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BALANCE SYSTEM SD BIODEX

1. 5 1 Orthopedic and Sports Medicine Fall Prevention Reference Notes Getting Started verses 6 1 Accessing the Main Menu Display Panel Keys Described e Screen Keys Th Training ROUTINE rte m teret en ete theo bee t Pr he i en egre re d de ien 7 1 Postural Stability Training Limits of Stability LOS Training Weight Shift Training Maze Control Training Random Control Training Bua A AA AAA AA 8 1 The Postural Stability Test The Limits of Stability Test Athlete Single Leg Stability Testing Performing a Fall Risk Test RepOrtS 9 1 Report Parameters Defined Sample Balance Reports Assessing Limits of Stability With The Biodex Balance System Understanding Patient Performance Balance System Statistics Defined System Ulililieg M 11 1 Configuration o aii 11 2 e Patient Management SS 11 2 Biodex Balance System Reimbursement ss 12 1 General Maintenance ini ir in 13 1 Bibliography a sasha ii ie deta 14 1 Appendix A Calculation of Limits of Stability Direction Control A 1 Appendix B Normative Data Referenced in Predictive Values Report B 1 Replacement R 1 lll TABLE OF CONTENTS 1 INTRODUCTION Display Module Auxillary Serial Port USB Printer port Display Height Locking Knob Support Handle Support Handle Release Pin Printer Printer Stand Power Cord Whee
2. oO Back Figure 7 1 The Training Menu screen provides access to the Postural Stability Limits of Stability Weight Shift Maze Control and Random Control training modes 71 THE TRAINING MODES POSTURAL STABILITY TRAINING See Figure 7 2 The Postural Stability Training mode is designed to emphasize specific movement patterns or strategies by placing markers anywhere on the screen grid The patient s score is a tally of how many times the patient can touch targets with the on screen cursor during any session Time counts up or down as set Postural Stability Training O Place Target j E j o Clear Target Clear Tracing TERI px ETS Ena 9 rom Ea Ea HE Ea Ec Time 00 00 Press START to Begin Score 00 00 o 8 More Options Print Figure 7 2 The Postural Stability Training screen To Access The Postural Stability Mode 1 Position the support handles as per patient protocol 2 Position the display height and tilt for patient comfort 3 At the Main Menu touch lt Training gt The Training Menu screen should now be displayed 4 Touch lt Postural Stability gt The Training Setup screen should now be displayed 5 Touch the appropriate lt Height gt key to highlight the patient height range setting desired Touch lt Next gt to advance to the Postural Stability Training screen 6 At the Postural Stability Training screen touch lt Place Target gt and then tou
3. Begin with handrails in the upright position and progress to lowering them Move platform as per training protocol 3 Bilateral Upper Extremity Activities e Place both hands in a north south east west and diagonal position Select desired training mode Begin with a stable platform and progress accordingly Move platform as per training protocol Begin on knees and progress to toes to one knee to one foot Progress to unilateral balance palm centered on the platform FALL PREVENTION 1 Bilateral Exercises Begin with static level weight shifts l rogress to dynamic level 12 weight shifts Use circular grid to demonstrate where tendency to fall occurs e Have patient perform both anterior posterior and medial lateral exercises 2 Unilateral Exercises Have patient hold platform steady and illustrate how well the patient holds the platform stable Different patterns circles anterior posterior medial lateral to increase strength of the lower extremity REFERENCE NOTES 1 Caution must be noted when performing this activity Ensure that the patient has the ability to handle this challenging activity 2 Ensure proper bilateral stabilization prior to unilateral stabilization 3 Ensure that patient uses the handrails as needed 4 Ensure that bilateral and unilateral static stability are adequate prior to progressing to unilat eral dynamic stability 5 The more unstable the platform eight vs one the
4. 09010 MOUNT CABLE TIE 1 REQ DG 08419 CABLE TIE 4 REB D 48 REPLACEMENT R 2 WS I PAN L FASTENERS SNI iN 110 2 75 LG AN A RED BLACK WIRE y 5 120 V UNIT 95 300 E73 CHASSIS GROUND CABLE 1 RED 45 CI2907 FUSE 16 AMP 120 V 1 RER D BALANCE SYSTEM ASSY 70 950 385 4304 PLUG COVER 2 REB D 717009263 SCR PAN H SEMS 44 40 x 25 4 REQ D A 51 050 300 4700 DISPLAY ASSY 1 REDD 62 950 300 1604 LABEL SUPPORT HANDLE RELEASE 1 REU D 64 950 300 1302 LABEL BIDDEX PRODUCT 2 REO D 55 00550 LABEL FUSE ING 1 REO D WARN 56 09550 LABEL SZ CAUTION 1 RERO 53 050 300 PA02 BASE COVER 1 RER D 5 C12488 SCR 43 950 300 E705 TRANSFORMER CABLE 1 RED D DATA amp PONER CABLE 950 300 704 REF SQ POSITION amp TILT ORE gt ie 950 300 702 REF ie _ MOTOR POWER CABLE f U DZ 4945 300 E714 REF GAME PORT INTERNAL CABLE 945 300 711 REF 49 09393 LABEL DANGER HIGH VOLTAGE 2 PER D 012887 FUSE 3 15 AMP 120 V 2 REN D R 230 V 12907 FUSE 16 AMP 230 V 1 REO D 012913 FUSE 2 AMP 230 V 2 REG D 0 834 c 91 8E ONKE D H 0 039 1 0 04 CL 331 33 1 0 039 CT l Md HMD c 0 039 CT d3NOd ON 6 DE 0 Id Xs 38 0 02 DE ONTDSS OL 381A N33 IN NAGE a0 22V 1B IVals 9 DEN 1 IND HAY WHE E SLIDA Dec 0E 066 ka SLA STI MLF 97 uug
5. REPLACEMENT Pes BALANCE CONTROL MODULE ASSY 9 C12164 STANDOFF 4 19 LG 2 REDD 09197 SCR SOC FLAT HD 1 4 20 75 LG 4 REP DQ 08001 LOTITE LIE REF D SOLDER PADS Y 4 62 950 200 1850 BLOCK TOP ANTG 2 REWD LIT A 50 00 4851 BLOCK BOTTOM ANTG 2 RED D 950 300 1200 WELOMENT U JDINT G MNTG PLATE 1 REQ D 9950 30 56 MODIFICATION 425 SPROCKET M 1 gt CS L12910 FLANGED BRONZE BRG 1 RED 950 300 E702 STIFRAESS ADJ POT ASSY 1 ROE NS d op 08904 CLAMP CABLE g z 1 COBZIO SCR BUT HO 46 200 2516 q GDCORO SCR SET CUP 10 321NFx 18 6 6 REU D 251 WAGER 16 FLAT 1 FEO e ES z L Bm LOCTITE ELLE REF 09418 CABLE TIES 3 RED E Te DHT SR HEX ID S16 18x 50 Lo AS LP 29 08043 WASHER LOCK 5 16 5RETD 950 300 4355 MODIFIFCATION G7 Er Y I 2 009421 SCR HEX HD 1 4 20 50 LG 4 RED D Se MI 9 qe 0807 WASHER UK 1 4 4 REND I U RR uma al BRA oa D955 110 315 FLANGED BRG 3 REDO i RASE E 12 COTO RETAINING COMPOUND GREEN MR E E 08277 BRG THRUST S8 d 5 8 R A Aa 3 810x 7500x OBTHK 9 s ZUM PF fL SN 3 EDD 960 200 1316 PLATE LOCK 8 RED DC2 09938 PIN ROLL 1 8 G DIA x 63 LG 8 REID CENTER PIN ON PLATE 08776 PIN DOWEL 4 1 4 DIA x 75 LG MEL AE Tie gt 8 TE uj e ets ep 24 11730 SUPER LUBE REF 950 300 4130 U JOINT MOTOR C1 218 12872 RETAINING RI
6. 08096 SCR SET CLP 2 5 10 32UNFx 18 LG 4 RED D 08001 LOCTITE BLUE REF 6 950 300 M355 MODIFICATION 23 SPROCKET 197 1 RED om Y 5 8 4 REN D Man C08001 LOCTIE BLUE A R tg Rs 045 300 W200 MOTOR BRAT ONON WELOMENT 1 RED D 050 300 E714 MOTOR BALANCE DEVICE 1 RER D R 7 REPLACEMENT SIRAIN GAGE PLATE ASSY 12116 C08001 LOCTITE REF 09253 SCR PHIL PAN HD HAON x 25 LG 4 REDO A COUS WASHER 2 00 112 1D x 03 THK 4 RD 050 300 N343 BRKT LEFT 2B Md Lu PC BOARD 1 RED O MEAS T 25 950 300 810 BALANCE SYSTEM STRAIN GAUGE BOARD ASSY STRAIN GALIGE 4 24 C10829 LOOP STRAIN GAUGE 3 See CABLE 4 RETO pS ET ow STRAIN GAUGE 2 s e f STRAIN GAUGE 1 aa 23 050 300 E701 CABLE STRAIN GAUGE 10 32x 25 LG 10 RED C08001 REF EXTENSION 2 RED D 350 300 4170 WLDMENIQI 945 300 M307 SPRING SKIRT 1 REQ O PAD 12 REN D 1006 SCR SLOTTED FLAT H0 2 0 12873 SCR BUT HO 4 40x 31LG 16 RED D 4 6 32x 63 LG 8 RED 0800 LOCTITE BLUE MR 9 050 300 4322 BLOCK LINEAR BRG 2 REID 7012871 LINEAR BRG 38 DIA 2 RED D 8 C08944 RETAINING RING EXT 63 DIA 4 REQ D CO8001 REF 945 300 N325 PIVOT BOARD 11 WEAR PLATE 8 REQ D 08708 SCR BUT HD 9 10 32x 25 6 2 REN STRAIN C10360 WASHER FLAT 10 2 RED DO GAUGE 41 08500 NUT HEX ELASTIC S 5
7. The Fall Risk Testing Options screen TESTING 8 14 Fall Risk Test Results Actual STD Score Dev Overall Stability Index Your score compared to age group of healthy people H L CA E oe ee ee CN 4 Racial Your Score 72 89 yrs IN 54 71 yrs M 36 53 yrs BE 17 35 yrs Print Results Save Results Home Figure 8 15 A sample Fall Risk Test Results screen PERFORMING A FALL RISK TEST See Figures 8 13 and 8 15 1 Position support handles as per patient protocol 2 Position display height and tilt for patient comfort 3 At the Main Menu touch Testing The Testing Menu screen should now be displayed 4 Touch Fall Risk The User Setup Information screen should now be displayed 5 Touch the Keypad icon for Name and enter the patient s name Touch lt OK to return to the User Setup Information screen 6 Touch the Keypad icon for Age and then enter the patient s age Touch OK to return to the User Setup Information screen 7 Touch the appropriate Height key to highlight the patient height range setting desired Touch Next to advance to the Patient Position screen 8 Position the patient on the system and explain the test protocol Press Start on the display to activate the cursor and have the patient move the cursor to the center point on the grid 9 Touch Record to bring up the Position Patient Entry screen Using the keypads enter the patient s left foot l
8. switch on the printer Ensure the printer s green Ready LED comes on to indicate the printer is receiving power Refer to the supplied printer manual for additional printer information 321 ASSEMBLY amp INSTALLATION USB Printer Port Auxiliary Serial Port 1 Figure 3 1 The printer power cable should be plugged into the AC receptacle on the rear base of the dis play support post The printer USB cable should be plugged into the USB port on back of the display Figure 3 2 Connect the power cable and USB cable to the rear of the printer ASSEMBLY amp INSTALLATION 3 2 PARTS AND ADJUSTMENTS See Figure 3 3 Mechanical adjustments to the Biodex Balance System are straightforward and uncomplicated In fact there are only three adjustments that need be addressed to accommodate any patient Support Handle Position Display Height and Display Tilt All other test and exercise functions are software controlled To Adjust the Support Handle 1 To position the Support Handle for patient use hold the Support Handle while pulling out on the Support Handle Release Pin Rotate the handle to the desired position Release the pin to lock the Support Handle in place 2 To release the Support Handle so that it cannot be used by the patient hold the handle while pulling out on the Support Handle Release Pin Fully lower the handle then release the pin Ajustement de l appui 1 Pour regler l angle de l appu
9. until the desired target size is displayed THE TRAINING MODES 7 10 8 If desired touch lt Clear Tracing gt to remove any tracing that remains on the screen from a pre vious exercise session 9 Touch More Options to advance to the Random Control Training Options screen if desired Here you can set the total time for the exercise enter initial and ending platform stability set tings and turn tracing ON OFF Touch OK to confirm your selections and return to the Random Control Training Options screen or Cancel to return to the Random Control Training Options screen without making changes Use the lt A gt or lt W gt keys to set the total time in 10 second increments during the routine the system will count down from the time setting selected NOTE Total time must be set before you can set beginning and ending platform stability To set initial platform stability touch the appropriate key and then enter the setting from the keypad displayed static 12 is most stable 1 is least stable Touch OK to return to the Random Control Training Options screen and set the ending platform stability in the same man ner To turn tracing ON OFF touch lt Tracing gt to toggle between choices 10 At the Random Control Training screen touch the A or lt W gt keys to select the desired platform stability if not already selected static 12 is most stable 1 is least stable 11 Explain the training
10. 16 18 8 RED D STRAIN GAUGE 4 950 300 A080 STAIN 2 GAUGE ASSY 4 REID 950 300 M321 PLATE STRAIN 1 N GAUGE 1 REB D 12874 SCR SET OVAL POIN 950 300 M325 SHAFT GUIDE 2 REB D 1 4 20x 63 LG 1 REG D 8702 ADHESIVE PERM LOK HMIG0 A R C08001 REF 15 950 300 4324 BAR QA CONTACT POINT 3 REW D 1 REWU EM E y 08702 REF 950 300 M320 PLATE C08702 PERH LIX MIGO VP AZ o AD TP 1 0 BARD LAEL D RENO OWE CHAMPERS IN THIS SIDE REF LOCATION REF STRAIN GAUGE 2 STRAIN GAUGE 3 REPLACEMENT R 8 BIODEX Biodex Medical Systems Inc 20 Ramsay Road Shirley New York 11967 4704 Tel 800 224 6339 In NY and Int l call 631 924 9000 Fax 631 924 9338 Email sales biodex com www biodex com
11. After completing the test a Test Complete message is displayed Touch lt Results gt to advance to the Athlete Single Leg Stability Test Results screen 18 At the Athlete Single Leg Stability Test Results screen touch lt Print gt to automatically gener ate a printed report if desired 19 To save the test data touch lt Save Results gt and then touch lt OK gt in response to the Save Results for later reporting or export prompt The system will display Save Results Completed after the results are saved 20 To return to the Opening Menu from the Athlete Single Leg Stability Test Results screen touch lt Home gt TEST PROTOCOL FOR ATHLETE SINGLE LEG STABILITY TESTING This test protocol can be used to compare patients of similar age ranges in a normative database Test Duration 20 seconds Level Four Stance Type Single leg Trials 3 References Athlete Single Leg Stability Test results compliation of data from Paterno MV et al Neuromuscular Training Improves Single Limb Stability in Young Female Athletes J Orthopedic Sports Therapy June 2004 Arnold BL Schmitz R Examination of Balance Measures Produced by the Biodex Stability System J of Athletic Training 1998 33 4 323 327 Rozzi S et al Knee Joint Laxity and Neuromuscular Characteristics of Male and Female Soccer and Basketball Players American J Sports Medicine Vol 27 No 3 1999 8 13 TESTING PERFORMING A FALL RISK TEST The Fall R
12. Biodex 92 228 LEONARD K et al CHANGES IN DYNAMIC POSTURAL STABILITY FOLLOWING CRYOTHERAPY TO THE ANKLE AND KNEE J of Athletic Training Vol 34 2 S 68 April June 1999 Biodex 91 107 LEPHART S et al LEARNING EFFECTS AND RELIABILITY OF THE BIODEX STABILITY SYSTEM Sports Medicine amp Neuromuscular Laboratory Univ of Pittsburgh Pittsburgh PA Biodex 93 208 MAGILL J et al CHANGES IN DYNAMIC POSTURAL STABILITY WITH THE USE OF NEOPRENE SLEEVES J of Athletic Training Vol 34 2 S 30 April June 1999 Biodex 91 103 MALLEY C et al THE EFFECTS OF THREE DIFFERENT ANKLE TRAINING PROGRAMS ON FUNCTIONAL STABILITY AND SINGLE LIMB STANCE J of Athletic Training Vol 34 2 S 30 April June 1999 Biodex 91 105 NELSON AJ et al USING THE BIODEX UNWEIGHING SYSTEM BALANCE SYSTEM AND GAIT TRAINER IN AN INTEGRATED REHABILITATION PROGRAM Abstract May 2001 Biodex 92 217 PATERNO MV et al THE RETURN OF NEUROMUSCULAR COORDINATION AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION Biodex Medical Systems Biodex 91 112 PATERNO MV et al NEUROMUSCULAR TRAINING IMPROVES SINGLE LIMB STABILITY IN YOUNG FEMALE ATHLETES JOSPT Vol 34 6 305 316 June 2004 Biodex 492 245 14 3 BIBLIOGRAPHY PINTO KK et al THE EFFECTS OF ANKLE TAPING AND BALANCE ACTIVITIES ON BIODEX STABILITY MEASUREMENTS J of Athletic Training Vol 34 2 S 30 April June 1999 Biodex 91 102 RIEMANN BL et al
13. Leg Stability protocols INTRODUCTION 1 2 2 SYSTEM SPECIFICATIONS Dimensions Base 30 w x 44 depth x 8 h 76 x 112 x 20 cm Platform 21 5 dia 55 cm Display Height Adjustable from 53 to 68 h above platform 135 x 173 cm 76 h 193 cm maximum from floor Support Rails Adjustable from 25 to 36 5 above platform 64 to 93 cm Rails can swing away from platform when not in use Platform Tilt 20 degrees from horizontal in all directions Stability Levels Twelve levels plus locked for static measurements Game Port Simulates joystick output suitable for an IBM PC compatible game port Color Touch Screen Display Viewing Area 6 6 w x 5 h 168 x 127 mm Resolution 800 pixels x 600 pixels Accuracy 1 degree of tilt Angle Adjustable from vertical back to approximately 45 degrees Printer HP DeskJet Printer Stand 24 x 24 61 x 61 cm Patient Capacity Up to 400 Ib 136 kg Weight 196 Ib 89 kg Power 115 VAC 50 60 Hz 15 amp line or 230 VAC 50 60 Hz 15 amp line Power Rating 350 watts Certification ETL listed to UL 2601 1 and cETL listed to CAN CSA C222 No 601 1 M90 IEC 60601 1 Warranty 2 years parts 1 year labor 2 SYSTEM SPECIFICATIONS 3 ASSEMBLY amp INSTALLATION The Biodex Balance System SD is shipped in a single carton Except for the printer which the user must install as explained below the entire system is factory assembled and ready to operate If desired the
14. Next gt to advance to the Patient Position screen 8 Position the patient on the system and explain the test protocol Press lt Start gt on the display to activate the cursor and have the patient move the cursor to the center point on the grid 9 Touch lt Record gt to bring up the Position Patient Entry screen Using the keypads enter the patient s left foot left heel right foot and right heel positions using the midline of the foot and the platform grid as reference points Touch lt Next gt to advance to the Athlete Single Leg Stability Testing screen 10 At the Athlete Single Leg Stability Testing screen touch lt Stance gt to toggle between left and right leg positioning 11 Touch lt Tracing gt to toggle tracing ON or OFF as desired 12 Touch lt Clear Tracing gt to clear any tracing that remains from previous tests 13 Touch lt More Options gt to advance to the More Options screen if desired Here you can set the Test Trial Time enter initial and ending platform stability settings enter the number of trials and enter the Rest Countdown Touch lt OK gt or confirm your selections and return to the Athlete Single Leg testing screen Use the lt A gt or lt W gt keys to set the total time in five second increments during the routine the system will count down from the time setting selected NOTE Total time must be set before you can set beginning and ending platform stability To set initial or ending p
15. Protocol Platform Setting 8 Foot Angle Heel Position Left Percent Actual Difference Score Overall 17 3 0 Anterior Posterior Index 2 Medial Lateral Index Anterior Left Posterior Test Trial Time 20 Test Trials 1 Right Actual STD Score 245 Right Comments Clinician 9 2 Sample Postural Stability Bilateral Comparison Test Report 9 5 REPORTS Name Alan Heyen Date 10 20 2005 11 54 AM Height 65 73 Age 57 Foot P n Protocol Platform Setting 8 Foot Angle 0 Test Trial Time 20 Heel Position Test Trials 1 Time to Complete Test 12 o o usd Direction Control Actual Overall 53 Forward Backward Right Left Forward Right Forward Left Backward Right Backward Left e BEBER BRRRRRBRE Comments Clinician 9 3 Limits of Stability Single Leg Test Report unilateral stance REPORTS 6 Name Simon Fletcher Date 10 20 2005 11 31 AM Height 65 73 Age 27 Protocol Left Platform Setting 8 Foot Angle 5 5 Test Trial Time 20 Heel Position e4 Test Trials 3 Time to Complete Test 12 e o per Direction Control Actual Overall 62 Forward Backward Right Left Forward Right Forward Left Backward Ri ght Backward Left RPEBREBR ii Comments Clinician 9 4 Limits of Stability Test Report bilateral stance og7 REPORTS Name Horace Clark Height 65 73 Age 28 Foot Placem
16. Y ana A 50 5 0E UD UIW NI Ah r a Id 39019 NIVALS iin NDd DN WA ES eA AS913192 1900 iQ WNHdINI 11 4 00 G76 e HJ Sf 60680 AMENII 00 00 056 VIVO 9 ddMHd NIVH BV 00 3 00 056 ONg tP HN 1DH V Ir 0808 103INOJ AlddS YaWOd 80d 0083 00 066 INIA IN CS NdJISAS SONY IG REPLACEMENT RE FRAME ASSY 950 300 4020 ADJ DISPLAY TS 9 TUBE ASSY 1 REQ D I 08893 COLLAR CLAMP 6 1 25 DIA 1 REN D 950 300 W140 WELDMENT 5 HANDLE BAR 1 RED 9 08969 GRIP FOAM 1 2 1D x14 LG 2 REID i inn Q A SD U5 300 4330 HANDLE BAR PULL PIN O na o Wes SPRING COMPRESSION di RED D 12740 SCR m 1 OY Pira SUPER LUBE GREASE A R 10 32UNFx 38 LG 10 PED D i mis KNOB BALL 1 REQ D C08001 LOCTITE BLUE A R 08920 HOLE PLUG 1 REG D QD Y 7 950 300 M340 SPACER 1 REN D 8 C08921 BRG NYLINER 1 25 DIA 2 PER D 2 D 950 300 W100 WELDMENT BASE PAN 1 REQ D 23 C10367 RETAINING CLAMP H 25 DIA 1 REG D 09004 NUT HEX HD 08519 NUT CLIP 6 32 2 REB D 10 32 7 D SC11561 CASTER 2 REO N 7 EDO TAO IO AE 14 5 16 18x2 0 LG 2 RER D AND COBOO REF 09406 SCR PHIL PAN HD Q2 6 32UNCx 50LG 2 REB D REPLACEMENT R 6 08897 GEAR SPUR 9 19 T LRER D 945 1 10 M452 LONG SQUARE KEY 1 REN D 498
17. direction Moderate has 36 targets 18 in each direction Most difficult has 72 targets 36 in each direction In the case of the easiesst maze If the wall is hit 6 times the resulting score will be 22 28 78 Maze Control Training STATIC ET En CN ETS ES Ga ECM ERES Clear Ea Ea EXE Time 00 00 Press START to Begin Score 00 00 More Options Back Print Figure 7 5 The Maze Control Training screen To Access The Maze Control Mode 1 Position the support handles as per patient protocol 2 Position the display height and tilt for patient comfort 3 At the Main Menu touch lt Training gt The Training Menu screen should now be displayed 4 Touch lt Maze Control gt The Training Setup screen should now be displayed 5 Touch the appropriate lt Height gt key to highlight the patient height range setting desired Touch lt Next gt to advance to the Maze Control Training screen THE TRAINING MODES 7 8 6 Touch lt Skill Level gt to increase or decrease the number of targets displayed on the graph Three skill levels are available from which to choose Touch lt Skill Level gt until the desired target configuration is displayed 7 If desired touch lt Clear Tracing gt to remove any tracing that remains on the screen from a pre vious exercise session 8 Touch lt More Options gt to advance to the Maze Control Training Options screen if desired Here you can set the total time
18. en position bloqu e De la mame facan si le syst me n est pas utilis pendant un intervalle de 3 minutes il se bloque 3 R gler l appui et l ecran pour maximizer le confort et la s curit du patient 4 Pour des patients post op ratoires v rifier avant de les faire monter sur le plateau qu ils sont capables de stabiliser leurs articulations Un contrile insuffisant pourrait les mettre risque 5 Si les patients travaillent les yeux ferm s il faut se tenir pr t les aider ou mettre en place l appui 6 Puisque l utilisation du plateau de stabilit sollicite toutes les articulations de l extr mit s assurer que les cicatrisations sont suffisamment avanc es pour supporter l exercice 7 Les r sultats sont meilleurs avec le patient plac au milieu du plateau 8 Les patients doivent d marrer avec l appui et apprendre progressivement ne plus s en servir De cette facon les patients d veloppment leur compr hension du plateau de stabilit en minimisant les risques 9 La courbe d apprentissage du syst me peut influencer les r sultats d un examen La litt rature clinique sugg re qu il faut r aliser trois examens blanc avant de faire un examen d finitif 10 R gler l cran droit devant les yeux du patient Ceci aidera maintenir une bonne position pendant l exmen ou l entra nement ADDITIONAL CONSIDERATIONS FOR FALL PREVENTION PROGRAMS In addition to the above the following considerations should a
19. entire Balance System SD program lt HOME gt Touch this key to return to the Main Menu lt NEXT gt Touch this key to advance to the next logical screen lt BACK gt Touch this key to return to the previous screen lt OK gt Touch this key to confirm selections or entries and advance to the next screen 6 Training Testing Utilities Figure 6 1 The Balance System Main Menu Figure 6 2 The Display Panel Keys GETTING STARTED 6 2 7 THE TRAINING MODES The training modes provide a simple means of setting up a training or exercise session Five interactive game like training modes are provided These allow for fast patient setups less for mal protocols than the testing routines and the ability to change stability levels from very unstable to static during the actual training session All five training modes can be customized to provide specific rehab goals with the on screen grid and score keeping functions used to both help motivate users and keep them focused on the task at hand In the training modes only the most basic parameters are addressed Training data cannot be saved but the print screen function will allow the user to generate a printout of the training results Training mode formats include postural stability limits of stability weight shift maze control and random control as described in the following sections Training Postural Stability Limits of Stability Random Control
20. for the exercise enter initial and ending platform stability set tings and turn tracing ON OFF Touch OK to confirm your selections and return to the Maze Control Training Options screen or lt Cancel gt to return to the Maze Control Training Options screen without making changes Use the lt A gt or lt W gt keys to set the total hits NOTE Total time must be set before you can set beginning and ending platform stability To set initial platform stability touch the appropriate key and then enter the setting from the keypad displayed static 12 is most stable 1 is least stable Touch lt OK gt to return to the Maze Control Training Options screen and set the ending platform stability in the same manner To turn tracing ON OFF touch lt Tracing gt to toggle between choices 9 At the Maze Control Training screen touch the lt A gt or lt W gt keys to select the desired plat form stability if not already selected static 12 is most stable 1 is least stable 10 Explain the training protocol to the patient and then press lt Start gt on the display to begin the training session The Stability Training grid on the screen charts the patient s stability per formance through the course of the training session touch the lt Magnifying Glass gt to enlarge the screen if desired The Elapsed Time from the start of the training session is shown at the top right of the display while the stability level is illustrated by a ba
21. more challenging the activity will become Ensure the patient uses the handrails at all times 5 1 APPLICATIONS N NOTE DE R F RENCE 1 Cette activit doit tre entreprise avec pr caution S assurer que le patient est capable de r aliser l activit 2 S assurer d une bonne stabilit bilat rale avant de commencer un travail sur la stabilit uni lat rale 3 S assurer que le patient sait utiliser l appui correctement 4 S assurer que la stabilit bilat rale statique sur une seule jambe est ad quate avant de proc der la stabilit unilater rale 5 Plus le plateau est instable 8 quivaut un r glage plus stable le r glage 1 quivaut un niveau moins stable plus l activit est difficile r aliser S assurer que la patient utilise l appui tout moment APPLICATIONS 52 6 GETTING STARTED The Biodex Balance System software program is easy to master Simply follow the screen prompts as they lead you step by step through testing and training protocols or software utility options For each screen active option keys are highlighted in boldface type Touch the desired on screen key to make your selection Option choices progress logically based on the selections made ACCESSING THE MAIN MENU To access the Balance System Main Menu See Figure 6 1 1 Press the lt ON STANDBY gt button on the display to turn the Balance System ON The Main Menu screen should now be display
22. of the Actual Value under the column labeled Predictive Values Should your patient s Actual Values not fit into the range of the Predictive Values there is a balance problem Bilateral comparisons can be made to determine progress made during rehabilitation on the Comparative Report see Figure 9 2 Anterior Posterior Stability Index Represents the variance of platform displacement in degrees from level for motion in the sagittal plane Medial Lateral Stability Index Represents the variance of platform displacement in degrees from level for motion in the frontal plane Standard Deviation The amount of variability in the statistical measure A low standard deviation demonstrates that the range of values from which the mean was calculated were close together DATA 10 2 11 SYSTEM UTILITIES The System Utilities allow users to access the System Configuration and Patient Management screens To access the System Utilities touch lt Utilities gt on the Main Menu The System Utilities screen should now be displayed From here you can select Configuration or Patient Management by touching the desired icon CONFIGURATION See Figure 11 1 and 11 2 At the System Utilities screen touch lt Configuration gt and then enter 781 in response to the Enter Access Code prompt Touch lt OK gt The Configuration screen should now be displayed At this screen users can set values for Screen Time Out Date Time and Default Settings
23. on screen report then touch Print to print the test results Data Export To export the results of any saved test touch Export Data The data will immediately sent to the export program Delete Page Although the Balance System SD display can store up to 1000 test records you may want to decrease the number of stored records from time to time To delete any full page display of saved reports touch Delete Respond lt OK gt to the delete prompt The page displayed will be deleted from the display memory The delete function only works with pages you cannot select a specific test or patient to delete without deleting every test and patient displayed on the screen 11 3 SYSTEM UTILITIES Configuration Printer resolution High Tone Joystick Emulation Disabled Figure 11 1 The Configuration screen SYSTEM UTILITIES 11 4 Default Settings Fall Risk Platform Setting E Predictive Values Age Range Index 17 35 YRS 0 82 r 2 76 36 53 YRS 1 23 r 3 03 a BEE 54 71 YRS 1 79 7 3 35 72 89 YRS 1 90 r 3 50 rx Restore Defaults c Cancel oK BEE Figure 11 2 System Default Settings 11 5 SYSTEM UTILITIES Patient Management 4 Joseph Simpson 11 25 2005 5 12 pm 4 Phil Karabin 11 25 2005 3 22 pm 4 George Johnson 11 25 2005 11 22 am OD O Back Delete Page Figure 11 3 The Patient Management screen SYSTEM UTILITIES 11 6 12 BIODEX BALANCE SYST
24. or and 16 degrees in the lateral direction In the static mode the patient s movements are calculated as the average amount of angular dis placement of the Center of Gravity COG This is then further defined as a percentage of the patients s Limits of Stability At 10076 of the LOS a patient will fall if they don t respond appropriately Center is established in the test protocol during the centering process where patients must posi tion themselves so the platform is flat and the cursor is centered In actuality this process is to position the COG over the point of the vertical ground reaction force An Anterior Posterior Stability Index of 6 8 means the average displacement from center is 6 8 degrees LOS for A P motion is 12 degrees In this case the patient was able to control their bal ance to remain within 57 of their A P LOS Balance is a complex process involving visual vestibular and neuromuscular control The Biodex Balance System will prove to be a more sensitive test of balance performance because being a dynamic tilting platform it will invoke the neuromuscular control aspects more so than a static force plate type system as well as the visual and vestibular components The Biodex Balance System will provide an accurate reliable assessment of a patient s balance performance This objective measure can be correlated to actual functional activity performance fall incidence and fall direction In addition balance mobility
25. system can be configured for IBM computer compatibility allowing the foot plate to be used like a joystick for interactive video game use Joystick options are discussed in the System Utilities chapter PRINTER INSTALLATION See Figures 3 1 and 3 2 NOTE It may be necessary to have the help of another person to steady the printer during the following procedure 1 Refer to the supplied printer manual to unpack the printer and ensure that it has not been damaged by shipping 2 Position the printer on the printer stand as shown 3 Locate the black printer power cable Plug the small end into the power receptacle on the back of the printer Do not connect any other equipment to this receptacle 4 Plug the AC plug end of the power cable into power cable port on the back lower base of the Balance System 5 Locate the white USB cable Connect one end of the cable to the USB port on back of the Balance System display Connect the other end of the cable to the USB port at the back of the printer directly above the power cable port 6 Ensure both cables are positioned so that they will not interfere with the patient or get caught in the Balance System platform or handles 7 Insert several sheets of paper into the printer paper holder Insert the paper holder into the top of the printer so that the open end interlocks with the printer and the paper faces out toward you 8 With power ON to the Balance System press the lt Power ON gt
26. to toggle tracing ON or OFF as desired TESTING 8 8 12 Touch lt Clear Tracing gt to clear any tracing that remains from previous tests 13 Touch lt More Options gt to advance to the Limits of Stability Test Options screen if desired Here you can set the number of trials rest countdown platform stability and limits of stability hold time Touch lt OK gt to confirm your selections and return to the Limits of Stability Testing screen Use the lt A gt or lt W gt keys to set the Limits of Stability Hold Time To set number of trials rest countdown or platform stability static 12 is most stable 1 is least stable touch the appropriate key and then enter the setting from the keypad displayed 14 Press lt Start gt to release the platform if not static and activate the Limits of Stability Test screen 15 With the patient ready to begin the test touch lt Collect Data gt The screen will provide a three second countdown before beginning the first of three test trials The display screen will show Test Trial Time Platform Setting and Stance to the left of the grid Trial Number and score are displayed to the right of the grid NOTE To stop a test in progress at any time and return to the Limits of Stability Testing screen with the platform locked touch Cancel or Stop 16 When the first trial is finished the screen will display Trial 1 Complete the platform will return to the locked position
27. with the platform locked touch lt Cancel gt or lt Stop gt 15 When the first trial is finished the screen will display Trial 1 Complete the platform will return to the locked position and the rest countdown will begin for the second trial Touch lt Collect Data gt to begin the second test trial and continue in the same manner to complete trials two and three 16 After completing the test a Test Complete message is displayed Touch lt Results gt to advance to the Fall Risk Test Results screen 17 At the Fall Risk Test Results screen touch lt Print gt to automatically generate a printed report if desired 18 To save the test data touch lt Save Results gt and then touch lt OK gt in response to the Save Results for later reporting or export prompt The system will display Save Results Completed after the results are saved 19 To return to the Opening Menu from the Fall Risk Test Results screen touch lt Home gt TESTING 8 16 TEST PROTOCOL FOR FALL RISK BALANCE TESTING This test protocol can be used to compare patients of similar age ranges in a normative database Test Duration 20 seconds Level Eight Stance Type Bilateral A minimum of three test trials should be used to avoid excessive balance deviations The patient s performance is noted as a stability index Test results are compared to age depend ent normative data Scores higher than normative values suggest further assessment f
28. ALE ATHLETES J of Athletic Training Vol 35 No 2 suppl S38 April June 2000 Biodex 91 189 FINN JA et al STABILITY PERFORMANCE ASSESSMENT AMONG SUBJECTS OF DISPARATE BALANCING ABILITIES Southern Connecticut State University 501 Crescent St New Haven CT 06515 Phone 203 392 6036 Biodex 1493 286 FLYNN WL et al CHANGES IN DYNAMIC POSTURAL STABILITY FOLLOWING CRYOTHERAPY J of Athletic Training Vol 32 2 5 6 April June 1997 Biodex 491 110 FREIDHOFE G et al PILOT ASSESSMENT OF THE BIODEX STABILITY SYSTEM WITH NORMALS TEST RETEST AND DAY TO DAY RELIABILITY University of Kentucky Div of P T Med Center Annex I Lexington KY Biodex 93 206 HINMAN MR FACTOS AFFECTING RELIABILITY OF THE BIODEX BALANCE SYSTEM A SUMMARY OF FOUR STUDIES J of Sport Rehab Vol 9 3 240 52 August 2000 Biodex 91 194 HORNYIK ML et al RELIABILITY OF LIMITS OF STABILITY TESTING A COMPARISON OF TWO DYNAMIC POSTURAL STABILITY EVALUATION DEVICES J of Athletic Training Vol 36 2 suppl S78 April June 2001 Biodex 92 229 BIBLIOGRAPHY 14 2 HORODYSKI MB et al MEASUREMENTS OF DYNAMIC POSTURAL STABILITY VISUAL SCANNING AND MENTAL FLEXIBILITY IN COLLEGIATE FOOTBALL PLAYERS J of Athletic Training Vol 34 2 585 April June 1999 Biodex 91 108 JORDEN RA et al THE INFLUENCE OF ANKLE ORTHOSES AND EXERCISE ON POSTURAL STABILITY J of Athletic Training Vol 36 2 suppl S 78 April June 2001
29. BALANCE SYSTEM SD OPERATION SERVICE MANUAL 950 300 950 302 950 304 BIODEX Biodex Medical Systems Inc 20 Ramsay Road Shirley New York 11967 4704 Tel 800 224 6339 In NY and Int l call 631 924 9000 Fax 631 924 9338 Email sales biodex com www biodex com FN 05 317 9 05 BALANCE SYSTEM This manual covers installation and operation procedures for the following products 950 300 System Balance SD 115 VAC 950 302 System Balance SD 230VAC 950 304 System Balance SD 100V Japanese NOTE The following symbol on your Biodex Balance System corresponds to this operation manual Symbol Meaning attention consult accompanying documents Symbol Signification Attention se r f rer la notice gt P P gt CAUTION Federal law restricts this device to sale or on the order of a medical practitioner When prescribed for therapeutic purpose a physician should clearly define the parameters of use i e total work maximum heart rate etc to reduce the risk of patient injury TABLE OF CONTENTS 10 11 12 13 14 Introduction aia did 1 1 System Specitica HONS asta diia 2 1 Assembly and Installation 4 eese erret tree e ben eni te rere reo e etd 3 1 e Printer Installation e Parts and Adjustments Clinical Considerations terrere teet rita tierra cte ua 4 1 General Clinical Considerations Additional Considerations For Fall Prevention Programs APP HCA OMS e
30. COMPARISON OF THE ANKLE KNEE HIP AND TRUNK CORRECTIVE ACTION SHOWN DURING SINGLE LEG STANCE ON FIRM FOAM AND MULTIAXIAL SURFACES Arch Phys Med Rehabil Vol 84 90 95 January 2003 92 237 ROZZI SL et al KNEE JOINT LAXITY AND NEUROMUSCULAR CHARACTERISTICS OF MALE AND FEMALE SOCCER AND BASETBALL PLAYERS American J Sports Med Vol 27 3 312 319 May June 1999 Biodex 91 101 SCHMITZ RJ et al INTERTESTER AND INTRATESTER RELIABILITY OF A DYNAMIC BALANCE PROTOCOL USING THE BIODEX STABILITY SYSTEM J of Sports Rehab 7 95 101 1998 Biodex 493 271 SIUDMAK PG et al CORRELATIONS BETWEEN DYNAMIC BALANCE PERFORMANCE AND ISOKINETIC FUNCTIONS OF KNEE FLEXOR EXTENSOR MUSCLES IN THE ELDERLY Biodex 93 295 TESTERMAN G et al EVALUATION OF ANKLE INSTABILITY USING THE BIODEX STABILITY SYSTEM Foot Ankle Int 1999 May 20 5 317 21 ISSN 1071 1007 Biodex 91 116 WILKERSON GB DYNAMIC JOINT STABILITY MECHANICAL AND NEUROMUSCULAR INTER RELATIONSHIPS Biodex Medical Systems Biodex 491 109 Rev 12 28 05 BIBLIOGRAPHY 14 4 APPENDIX A CALCULATION OF LIMITS OF STABILITY DIRECTION CONTROL Straight Line Distance to Target DIRECTION CONTROL SCORE Actual Distance Traveled X 100 WHERE _ _ t 1 4 4 4 7 Actual Straight Line Distance to Distance Target Traveled N trace k 1 I 7 V CENTER TARGET i 8 gt DLOS Scores 1 1 OVERALL DIRECTION CONTROL S
31. CORE or the Average of all the eight Targets A APPENDIX A APPENDIX B NORMATIVE DATA REFERENCED IN FALL RISK The following pertains to the Predictive Values noted on the Balance System Predictive Values Report Testing Parameters Level eight Bilateral stance Eyes open 20 seconds Five Trial reps 30 second rest period between sets Subjects 106 males and 84 females were tested Ages ranged from 17 89 years Results Group 1 N 31 Group 2 N 44 Group 3 N 78 17 35 yrs 36 53 yrs 54 71 yrs X 1 54 X 2 13 X 2 57 s d 0 72 s d 0 90 s d 0 78 NOTE Young subjects were more stable than older subjects Reference Group 4 N 47 72 89 yrs X 2 70 s d 0 80 This information was presented in abstract form at the New England Chapter of the American College of Sports Medicine Thursday October 1 1998 It is titled Stability Performance Assessment Among Subject of Disparate Balancing Abilities J A Finn M M Alvarez R E Jett D S Axtell D D Kemler Exercise Science Department Southern Connecticut State University New Haven CT APPENDIX B REPLACEMENT 0 034 A IEE E 0 833 2 26 94 CH XH IN 00060 7 l y 066 3 4 IA 3111007 100802 dWH ININIVISS 296013 1T 0 838 1 3182 dO E8E60 C 0 038 2 8 HS 1 A XIH ITIN 95280 CE 1 533 1 EH HONTH NN 61680 y HG 1 ASSY UWd Z NOLLDTRH 0 04 00 056 0 038 1 2 8 NI
32. DTAL BONY 0F160 CZ GS 1 3909 O07 ANI OZEH 00E G9 8 X GIEN Q0E Si6 9 0 038 E 3AISSHOV A OHL E60 WIHS MUS 6IEMHOOE G6 9 0 034 1 VID Se DT SHSM 240807 NON DE XNdW 0 038 1 3801 AST d001 DIAS DER 2 QG NMA OBIA 00E 056 DES 1 VH 381 233 DIRE Ty 2 D1 OG OREO CT AYTASTO NMA OS18 00 066 OH JS 30S BB sq NYd Tru 009800 QD 0 838 1 380 0 538 1 NIONOD carino esa BI 304 ALO yOL3 00E S 6 TW 912 00t ci6 02 0 838 1 91 95 eX0e p 1 D 008 HIW3AHI GCEN O0E GfG ASSY JAIL AV dS TOY REPLACEMENT pu 09065 LABEL FEDERAL 65 WARNING 1 RF D 950 385 E704 CABLE AUX GP SERTAL PORT 1 END 12124 SCR HEX JACK 14 40 x 25 2 REID 08001 LOCTITE 242 AR C12740 SCR PAN L FASTENERS LY 10 32x 3B LG 4 RED D 950 300 L603 LABEL DISPLAY HEIGHT LOCK 1 RED D 09415 WARNING LABEL 2 REQ D 09450 LABEL 220 240 66 VOLT 1 REO D 09509 LABEL ETL 09066 LABEL TYPE B EQUIP B0 Bl 09824 LABEL CE 1 RED 6121 LABEL BIODEX 58 X SERIAL LABEL 1 RER D ze 09303 LABEL REF WHITE WIRE 08922 CABLE LOOP 2 REG D 44 08425 NUT 410 32 REF 5 945 300 E711 GAME PORT 42 INTERNAL CABLE 1 REQ O 40x 50 LG 2 RED 950 300 711 POWER CORD EXTENSION 1 REG D 35 950 300 705 TRANSFORME 36 CABLE HARNESS 1 REU D PRINTER POWER CABLE 950 300 E703 REF
33. EM REIMBURSEMENT Clinicians are being reimbursed for the Biodex Balance System under the following CPT codes The code which best fits often varies with each specific payer Fees vary from state to state and from payer to payer Test and Measurements 97750 Physical Performance Test of Measurement with Written Report each 15 minutes Balance System generates a report to submit Therapeutic Procedures 97110 Therapeutic procedure one or more areas each 15 minutes therapeutic exercises to devel op strength and endurance range of motion and flexibility 97112 Neuromuscular Re education of movement balance coordination kinesthetic sense pos ture and proprioception each 15 minutes 97530 Therapeutic activities direct one on one patient contact by provider use of dynamic activities to improve functional performance each 15 minutes 1251 SYSTEM REIMBURSEMENT 13 GENERAL MAINTENANCE The Biodex Balance System requires only the most basic general maintenance performed on an as needed basis at least every three to four months CLEANING INSTRUCTIONS With the system turned OFF wipe down all surfaces with a damp cloth Mild soap and water can be used to remove stains and scuff marks As needed inspect all locking and adjustment mechanisms for signs of wear or damage If you have any questions or need further assistance contact the Biodex Customer Service Department GENERAL MAINTENANCE PROCEDURES Lubricate
34. Le harnais ne sert qu aider le patient atteindre le d ficit de stabilit Le harnais seul ne peut pas pr venir des chutes 2 Puisque le sys me de stabilit permet une inclinaison de 20 d marrer avec une stabilit 8 et avancer en fonction de la tol rance rencontr e NOTA Le niveau 8 est le niveau le plus stable et le niveau l est le niveau le moins stable les deux r glages permettent 20 d inclinaison 3 Des patients particuli rement faibles ou atrophi es surtout dans les extr mit s inf riures doivent atre surveill es de pras NOTA La cheville fournit une source capitale d informatioons sensorielles particuli rement importantes pour les personnes Eg es 4 Des s ances r p t es d entra nement de stabilit dans lesquelles l articulation se d place proche de ses limites entra nent une augmentation de la tonalit musculaire une sensibilit am lior e et des r ponses somato sensorielles plus vives 4 3 CLINICAL CONSIDERATIONS 5 APPLICATIONS ORTHOPEDIC AND SPORTS MEDICINE 1 Bilateral Balance Activities Select desired training mode Begin at level 12 or static and progress as tolerated Begin with handrails in the upright position and progress to lowering them Move platform as per training protocol Use ball toss drill to increase eye hand coordination 2 Unilateral Balance Activities Select desired training mode Begin at level 12 or static and progress as tolerated
35. NG EXTERNAL PLATE WELOMENT 1 REQ O 1 12 DIA 3 EDD COBDI4 SCR BUT HO 20 06335 NUT HEX HD JAM 3 8 16 8 RED D 10 32x 5 LG 12 REID 16 F amp A 197012875 SCR HEX HD 3 8 16x 75 LG GRADE 8 8 RED D 08001 LOCTITE BLUE A R a ll gt NOTE GRIND MARKING FLUSH ON TOP OF BOLT 960 300 335 PLATE 3 SE 25 045 3 905 ACME SCREW BEARING SPACER 3 REQ D SPRING 1 RE D ACME NUT STOP 6 REG O 23 08521 THRUST BEARING 3 RED D 945 300 1823 SHIM ADE SCREN GD 34 011730 SUPER LUBE GREASE A P AS REU D SHIM BETWEEN THRUST 2008522 TRUST WASHER 6 RE 44 08015 WASHER FLAT 3 8 45 08348 WASHER LOCK 3 8 ig 08338 NUT HEX HD 3 816 1 REID 08329 SCR SOC BUT H 1 4 20x 75 L 4 RED D C08001 LOTITE BLUE REF WASHER amp FRAME SUPPORT An 22 C08891 BOST BRONZE PLAIN BEARING 05 39 49 NUT MODIFIED PA 3 RED O PRESS ERG IN ACME 3 RED 1 SQ IT IS FLUSH WITH BOTTOM C11730 SUPER LUBE REF 31 950 300 4050 MOTOR AND BRKT ASSY 1 REWD REPLACEMENT R 4 QOSNSS 1111 7181 WE Od 53044115 NOLLISUG DIM WALA TIR ON NE SIN 31849 10 3 00 056 NINIS TEN 90 3 00 066 did dlNIdd 0001 00 066 BLACK WHITE GREEN 123 00 056 COL3 00E 06 p1L3 00 056 1X3 30049 NISUS NHHNNWAI 1013 00E 0S5 ASS Yu Na wawa T SS OT 7 O183 00E Mag NID vEL3 00 St6 rd mi
36. Stability settings of 12 through one allow the foot platform a full 20 degrees of deflection from level in any direction For patient centering prior to testing the foot platform deflection is limited to less than five degrees Overall Stability Index SI Represents the variance of foot platform displacement in degrees from level in all motions during a test A high number is indicative of a lot of movement during a test with static measures it is the angular excursion of the patient s center of gravity Use as a starting point for a perfectly balanced state COB x 0 COB y 0 COB is Center of Balance on Y 0 X Y gt 0 Y DI DI number of samples Anterior Posterior AP Stability Index Represents the variance of foot platform displacement in degrees from level for motion in the sagittal plane Y 0 Y Dly number of samples 9 REPORTS Medial Lateral M L Stability Index Represents the variance of foot platform displacement in degrees from level for motion in the frontal plane Y 0 X Dix number of samples Mean Deflection Average position for the patient in all motions throughout the test Mean Deflection gt Xn Yn n Xn Yn A Xn Yn position vector magnitude A P Mean Deflection Average position of side to side motion for the patient throughout the test gt Yn n of samples A P Mean Deflection Yn n th sample M L Mean Defl
37. This test is a good indicator of dynamic control within a normalized sway envelope Poor con trol inconsistencies or increased times suggests further assessment for lower extremity strength proprioception vestibular or visual deficiencies may be indicated The default setting for the LOS test is 75 LOS moderate still level References 1 Clark S Rose DJ Fujimoto K Generalizability of the Limits of Stability Test in The Evaluation of Dynamic Balance Among Older Adults Arch Phys Med Rehabilitation Vol 78 Oct 1997 Limits of Stability Testing Test Trial Time Score 620 eo 1 7 8 orm Setting 3 3 Both eee t ava O Skill Level Press START to Release Platform O 5 Back More Options Home Figure 8 7 The Limits of Stability Testing screen Limits of Stability Testing Options Limits of Stability hold time Number of Trials Rest Countdown e lt Figure 8 8 The Limits of Stability Testing Options screen Platform Setting 600 87 TESTING Limits of Stability Test Results Time to complete test 12 min 10 sec Direction Control Actual Goal Overall 53 gt 65 Forward 63 gt 65 Backward 43 gt 30 Right 46 gt 65 Left 59 gt 65 Forward Right 54 gt 65 Forward Left 55 gt 65 Backward Right 44 gt 65 Backward Left 52 gt 65 D O Print Results Save Results Home Figure 8 9 The Limits of Stability Test Results screen for a bilat
38. You can also turn Tone ON OFF adjust LCD brightness or Tone volume and select Measurement Units Printer Resolution or Joystick Emulation When you have finished making all of your selections and adjustments touch lt OK gt to return to the Main Menu Set Screen Time Out The Screen Time Out setting determines how long the display screen remains ON when the sys tem is not in use of the test exercise is completed Once the selected time expires the screen fades to black even if the system remains ON 1 At the Configuration Screen touch Set Screen Time Out The Set Test Exercise Complete Screen Time Out screen should now be displayed 2 Use the A or VW arrows to increase or decrease the value displayed in 30 second increments Time Out range is from 00 00 to 30 00 3 Touch OK to confirm your changes and return to the Configuration screen Touch Cancel to return to the Configuration screen without making any changes Set Date Time Time and Date are system wide parameters that show on all printed reports 1 At the Configuration Screen touch Set Date Time The Set System Date Time screen should now be displayed 2 Touch the parameter to set so that the selected field is highlighted 3 Use the A or VW arrows to increase or decrease the value displayed for the highlighted parameter 4 Repeat steps 2 and 3 until you have adjusted all the parameters you wish to correct 5 Touch OK to confirm
39. and a 10 second rest countdown will begin for the second trial Touch Collect Data to begin the second test trial and continue in the same manner to com plete trials two and three 17 After completing the test a Test Complete message is displayed Touch Results to advance to the Limits of Stability Test Results screen 18 At the Limits of Stability Test Results screen touch Print to automatically generate a print ed report if desired If you have performed a Bilateral Test the Test Results screen and report will provide a bilateral comparison 19 To save the test data touch Save Results and then touch OK in response to the Save Results for later reporting or export prompt The system will display Save Results Completed after the results are saved 20 To return to the Opening Menu from the Limits of Stability Test Results screen touch Home 8 9 TESTING ATHLETE SINGLE LEG STABILITY TESTING The test protocol for the Athlete Single Leg Stability Testing allows clinicians to test athletes against data derived from studies using the Biodex Balance System The low stability level of four will challenge athletes and provide the data necessary to assess the athlete s single leg pos tural stability Athlete Single Leg Stability Testing Right NES 0 20 Test Trials Platform Setting 2 of 3 1 7 Clear Tracing Press START to Release Platform O More Options Homs Fig
40. ch the screen loca tion where you would like a target to be placed Repeat this process to place up to nine targets on the screen 7 To clear any misplaced or unwanted targets touch lt Clear Target gt Each time this key is pressed the most recent target added to the screen will be removed THE TRAINING MODES 2 8 Touch lt More Options gt to advance to the Postural Stability Training Options screen if desired Here you can set the total time for the exercise enter initial and ending platform stability set tings and turn tracing ON OFF Touch OK to confirm your selections and return to the Postural Stability Training Options screen or Cancel to return to the Postural Stability Training Options screen without making changes Use the lt A gt or lt W gt keys to set the total time in 10 second increments during the routine the system will count down from the time setting selected NOTE Total time must be set before you can set beginning and ending platform stability To set initial platform stability touch the appropriate key and then enter the setting from the keypad displayed static 12 is most stable 1 is least stable Touch lt OK to return to the Postural Stability Training Options screen and set the ending platform stability in the same manner To turn tracing ON OFF touch lt Tracing gt to toggle between choices 9 At the Postural Stability Training screen touch the A or lt W gt keys
41. d ending platform stability settings enter the number of trials enter the Rest Countdown or toggle bilateral comparison to Yes or No Touch lt OK gt to confirm your selections and return to the Postural Stability Testing screen Use the lt A gt or lt W gt keys to set the total time in five second increments during the routine the system will count down from the time setting selected NOTE Total time must be set before you can set beginning and ending platform stability To set initial or ending platform stability static 12 is most stable 1 is least stable touch the appropriate key and then enter the setting from the keypad displayed Touch lt OK gt to return to the Postural Stability Testing Options screen and set the ending platform stability in the same manner e To set the number of trials or rest countdown touch the appropriate key and then enter the setting from the keypad displayed To turn tracing ON OFF touch lt Tracing gt to toggle between choices To toggle bilateral comparison Yes or No touch lt Bilateral Comparison gt 14 Press lt Start gt to release the platform if not static and activate the Postural Stability Test screen 15 With the patient ready to begin the test touch lt Collect Data gt The screen will provide a three second countdown before beginning the first of three test trials The display screen will show Total Trial Time Platform Setting and Stance to the left of the
42. e default Fall Risk Platform setting adjust Predictive Values or return these parameters to their original factory set default values To adjust the Fall Risk Platform setting 1 At the Configuration Screen touch lt Default Settings gt The Default Settings screen should now be displayed 2 Touch lt Platform Setting gt 3 Enter the desired platform setting via the key pad displayed 4 Touch lt Ok gt to return to the Default Settings screen To Adjust the Predictive Values 1 At the Configuration Screen touch lt Default Settings gt The Default Settings screen should now be displayed 2 Touch to highlight the predictive value to you wish to adjust 3 Use the A or VW arrows to increase or decrease the value displayed SYSTEM UTILITIES TZ PATIENT MANAGEMENT See Figure 11 3 At the System Utilities screen touch Patient Management gt and then enter 781 in response to the Enter Access Code prompt Touch OK The Patient Management screen should now be displayed This screen shows a listing of patient names and associated saved tests along with the date performed Use the lt A gt or lt W gt arrows to scroll through the list of patient tests View Test Results To view the results of any test displayed simply touch the desired entry on the Patient Management screen to produce an on screen report Print Test Results To print test results for any patient touch the desired test to generate an
43. e support handles as per patient protocol 2 Position the display height and tilt for patient comfort 3 At the Main Menu touch lt Training gt The Training Menu screen should now be displayed 4 Touch lt Limits of Stability gt The Training Setup screen should now be displayed 5 Touch the appropriate lt Height gt key to highlight the patient height range setting desired Touch lt Next gt to advance to the Limits of Stability Training screen 6 At the Limits of Stability Training screen touch lt Stance gt to toggle though the patient stance positions until the desired choice right leg left leg or both legs is displayed 7 Touch lt Skill Level gt to tighten or widen the spread between targets Three skill levels are avail able from which to choose Touch lt Skill Level gt until the desired target configuration is displayed THE TRAINING MODES 8 If desired touch lt Clear Tracing gt to remove any tracing that remains on the screen from a pre vious exercise session 9 Touch lt More Options gt to advance to the Limits of Stability Training Options screen if desired Here you can set the Limits of Stability Hold Time for the exercise and turn Tracing ON OFF Touch OK to confirm your selections and return to the Limits of Stability screen or Cancel to return to the Limits of Stability screen without making changes To set a Limits of Stability Hold Time use the lt A gt or lt W gt ke
44. ection Average position for the patient in the frontal plane throughout the test gt Xn n of samples M L Mean Deflection EE Xn n th sample Standard Deviation The amount of variability in the statistical measure A low standard deviation demonstrates that the range of values from which the mean was calculated were close together Y AJ Xn X n of samples Standard Deviation A Xn n th sample X mean deflection NOTE Mean A P and M L Deflections are from the patient s actual position in contrast to the Stability Index which is a variance from level as established during the centering patient portion of the test proto col The resulting scores for Mean A P and M L Deflections are not statistically effected by the centering process REPORTS 9 2 Percent Time In Zone Quadrant These values represent the percentage of test time the patient spends in each Zone Quadrant during the test The Target Zones A B C and D are equal to specific ranges of deflection and radiate in con centric circles from the center of the foot platform as follows Zone A zero to five degrees foot platform deflection from level Zone B six to ten degrees foot platform deflection from level Zone C 11 15 degrees foot platform deflection from level Zone D 16 20 degrees foot platform deflection from level Quadrants represent the four quarters of the Test Grid in the X and Y axis as follows For the Bo
45. ed This screen allows the user to select the Training Testing or Utilities menus DISPLAY PANEL BUTTONS DESCRIBED See Figure 6 2 There are only three buttons located on the Display Panel These buttons operate as follows On Standby Located at the bottom left corner of the display panel the lt ON STANDBY gt button is used to turn the system ON or to STANDBY system is turned ON but display is still OFF For ON the Balance System Main Menu screen will appear on the display and the foot plat form will automatically advance to the fully locked stable position if it is not already locked CAUTION The foot platform does not automatically lock when the system is turned to STAND BY Thus it is recommended that you first bring the platform to the fully locked position by press ing the ON STANDBY button to set the system to STANDBY ATTENTION Le plateau ne roste pas dans la position bloqu e en mode d attente STANDBY pour cette raison il faut d abord bloquer le plateau avant de s lectionner ce mode For STANDBY the display will turn OFF all data will be lost and power to the foot platform will cease Start The Start button is used to begin the selected training or testing protocol selected Stop The Stop button is used to end the selected training or testing protocol selected 6 1 GETTING STARTED SCREEN KEYS The following on screen touch keys are consistent whenever they appear throughout the
46. eft heel right foot and right heel positions using the midline of the foot and the platform grid as reference points Touch Next to advance to the Fall Risk Testing screen 10 At the Fall Risk Testing screen touch racing to toggle tracing ON or OFF as desired 11 Touch Clear Tracing gt to clear any tracing that remains from previous tests 8 15 TESTING 12 Touch lt More Options gt to advance to the Fall Risk Test Options screen if desired Here you can set the Test Trial Time enter the number of trials and enter the Rest Countdown Touch lt OK gt to confirm your selections and return to the Fall Risk Testing screen Use the lt A gt or lt W gt keys to set the Test Trial time in five second increments during the rou tine the system will count down from the time setting selected To set the number of trials or rest countdown touch the appropriate key and then enter the setting from the keypad displayed 13 Press lt Start gt to release the platform if not static and activate the Fall Risk Test screen 14 With the patient ready to begin the test touch lt Collect Data gt The screen will provide a three second countdown before beginning the first test trial The display screen will show Test Trial Time and Platform Setting to the left of the grid Trial Number and score are displayed to the right of the grid NOTE To stop a test in progress at any time and return to the Fall Risk Testing screen
47. ent Left Foot Angle 5 Heel Position Actual STD Score Dev eie 1 2 1 0 Overall Stability Index Anterior Posterior Index Medial Lateral Index 9 0 9 5 1 0 1 5 2 0 2 5 3 0 3 5 4 0 Your Score A Overall Stability Index Anterior Posterior Index Il Anterior Left Posterior Normal Score Date 10 20 2005 11 35 AM Platform Setting 4 Test Trial Time 20 Test Trials 3 STD Dev 4 5 5 0 5 5 6 0 Medial Lateral Index Right Comments Clinician 9 5 Athlete Single Leg Stability Test Report REPORTS 9 8 Name Anita Restivo Date 10 20 2005 11 39 AM Height 59 65 Age 72 Foot Placement Protocol Platform Setting 8 Foot Angle 5 5 Test Trial Time 20 Heel Position e4 Test Trials 3 Actual STD Score Dev Overall Stability Index 2 7 2 15 Your score compared to age group of healthy people 9 5 1 0 4 5 2 0 2 5 3 0 3 5 4 0 4 5 Your Score A 72 89 yrs D 54 71 yrs B 36 53 yrs M 17 35 yrs Anterior Left Right Posterior Comments Clinician 9 6 Fall Risk Test Report 9 9 REPORTS 10 DATA ASSESSING LIMITS OF STABILITY WITH THE BIODEX BALANCE SYSTEM The Limits of Stability LOS for standing balance has been defined as the maximum angle a body can achieve from vertical without losing one s balance Once the LOS is exceeded a fall stumble or step will ensue LOS in normal adults is eight degrees anterior four degrees posteri
48. eral test PERFORMNIG A LIMITS OF STABILITY TEST See Figures 8 7 and 8 9 1 Position support handles as per patient protocol 2 Position display height and tilt for patient comfort 3 At the Main Menu touch lt Testing gt The Testing Menu screen should now be displayed 4 Touch Limits of Stability The User Setup Information screen should now be displayed 5 Touch the Keypad icon for Name and enter the patient s name Touch lt OK to return to the User Setup Information screen 6 Touch the Keypad icon for Age and then enter the patient s age Touch OK to return to the User Setup Information screen 7 Touch the appropriate Height key to highlight the patient height range setting desired Touch Next to advance to the Patient Position screen 8 Position the patient on the system and explain the test protocol Press Start on the display to activate the cursor and have the patient move the cursor to the center point on the grid 9 Touch Record to bring up the Position Patient Entry screen Using the keypads enter the patient s left foot left heel right foot and right heel positions using the midline of the foot and the platform grid as reference points Touch lt Next gt to advance to the Limits of Stability Testing screen 10 At the Limits of Stability Testing screen touch lt Stance gt to scroll through the three stance positions provided left right or both 11 Touch racing
49. grid Trial Number and score are dis played to the right of the grid If desired at this point you can touch the lt Magnifying Glass gt to select the zoom feature You must however leave the zoom feature to make any changes NOTE To stop a test in progress at any time and return to the Postural Stability Testing screen with the platform locked touch lt Cancel gt or lt Stop gt 16 When the first trial is finished the screen will display Trial 1 Complete the platform will return to the locked position and a 10 second rest countdown will begin for the second trial Touch lt Collect Data gt to begin the second test trial and continue in the same manner to com plete trials two and three 17 After completing the test a Test Complete message is displayed Touch lt Results gt to advance to the Postural Stability Test Results screen NOTE If you have selected Bilateral Test the system will begin by testing the initial side as set up above After the third trial on the initial side is finished touch Test Other Leg to continue The system auto matically selects the opposite side and then allows the user to proceed from the Position Patient screen Repeat steps 8 17 to test the opposite side 18 At the Postural Stability Test Results screen touch lt Print gt to automatically generate a print ed report if desired If you have performed a Bilateral Test the Test Results screen and report will provide a bilateral compar
50. he predisposition of a falls direction Falling to either side significantly increas es the chances of a hip fracture 1 2 3 References 1 Cumming Robert G Klineburg Robin J Fall Frequency and Characteristics and the Risk of Hip Fractures JAGS 42 774 778 1994 2 Nevitt Michael C Cummings Steven R Hudes Estie Risk Factors for Injurious Falls A Prospective Study Journal of Gerontology Medical Sciences 46 5 M164 170 1991 3 This information was presented in abstract form at the New England Chapter of the American College of Sports Medicine Thursday October 1 1998 It is titled Stability Performance Assessment Among Subject of Disparate Balancing Abilities J A Finn M M Alvarez R E Jett D S Axtell D D Kemler Exercise Science Department Southern Connecticut State University New Haven CT TESTING 8 6 THE LIMITS OF STABLITIY LOS TEST This test challenges patients to move and control their center of gravity within their base of sup port During each test trial patients must shift their weight to move the cursor from the center target to a blinking target and back as quickly and with as little deviation as possible The same process is repeated for each of nine targets Targets on the screen blink in random order Three skill levels allow the targets to be grouped closer together or spread further apart If desired sin gle leg LOS test may be performed but no bilateral comparison is provided
51. i le tenir tout en tirant sur le verrou Trouver la position voulue rel cher le verrou pour garder la position ainsi trouv e 2 Pour carter l appui le baisser tout en tirant sur le verrou To Adjust the Display Height 1 Loosen the Display Height Locking Knob 2 Pull up or push down on the display until the desired height is achieved 3 Tighten the locking knob to secure the display in the desired position NOTE Position the display so that the patient can look straight at it This will help ensure good posture during the test or exercise session Pour adjuster la hauteur de l ecran 1 Desserrer la mollette de r glage de hauteur 2 D placer l cran la hauteur voulue 3 Serrer la mollette To Adjust the Display Tilt 1 Simply tilt the Display as required by patient or testing exercise protocol Ajustement de l inclinaison de l ecran 1 Pivoter l cran pour obtenir l angle voulu 3 3 ASSEMBLY amp INSTALLATION Display Height Auxiliar y Locking Knob Display Module Serial Port USB Printer Port Support Handle Release Pin Printer Printer Stand Support Handle Power Cord AC Receptacle Wheels Foot Platform Figure 3 3 Balance System adjustment mechanisms ASSEMBLY amp INSTALLATION 3 4 A4 CLINICAL CONSIDERATIONS Prior to allowing any patient to use this device make certain to read and comprehend this entire manual Ensure that you are completely familiar w
52. ician is ready to assist in case of loss of balance or use the optional patient support stand 6 Since the entire lower extremity is required to work to stabilize the balance device ensure that supporting structures above and below the joint are adequately strengthened prior to beginning rehabilitation on this device 7 For optimal operation ensure the patient is standing in the center of the platform 8 Patients should progress from hands on to hands off the support handle This will ensure that new or unstable patients have an adequate understanding of the Balance System and will help protect the patient against sudden or unexpected movement of the platform 9 Position the display so that the patient can look straight at it This will help ensure good pos ture during the test or exercise session 10 There is a learning curve that must be considered when testing with this device Clinical research suggests three trials be performed prior to testing For dynamic balance testing the default settings are preselected with three trials per side This should assist with the learning curve and better average the data 41 CLINICAL CONSIDERATIONS CONSIDERATIONS CLINIQUES GENERALES 1 Tout patient doit comrendre les principles du syst me de stabilit avant de s y mettre 2 D marrer toutes les s ances avec le platcau en position bloqu c NOTA Lors de la misc sous tension le syst me de stabilit se met automatiquement
53. ion 13 When you are finished reviewing the training screen touch lt Print gt to print the screen if desired 14 After printing or reviewing the screen press lt Start gt to immediately begin another training session using the same parameters or press lt Back gt to return to the Training Setup screen 7 3 THE TRAINING MODES LIMITS OF STABILITY LOS TRAINING ROUTINE See Figure 7 3 The Limits of Stability Training screen is designed to challenge the user to move through a movement pattern consistent with the sway envelope The sway envelope is that area a person can move their COG within their base of support It is approximated from vertical as 8 degrees to one side 8 degrees to the other total of 16 degrees of sway and 8 degrees forward and 4 degrees back 12 degrees total Limits of Stability training and testing are based on challenging the patient within this sway envelope Testing is usually done at 75 LOS which is the moder ate skill level Easy skill level is 50 and hard skill level is 100 of the sway envelop Scoring percentage based and reflects the directional accuracy of the movement to the blinking targets see Appendix B 1 time counts up Limits of Stability Training EIM EDS O 0 so Press START to Begin Score 00 00 QD Back Print Figure 7 3 The Limits of Stability LOS Training Screen To Access The Limits of Stability Training Mode 1 Position th
54. isk test allows identification of potential fall candidates Test results are compared to age dependent normative data Scores higher than normative values suggest further assessment for lower extremity strength proprioception and vestibular or visual deficiencies Previous studies have repeatedly demonstrated that poor balance is a risk factor for falls among elderly subjects The test protocol incorporated in this system was included to give the clinician normative data to assess their patient s risk for falling During testing the patient undergoes three trials of 20 seconds each at level eight with ten second rest periods in between each trial The patient stands bilaterally with feet shoulder width apart over the midline of the board At the completion of the test a Fall Risk Assessment Report can be printed with a score compared to normative data Results can also be viewed on the screen References 1 Finn JA et al Biodex Balance System Assessment Amoung Subjects of Disparate Balancing Abilities Presented at the 1999 American College of Sports Medicine Meeting Fall Risk Testing Trials 2 of 3 Score 1 7 Clear Tracing Test Trial Time E Q 0 20 Platform Setting Tracing Press START to Release Platform o BB Back More Options Ena Figure 8 13 The Fall Risk Testing screen Fall Risk Testing Options Number of Trials Rest Countdown Test Trial Time e Figure 8 14
55. ison 19 To save the test data touch lt Save Results gt and then touch lt OK gt in response to the Save Results for later reporting or export prompt The system will display Save Results Completed after the results are saved 20 To return to the Opening Menu from the Postural Stability Test Results screen touch lt Home gt 8 5 TESTING SUGGESTED TEST PROTOCOL FOR GENERAL POSTURAL STABILITY BALANCE TESTING The test protocol most commonly used with the Biodex Balance System is a Dynamic Balance test as follows Test Duration 20 seconds Stability Level 8 Stance Two Leg Reliability studies have been done for this protocol In addition much of the research being pre sented is at these levels Three or four trial repetitions should be performed prior to testing at each level Again this is supported by research The patient s performance is noted as a stability index The stability index represents the vari ance of platform displacement in degrees from level A high number is indicative of a lot of motion which is indicative of the patient having trouble balancing Differences between right and left limbs can be noted Orthopedic problems many times present neuromuscular control problems You will see this by testing single leg involved and uninvolved Balance training will improve their control Geriatric patients can also be tested for excessive sway The direction of the sway is important with regards to t
56. ith all aspects of adjustment training and testing as well as patient history Be sure to adhere to the following clinical guidelines at all times when using this system NOTE Never allow a patient to use the Balance System while unsupervised CONSIDERATIONS CLINIQUES Avant d appliquer le systame de stabilit un patient lire avec soin la pr sente notice Il faut se familiariser avec tous les aspects de r glage d entra neemnt et d examen ainsi qu avec le dossier du patient Respecter les consigues indiqu es ci dessous lors de l utilisation du syst me NOTA Ne jamais laisser un patient sans surveillance sur le syst me de stabilit GENERAL CLINICAL CONSIDERATIONS 1 All users should have a verbal understanding of the Balance System prior to stepping on the device 2 To ensure patient safety begin each session with the balance platform in the locked or static position NOTE The Balance System automatically places the platform in the locked position when the unit is turned ON or after a time period of three minutes when the system is not in use 3 Adjust support rail and biofeedback display for patient comfort and safety 4 When dealing with post operative patients ensure they possess adequate muscular control to stabilize the joint prior to placing them on the foot platform Inadequate muscular control could lead to increased joint translation 5 When patients are working with their eyes closed ensure that a clin
57. latform stability static 12 is most stable 1 is least stable touch the appropriate key and then enter the setting from the keypad displayed Touch lt OK gt to return to the Athlete Single Leg Stability Testing Options screen and set the ending platform stability in the same manner To set the number of trials or rest countdown touch the appropriate key and then enter the setting from the keypad displayed To turn tracing ON OFF touch lt Tracing gt to toggle between choices TESTING 8 12 14 Press lt Start gt to release the platform if not static and activate the Limits of Stability Test screen 15 With the patient ready to begin the test touch lt Collect Data gt The screen will provide a three second countdown before beginning the first of three test trials The display screen will show Test Trial Time Platform Setting and Stance to the left of the grid Trial Number and score are displayed to the right of the grid NOTE To stop a test in progress at any time and return to the Athlete Single Leg Stability Testing screen with the platform locked touch lt Cancel gt or lt Stop gt 16 When the first trial is finished the screen will display Trial 1 Complete the platform will return to the locked position and a 10 second rest countdown will begin for the second trial Touch lt Collect Data gt to begin the second test trial and continue in the same manner to com plete trials two and three 17
58. ls Foot Platform Figure 1 1 The Biodex Balance System SD primary components and adjustment mechanisms 1 INTRODUCTION Featuring four test protocols five training modes and intuitive touch screen operation the Balance System SD allows testing and training in both static and dynamic formats Extremely versatile it is the only system that provides fast accurate Fall Risk Assessment and Conditioning for older adults plus closed chain weight bearing assessment and training for lower extremity patients Using this unique device clinicians can assess neuromuscular control by quantifying the ability to maintain dynamic bilateral and unilateral postural stability on a static or unstable surface Use any of four test protocols including fall risk athletic single leg stability limits of stability and postural stability The Balance System SD also serves as a valuable training device to enhance kinesthetic abilities that may provide some degree of compensation for impaired proprioceptive reflex mecha nisms following injury An easy to follow touch screen format makes the system simple to learn and operate leading the user step by step through testing protocols and training modes All test results and training sessions are documented on easy to read 8 5 x 11 reports which can be placed into the patient s file Comparisons to normative data can be made for population specific tests using the Fall Screening and Athlete Single
59. lso be considered when working with patients in a fall prevention program 1 It is strongly recommended that the Biodex Unweighing System be used in conjunction with balance training testing NOTE The Biodex Unweighing System is intended to assist the patient who has balance deficits Clinicians should not rely on this device to prevent falls 2 Since the Biodex Balance System allows up to 20 degrees of surface tilt begin with static or stability level 12 and progress as tolerated NOTE The static setting is most stable level one is least stable Levels 12 to 1 provide a full 20 degrees of surface tilt 3 Patients with extreme weakness or atrophy especially of the lower extremity should be close ly monitored CLINICAL CONSIDERATIONS 4 2 NOTE The ankle provides a critical source of sensory input controlling the degree of sway in elderly patients 4 Repeat bouts of balance training where the joint is displaced nearly to its limits have been shown to increase muscle tone thus increasing muscle spindle sensitivity and enhancing the somatosensory response AUTRES CONSIDERTIONS POUR DES PROGRAMMES DE PREVENTION DE CHUTES En plus de ce qui precade les points voqu s ci dessous doivent atre tudi s dans le cadre d un travail avec des patients dans un programme de pre vention de chute 1 L utilisation du harnais de soutieu est recommend lors de l entra nement et de valuation de la stabilit NOTA
60. mode the patient must utilize various hip knee and ankle strategies to manipulate the moving platform s cursor to within the random moving target Scoring is percentage based and equals the total time inside the circle total time in and outside of the circle Time counts up or down as set Random Control Training Q STATIC Erm KE Skill Level no ae E NE ECS Circle Speed 5 EA Ex E EE Clear Tracing SORDO Press START to Begin Score 00 00 More Options Print 6 Figure 7 6 The Random Control Training screen To Access The Random Control Training Mode 1 Position the support handles as per patient protocol 2 Position the display height and tilt for patient comfort 3 At the Main Menu touch lt Training gt The Training Menu screen should now be displayed 4 Touch lt Random Control gt The Training Setup screen should now be displayed 5 Touch the appropriate lt Height gt key to highlight the patient height range setting desired Touch lt Next gt to advance to the Random Control Training screen 6 At the Random Control Training screen the target circle should be flashing in the center of the stability grid Touch lt Circle Speed gt to toggle though the three target circle speeds until the tar get circle flashes at the desired speed 7 Touch lt Skill Level gt to enlarge or decrease the target circle size Three skill levels are available from which to choose Touch lt Skill Level gt
61. ng Options screen or lt Cancel gt to return to the Weight Shift Training Options screen without mak ing changes Use the lt A gt or lt W gt keys to set the total hits NOTE Total hits must be set before you can set beginning and ending platform stability To set initial platform stability touch the appropriate key and then enter the setting from the keypad displayed static 12 is most stable 1 is least stable Touch lt OK gt to return to the Weight Shift Training Options screen and set the ending platform stability in the same manner To turn tracing ON OFF touch lt Tracing gt to toggle between choices 10 At the Weight Shift Training screen touch the lt A gt or lt W gt keys to select the desired platform stability if not already selected static 12 is most stable 1 is least stable 11 Explain the training protocol to the patient and then press lt Start gt on the display to begin the training session The Stability Training grid on the screen charts the patient s stability perform ance through the course of the training session touch the lt Magnifying Glass gt to enlarge the screen if desired The Elapsed Time from the start of the training session is shown at the top right of the display while the stability level is illustrated by a bar graph in the upper right cor ner A running patient score is also provided in the upper right corner Note that the stability level of the foot platform can be changed at a
62. ny time during the exercise session NOTE If you have selected to enlarge the screen by touching the lt Magnifying Glass gt you must return to the normal viewing screen format to make any changes 12 At any time during the training session the tracing can be erased by pressing Clear Tracing gt 13 To stop the training session at any time press lt Stop gt on the display The system will stop gathering data and the platform will advance to the locked position 14 When you are finished reviewing the Weight Shift Training screen touch lt Print gt to print the screen if desired 15 After printing or reviewing the screen press lt Start gt to immediately begin another training session using the same parameters or press lt Back gt to return to the Training Setup screen ys THE TRAINING MODES MAZE CONTROL TRAINING See Figure 7 5 This mode allows the patient to follow a reproducible pattern of movement throughout a maze in both static and dynamic environments Three skill levels allow the maze to be modified to create a simple or more difficult environment for the patient to navigate through Change the platform from static mode to dynamic mode to facilitate progression Time counts up or down as set Scoring is percentage based on the net good hits total target hits If the cursor hits the boundary that hit is subtracted from the total possible amount of good hits Easiest maze has 28 total targets 14 in each
63. o a progression into dynamic test ing and training Test formats include Postural Stability Limits of Stability Athlete Single Leg and Fall Risk Both the Athlete Single Leg and Fall Risk results can be compared to normative data Postural Stability and Limits of Stability testing are available at variable levels of difficulty Bilateral reports comparsion of postural stability performance of standing on one leg versus standing on the other are available in More Options of Postural stability testing Testing Postural Stability Limits of Stability lt p Back Figure 8 1 The Testing Menu screen 8 1 TESTING THE POSTURAL STABLITIY TEST The Postural Stability Test emphasizes a patient s ability to maintain center of balance The patient s score on this test assesses deviations from center thus a lower score is more desirable than a higher score Platform stability can be varied during a this test by selecting lt More Options gt from the Postural Stability Testing screen Clinicians can also set trial time number of trials starting and ending platform stability rest countdowns or bilateral test Position Patient Have Patient Position Cursor in Center 2 Back Home Next Figure 8 2 The Position Patient screen Position Patient Left Foot Angle Right Foot Angle NES Left Heel Right Heel Record Heel and Foot Positions D Back Home Next Figu
64. or lower extremity strength proprioception and vestibular or visual deficiencies Poor balance is a major contributor to falls Strength particularly high speed and proprioceptive training have demon strated positive results in balance improvement NOTE For information on normative data referenced in the Predictive Values Report see Appendix C References 1 Finn JA et al Biodex Balance System Assessment Amoung Subjects of Disparate Balancing Abilities Presented at the 1999 American College of Sports Medicine Meeting 8 17 TESTING 9 REPORTS Biodex Balance System SD offers reports for each of the five test modes These can be used to objectively measure and record the patient s ability to stabilize the involved joint under static or dynamic stress Reports can be generated to reflect single leg both legs and bilateral comparison testing protocols Report formats include Postural Stability Limits of Stability Athlete Single Leg and Fall Risk Both the Athlete Single Leg and Fall Risk Reports offer a comparison to nor mative data Sample reports for each testing mode are provided later in this chapter REPORT PARAMETERS DEFINED The following parameters appear on various reports Stability Level Indicates the stability stiffness of the foot platform When locked the foot plat form is fully stable A setting of 12 is the most stable released setting A setting of one is the least stable foot platform setting
65. pril June 1999 Biodex 491 104 BLACKBURN TA et al SINGLE LEG STANCE DEVELOPMENT OF RELIABLE TESTING PROCEDURE Berkshire Institute of Orthopedic amp Sports Physical Therapy Wyomissing PA Biodex 193 207 CACHUPE WJC et al RELIABILITY OF BIODEX BALANCE SYSTEM MEASURES Human Performance Dept San Jose State University June 2000 Biodex 491 198 CAGGIANO NA et al THE RELATIONSHIP BETWEEN ANKLE KINESTHESIA AND PEAK TORQUE WITH SINGLE LEG MULTIAXIAL PLATFORM STABILITY J of Athletic Training Vol 34 2 5 31 April June 1999 Biodex 91 106 CAMPBELL MH et al THE CORRELATION BETWEEN ISOKINETIC STRENGTH MEASURES AND FUNCTIONAL PERFORMANCE IN AN ELDERLY POPULATION Biodex 493 293 14 1 BIBLIOGRAPHY CAVANAUGH JT et al BALANCE AND POSTOPERATIVE LOWER EXTREMITY JOINT RECONSTRUCTION Orthopaedic Phys Therapy Clinics of No America Vol 11 1 75 99 March 2002 Biodex 492 244 DiCOSTANZA K et al EFFECT OF ADHESIVE MEDIAL LONGITUDINAL ARCH SUPPORT ON POSTURAL SWAY J of Athletic Training Vol 36 2 suppl 566 April June 2001 Biodex 192 227 DOVER G et al RELIABILITY OF INVERSION AND EVERSION PEAK TORQUE MEASUREMENTS FROM THE BIODEX SYSTEM 3 ISOKINETIC DYNAMOMETER J of Athletic Training Vol 35 2 suppl S 91 April June 2000 Biodex 91 185 FERRIS CM et al A COMPARISON OF STRENGTH PROPRIOCEPTION LAXITY FLEXIBILITY AND BALANCE BETWEEN BASKETBALL AND NON BASKETBALL COLLEGIATE FEM
66. programs can be evaluated through objective assessment of the effects of lower extremity exercise on balance performance INTERPRETING PATIENT PERFORMANCE The patient s performance is noted in the following ways 1 Stability Index The stability index represents the variance of platform displacement in degrees from level A high number is indicative of a lot of motion which is indicative of the patients having trouble balancing Differences between right and left limbs can be noted 2 Percent Time in Zone Quadrant Example If a patient with a right lateral ankle sprain spends the vast majority of time in Zone 1 the trend will be to fall into inversion This gives feedback as to the exact ankle position being challenged 3 Test Grid For testing as the patient goes further and further from the center of axis the patient is being challenged to sustain proper position For rehabilitation we can note how far the patient can deviate from the center and still maintain a proper position 105 DATA BALANCE SYSTEM STATISTIC DEFINITIONS Stability Index Represents the variance of platform displacement in degrees from level A high number is indicative of the patient having trouble balancing The patient s Actual Stability Index is represented in the Predictive Values Report see Figure 22 under the column labeled Actual Values The Actual Value can be compared to age related Predictive Value this is found to the immediate left
67. protocol to the patient and then press Start on the display to begin the training session The Stability Training grid on the screen charts the patient s stability perform ance through the course of the training session touch the Magnifying Glass to enlarge the screen if desired The Elapsed Time from the start of the training session is shown at the top right of the display while the stability level is illustrated by a bar graph in the upper right cor ner A running patient score is also provided in the upper right corner Note that the stability level of the foot platform can be changed at any time during the exercise session NOTE If you have selected to enlarge the screen by touching the Magnifying Glass you must return to the normal viewing screen format to make any changes 12 At any time during the training session the tracing can be erased by pressing Clear Tracing gt 13 To stop the training session at any time press lt Stop gt on the display The system will stop gathering data and the platform will advance to the locked position 14 When you are finished reviewing the Random Control Training screen touch lt Print gt to print the screen if desired 15 After printing or reviewing the screen press lt Start gt to immediately begin another training session using the same parameters or press lt Back gt to return to the Training Setup screen THE TRAINING MODES 8 TESTING The Biodex Balance S
68. r graph in the upper right cor ner A running patient score is also provided in the upper right corner Note that the stability level of the foot platform can be changed at any time during the exercise session NOTE If you have selected to enlarge the screen by touching the lt Magnifying Glass gt you must return to the normal viewing screen format to make any changes 11 At any time during the training session the tracing can be erased by pressing lt Clear Tracing gt 12 To stop the training session at any time press lt Stop gt on the display The system will stop gathering data and the platform will advance to the locked position 13 When you are finished reviewing the Maze Control Training screen touch lt Print gt to print the screen if desired 14 After printing or reviewing the screen press lt Start gt to immediately begin another training session using the same parameters or press lt Back gt to return to the Training Setup screen 79 THE TRAINING MODES THE RANDOM CONTROL TRAINING This training mode allows the patient to perform neuromuscular control activities in random pat terns generated by the display and is ideal for motor control and vestibular training The size and speed of the target can be modified for progressions ranging from easy to difficult While in static mode the patient can work within their sway envelope to move the cursor and attempt to keep it within the moving target In dynamic
69. re 8 3 The Patient Position screen with patient positions entered TESTING 8 2 Postural Stability Testing Options Initial Platform Ending Platform Test Trial Time Setting Setting Rest Countdown Number of Trials E Bilateral Comparison YES Lx lt Figure 8 4 The Postural Stability Testing Options screen Postural Stability Testing 0 2 of 3 Test Trials 4 7 4 Setting Both lear Tracing Press START to Release Platform More Options Back Home Figure 8 5 The Postural Stability Testing screen 8 3 TESTING Postural Stability Test Results Bilateral Test Left Leg Results Right Leg Results Actual STD Actual STD Score Dev Score Dev Overall Stability Overall Stability Index ___ Index _ _ Anterior Posterior Anterior Posterior index index Medial Lateral Medial Lateral Index Index Time in Time in Zone A B Zone A B c D c D Time in Time in Quadrant H Quadrant Hn Se HH v Print Results Save Results Home Figure 8 6 A sample Postural Stability Test Results screen for a bilateral test PERFORMNIG A POSTRUAL STABILITY TEST See Figures 8 2 and 8 6 1 Position support handles as per patient protocol 2 Position display height and tilt for patient comfort 3 At the Main Menu touch Testing The Testing Menu screen should now be displayed 4 Touch Post
70. ress Start to immediately begin another training session using the same parameters or press Back to return to the Training Setup screen m THE TRAINING MODES WEIGHT SHIFT TRAINING See Figure 7 4 This training mode allows for exercise in the most basic of activities weight shifting The patient has the ability to shift weight in medial lateral anterior posterior and diagonal planes This can be done with both static and dynamic settings During this training routine the target zone defined by two parallel lines can be rotated to any of three positions while the amount of excur sion within the target area can be modified to allow for the most limited to most difficult degree of weight shifting To reposition the target zone hit lines at any time simply touch the desired line and re touch the screen where you want the line to be relocated Scoring is percentage based and equals net good hits total target hits If you cross the boundary that counts against the good hit total All outside boundary hits are subtracted from the total amount of target hits This value equals the net good hits For example Enter 10 as the of target hits There were 4 times the cursor went outside the boundary 10 4 6 good hits Score 6 10 or 60 For weight shift training the time value always counts up NOTE A wall hit is counted as one hit within the path to the target hit Weight Shift Training Rotate Target Target zone hi
71. t lines Skill Level Clear Tracing DEDANS Press START to Begin Score 00 00 More Options Figure 7 4 The Weight Shift Training Screen To Access The Weight Shift Training Mode 1 Position the support handles as per patient protocol 2 Position the display height and tilt for patient comfort 3 At the Main Menu touch Training The Training Menu screen should now be displayed 4 Touch Weight Shift The Training Setup screen should now be displayed 5 Touch the appropriate Height key to highlight the patient height range setting desired Touch Next to advance to the Weight Shift Training screen THE TRAINING MODES 7 6 6 At the Weight Shift Training screen touch lt Rotate Target gt to toggle through the three patient target positions until the desired rotation is displayed on the grid 7 Touch lt Skill Level gt to enlarge or decrease the target box size Three skill levels are available from which to choose Touch lt Skill Level gt until the desired target configuration is displayed 8 If desired touch lt Clear Tracing gt to remove any tracing that remains on the screen from a pre vious exercise session 9 Touch lt More Options gt to advance to the Weight Shift Training Options screen if desired Here you can set the total hits for the exercise default 60 set platform stability and turn trac ing ON OFF Touch OK to confirm your selections and return to the Weight Shift Traini
72. th Feet protocol Quadrant 1 right anterior Quadrant 2 left anterior Quadrants represent the four quarters of the Test Grid in the X and Y axis as follows For the Both Feet protocol Quadrant 3 left posterior Quadrant 4 right posterior For the Single Foot protocol Quadrant 1 lateral anterior e Quadrant 2 medial anterior Quadrant 3 medial posterior Quadrant 4 lateral posterior Test Grid Provides a visual representation of Time Spent in Zone Quadrant View is orientated as if patient were looking down at foot platform while facing the display module Anterior Posterior and Medial Lateral Deflection Graphs Provides a visual representation of A P and M L deflection during the test View is oriented as if foot platform were positioned at eye level on a horizontal plane X axis time and stability level 9 3 REPORTS SAMPLE BALANCE REPORTS See Figures 9 1 9 6 Name Anne Ewell Date 10 20 2005 11 57 AM Height 59 65 Age 29 Foot Placement 1 Platform Setting 12 7 Foot Angle Test Trial Time 20 Heel Position Test Trials 1 Actual STD Score Dev Overall 2 5 Anterior Posterior Index Medial Lateral Index Time in Zone Time in Quadrant Anterior Left Right Posterior Comments Clinician 9 1 Sample Postural Stability Single Leg Test Report REPORTS 9 4 Name Cindy Speer Height 59 65 Age 39 Date 10 20 2005 11 45 AM
73. the spring assemblies with white lithium grease Lubricate the eight push plates with white lithium grease Lubricate the acme threaded rods with white lithium grease NOTE When checking for lubrication it may only be necessary to re distribute the existing grease CAUTION Some steps of these procedure require the Balance System to be turned ON When this is the case use extreme caution working on the system ATTENTION Certaines tapes de la pr sente marche suivre n cessitent que le systeme d quili brage soit mis SOUS TENSION En pareille circonstance user de pr cautions extr mes dans la maniplation du systeme 13 GENERAL MAINTENANCE 14 BIBLIOGRAPHY ARNOLD BL et al NORMAL STABILITY PATTERNS AND RELATIONSHIP AS ASSESSED WITH THE BIODEX BALANCE SYSTEM J of Athletic Training Vol 32 2 S 25 April June 1997 Biodex 4593 268 EXAMINATION OF BALANCE MEASURES PRODUCED BY THE BIODEX STABILITY SYSTEM J of Athletic Training Vol 33 4 323 27 Dec 1998 Biodex 193 287 BALLARD T PRODUCT PROFILE THE BIODEX BALANCE SYSTEM Biodex Medical Systems Biodex 491 111 BEHAN E A COMPARISON OF A DYNAMIC BALANCE SYSTEM TO A STATIC FORCE PLAST SYSTEM FOR ORTHOPEDIC AND MUSCULOSKELETAL REHABILITATION Biodex Medical Systems Biodex 491 113 BLACKBURN JT et al BALANCE AND JOINT STABILITY THE RELATIVE CONTRIBUTIONS OF PROPRIOCEPTION AND MUSCULAR STRENGTH J of Athletic Training Vol 34 2 5 30 A
74. to select the desired plat form stability if not already selected static 12 is most stable 1 is least stable 10 Explain the training protocol to the patient and then press Start on the display to begin the training session The Stability Training grid on the screen charts the patient s stability per formance through the course of the training session touch the lt Magnifying Glass to enlarge the screen if desired The Elapsed Time from the start of the training session is shown at the top right of the display while the stability level is illustrated by a bar graph in the upper right hand corner Note that the stability level of the foot platform can be changed at any time during the exercise session NOTE If you have selected to enlarge the screen by touching the Magnifying Glass you must return to the normal viewing screen format to make any changes NOTE As the patient moves the platform during the training session a tracing feature records the route of the cursor on the grid This feature can be used to visually illustrate a patient s positioning throughout the routine or as a target i e asking the patient to trace a letter square circle etc 11 At any time during the training session the tracing can be erased by pressing Clear Tracing gt 12 To stop the training session at any time press lt Stop gt on the display The system will stop gathering data and the platform will advance to the locked posit
75. ural Stability The User Setup Information screen should now be displayed 5 Touch the Keypad icon for Name and enter the patient s name Touch lt OK to return to the User Setup Information screen 6 Touch the Keypad icon for Age and then enter the patient s age Touch OK to return to the User Setup Information screen 7 Touch the appropriate Height key to highlight the patient height range setting desired Touch Next to advance to the Patient Position screen 8 Position the patient on the system and explain the test protocol Press Start on the display to activate the cursor and have the patient move the cursor to the center point on the grid 9 Touch Record to bring up the Position Patient Entry screen Using the keypads enter the patient s left foot left heel right foot and right heel positions using the midline of the foot and the platform grid as reference points Touch Next to advance to the Postural Stability Testing screen 10 At the Postural Stability Testing screen touch lt Stance gt to scroll through the three stance positions provided left right or both 11 Touch racing to toggle tracing ON or OFF as desired TESTING 8 4 12 Touch lt Clear Tracing gt to clear any tracing that remains from previous tests 13 Touch lt More Options gt to advance to the Postural Stability Test Options screen if desired Here you can set the Test Trial Time enter initial an
76. ure 8 10 The Athlete Single Leg Stability Testing screen Athlete Single Leg Stability Testing Options Test Trial Time Initial Platform Ending Platform Setting Setting Number of Trials Rest Countdown go lt 2 Figure 8 11 The Athlete Single Leg Stability Testing Options screen TESTING 8 10 Athletic Single Leg Stability Test Results Actual STD Normal STD Score Dev Score Dev Overall Stability Index Anterior Posterior index Medial Lateral Index o 0000 View Stability Index Print Results Save Results Home Figure 8 12 A sample Athlete Single Leg Stability Results report 811 TESTING PERFORMING AN ATHLETE SINGLE LEG STABILITY TEST See Figures 8 10 8 12 1 Position support handles as per patient protocol 2 Position display height and tilt for patient comfort 3 At the Main Menu touch lt Testing gt The Testing Menu screen should now be displayed 4 Touch lt Athlete Single Leg Stability gt The User Setup Information screen should now be displayed 5 Touch the lt Keypad gt icon for Name and enter the patient s name Touch lt OK gt to return to the User Setup Information screen 6 Touch the lt Keypad gt icon for Age and then enter the patient s age Touch lt OK gt to return to the User Setup Information screen 7 Touch the appropriate lt Height gt key to highlight the patient height range setting desired Touch lt
77. x EN ON H MIS RICE 1 ASSY 3181 TSME LLE80 J GI60J 006 056 62 30d SALNTdd 090W 00E 055 0 08 p IV H OLE HSYM 88201 CL 0 098 21 ZE 014 OH H LAN 6 0 034 1 d3nd03SNWaL VV dO 0 83421 dY HD 9 0 839 1 ASSY 3 ASSY WALSAS NV We ME a 31IHA LO 3 00 066 HUH 2180 QO TdS LEEH OOE SV6 61 Wad OL0V 00E 066 C1 3 4 1 BLE t fad G2 0 038 1 ASS 3 1 ASSY 3 1M00N MAINO 3JNY WG O DY 00 056 sp U EDO DD 02 9 1 XH NN 88080 G ddIS 4304 9083 00F 066 7 Wd Tid Os ED CO 1 033 21 HSV AANA 05160 INIT 331113 688219 CE 0 833 2 ONIONI HVE HHV 020600 f WM 3 HH cE 01 INN 52180 8 0 858 2 3182 DT E2680 L8 0 CD LY HHRWW 8y080 TD X001 HKW 250800 6 48 cE 0H IN 0 0 834 1 ASSY 0408 Jd 8DNISS334 9 AY 35v38 OEL 0 8 21 30 91 NTS TIEN OQE G DER 2 LD SNINIVISY INTA 1 0 859 21 N 2 a y 354389 3811 dd E33 2T IddS 96880 IJ D va Bs 10580 8 0 E0680 G A 3118 3111907 10080 OEL 21 1108 301110 JNIdS E0 0 1 LO ya NE LIN 972800 JIJ diD 628013 LY d 39M9 NIVALS OpOY ODE 056 ve 1033 9705 1 81 91 5 OH NL JOS XIS 8 680 E 0 058 p dvds L2EN 00 066 DOE 576
78. your changes and return to the Configuration screen Touch Cancel to return to the Configuration screen without making any changes al SYSTEM UTILITIES Turn Tone ON OFF This setting enables or disables an audible tone which signals test or exercise start completion and countdown between trials 1 At the Configuration screen simply touch the ON or OFF icon to select the desired setting Adjust LCD Brightness This setting brightens or darkens the display screen for all applications 1 At the Configuration screen simply touch along the LCD Brightness Bar Scale until the desired display brightness is achieved The left end of the scale is darkest the right end of the scale is lightest Adjust Tone Volume This setting raises or lowers the volume of the audible tone which signals test or exercise start completion and countdown between trials 1 At the Configuration screen simply touch along the Tone Volume Bar Scale until the desired level is achieved The left end of the scale is least loud the right end of the scale is most loud Select Measure Units Printer Resolution or Joystick Emulation All three of these setting are simple toggle choices Simply touch the desired parameter to view the choices then touch the setting you want to select Measurer Units Metric or US ePrinter Resolution normal or high eJoystick Emulation disabled or enabled Default Settings At the Default Settings screen users can set th
79. ys to scroll to the desired set ting Hold times range from 025 to 5 seconds To turn tracing ON OFF touch lt Tracing gt to toggle between choices 10 At the Limits of Stability Training screen touch the lt A gt or lt W gt keys to select the desired platform stability static 12 is most stable 1 is least stable 11 Explain the training protocol to the patient then press Start to begin the LOS training ses sion The LOS Training screen reflects the patient s stability performance through the course of the LOS training session The Elapsed Time from the start of the training session is shown at the top right of the display while the stability level is illustrated by a bar graph A running patient score is also provided in the upper right corner Note that the stability level of the foot platform can be changed at any time during the exercise session NOTE If you have selected to enlarge the screen by touching the Magnifying Glass you must return to the normal viewing screen format to make any changes 12 At any time during the training session the tracing can be erased by pressing Clear Tracing gt 13 To stop the training session at any time press Stop on the display The system will stop gathering data and the platform will advance to the locked position 14 When you are finished reviewing the training screen touch Print to print the screen if desired 15 After printing or reviewing the screen p
80. ystem SD allows clinicians to assess a patient s neuromuscular control in a closed chain multi plane test by quantifying the ability of the patient to maintain dynamic uni lateral or bilateral postural stability on either a static or unstable surface The degree of surface instability is controlled by the system s microprocessor based actuator The clinician selects the test duration stability level and protocol In a dynamic test once the session beings the patient s ability to control the platform angle is quantified as a variance from the locked level position as well as degrees of deflection over time A large variance may be indicative of poor neuromuscular response Further insight into specific neuromuscular activation patterns is realized with the quantification of anterior poste rior and medial lateral platform tilt Predictive Values and Comparative Bilateral Reports are available to chart the patient s performance Bilateral comparisons quickly document differences between each lower extremity Static testing measures the angular excursion of the patient s center of gravity Body height must come into play for static measures A person s Center of Gravity COG is approximately 55 of their height Based on the selected height an appropriate static measure scaling is applied Testing in this mode is ideal for baseline testing for movement disorder vestibular dysfunction and orthopedic patients Good static testing scores can lead t

BALANCE SYSTEM SD BIODEX

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