action of the elastic 5 that retracts the wire shortening it The elastic element 6 acts as a clutch as it allows the subject to go beyond the ang
10. ing the scapula thoracic joint to make a movement that must physiologically mainly be carried out by the scapulohumeral joint The proximal part of the goniometer is positioned using double sided tape at the scapular spine and the velcro strip is used to connect the lower part to the thoracic strap By adjusting the wire the range of elevation for the scapula is defined beyond which the circuit is closed and the FB signal is activated INCORRECT POSITION CORRECT POSITION Frontal Standing Reaching the handle Elevating the scapula Goniometer Negative feedback Page 11 POSTURE MONITORING FEEDBACK Teorema Project LELEIIIIIEIIIIIIEIEIIIIEIEIIIIIEIIIIIIEIIIIIEIEIIIIIELIIIIEIIIIEIEIEIIIIIEEIIIIEIIIIIEIEIIIIIIIIIIEIEIIIIIEIIIIIIEIEIIIEIEIIIIIEIIIIEIEEIIIIEEIEIIIIEIEIIIEIEIIIIIEIEIIIIIEEIIIIEIEIIIIEIEIIIIIEIIIIIEIIEIIIIEEIIIIEI rr o COMPENSATION 2 COUNTER SIDEWAYS INCLINATION OF THE TRUNK Another compensation mechanism that a patient can use is to bend the trunk to avoid abducting the arm or flexing the elbow What is being sought is monitoring of the trunk on the frontal plane while the hand reaches the handle The inclinometer is positioned on the velcro strip on the thoracic viewer with the antenna facing in the opposite direction to inclination of the trunk The system is activated when the antenna goes beyond the horizontal The more the antenna is pointed downwards the greater the range left to the patient for u
11. le established without causing the instrument to lock up resulting in it breaking The longer the elastic 6 is left the longer the period of time the FB will remain active Otherwise if you wish to switch the FB off quickly and are working with a limited articular range use the adjustment buckle on the elastic 7 to keep the elastic 6 at a lesser length The external connectors 12 on the additional signaling device are used for connecting up the plugs on the goniometer 2 Push the functionality button 11 to check the battery status 7 4 The Velcro connectors 1 at the ends of the goniometer can 3 be connected Zz e To the Velcro double sided tape connectors B ee e To the 2 Velcro straps for the goniometer E For elbow exercises lt 7 6 e To the thoracic viewer strap C AA N e To the male Velcro extension D Eo 1 B Velcro double sided tape connectors For exercises for the thoracic scapula joint hook up the ends of the goniometer 1 to the two connectors B that have double sided tape on the opposite side to the Velcro Remove the protective paper and stick to the skin so that raising tilting or abduction of the scapula will cause the protector to be tensioned POSTURE MONITORING FEEDBACK Teorema Project POPPER REET E EERE EE EEE HE EETE EEE EEEEHEEEEE EEE EEEEE EEE OEE EEE EEEEE EEO EEEH EE EEEE EEE EEEE EEO EEEE HOSES EH EE EOEE TEE EEEE EEO EEE EEE EEEEE EE EEEE EEE OEEEHEEEEEE EE TEEEE ERE EEEE RE EE
12. o connect it to the male Velcro 9b on the inclinometer support Push the functionality button 11 to check the battery status Use the external connections 12 to insert the plug for the inclinometer 2 and the plug for the electrical connection 5 Use the buzzer LED switch 13 to switch from visual mode LED 14 to Acoustic mode buzzer To activate the vibrator FB insert the plug 17 in hole 15 and position the buzzer LED switch 13 to LED When the circuit is closed the vibrating pad and LED are activated simultaneously eoo ocnnrrncnrrnn caca crannncnnnnnrrnncrrnnnccrnnncrrnnncrrnnnccrnnncnrnncsr o The vibrating pad 16 must be put in contact with the skin keeping in in place with some tape or by positioning it under the straps It is adjusted by changing the inclination on the antenna The antenna must always be rotated to the right in order to avoid it being loosened by rotating it in the opposite direction The closer one gets to the horizontal the more the system becomes sensitive to inclinations of the trunk If the antenna is positioned at the back Photo 1 it informs the person of an increase in bending of the trunk if is it positioned in the front Photo 2 on the elastic straps it will indicate when the trunk is extended beyond the range set If positioned with the pointer to the right Photo 3 it will pick up inclinations of the trunk to the left and vice versa Photo 4 POSTURE MONITORING FEEDBA
13. roject COMPENSATION 6 FLEXION OF THE TRUNK SIT For patients with a hunchback posture that is difficult to correct providing positive FB when correct extension of the trunk is achieved is more effective and less frustrating Positioning the inclinometer on the front at the sternum the inclination of the same is regulated so that the sound sensor is activated at the range set INCORRECT POSITION CORRECT POSITION Sagittal Seated Filling a cup Flexion of the trunk Inclinometer Positive feedback SICHT COMPENSATION 7 FLEXION OF THE TRUNK This task and its context are similar to the previous case but differ in that the patient manages to keep the trunk aligned more easily The FB is activated when the patient loses control of the correct posture and calls on them to regain the initial position INCORRECT POSITION CORRECT POSITION Sagittal Seated Filling a cup Flexion of the trunk Inclinometer Negative feedback Page 14 CHINESPORT ul REHABILITATION and MEDICAL EQUIPMENT CHINESPORT spa Via Croazia 2 33100 Udine Italy Tel 39 0432 621 621 Fax 39 621 620 export chinesport it www chinesport com
14. sing inclination compensation before getting the signal to stop INCORRECT POSITION CORRECT POSITION Counter bending of the sid Frontal Standing Reaching the handle ae ne Inclinometer Negative feedback of the trunk COMPENSATION 3 HOMOLATERAL INCLINATION OF THE TRUNK When making the gesture of turning the handle the patient can use the trunk to reinforce the movement which should be done exclusively by the upper limb Compared to the previous situation the inclination is opposite that is on the same side as the limb working The antenna will therefore be aligned in the opposite direction and the patient will receive lt 0 FB as soon as they move the trunk on the frontal plane gt INCORRECT POSITION CORRECT POSITION Homolateral inclination of Frontal Standing Reaching the handle a ER hie en Inclinometer Negative feedback e trun Page 12 POSTURE MONITORING FEEDBACK Teorema Project LELEIIIIIEIIIIIIEIIIIIEIEIIIIIEIIIIIIIEIIIIEIEIIIIIELIIIIEIIIIEIIEIIIIIIEEIIIIEIIIIIEIEEIIIIIIIEIIIEIEEEIIIIEIEIIIIEIEIIIIEIEIIIIEEIIIIEIIEEIIIIEEEIEIIIIEIEIIIEIEIIIIIEIEIIIIIEEIIIIEIEIIIIIEEIIIIIEIIIIIEIIEIIIIEEIIIIEI EI COMPENSATION 4 COUNTER SIDEWAYS INCLINATION OF THE TRUNK This exercise involves turning the handle anticlockwise This movement is done mainly due to abduction of the arm The patient will probably be able to do the task at a certain height but will have difficulty if the handl
15. the arm for which fine use of the hand is activated proximal control of the trunk is fundamentally important Attention must not be focussed solely on interaction with the aid but must also take the way the patient uses the various areas of their body into account Simple gestures like opening closing a door or window and taking a glass of water if included in therapeutic contexts with position monitoring instruments are very useful for correct functional relearning The use of position feedback instruments inclinometer goniometer makes it possible to draw the patient s attention to the motorial behaviour of areas of their body of which the patient is not always fully aware providing information on performance and focussing attention on important aspects of the gesture Also adding Feedback has a motivating effect and produces an immediate increase in performance POSTURE MONITORING FEEDBACK LEILEILIEIEEIIIIIEELIIIEIIIIIEIEELIIIEIIIIIIEEEIIIIIEIIEIIEIIIIEIEEIIIIEIEIIEIEEIIIIIEEIIIIIESIIIEIEIIIEIEIEIIIIIEEIIEIIIEEIIIIIEI III INCLINOMETER PRESENTATION The inclinometer is a sensor that closes an electric circuit when movements occur on the frontal saggital plane providing position feedback as it reads absolute movements of the body trunk movements in the examples that follow and provides information on them THREE TYPES OF FEEDBACK The signalling device can be visual acoustic or vibratory Visual feedback
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