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1 | FCC Manual Addendum | Users Manual | 20.37 KiB |
Class A Digital Device This equipment has been tested and found to comply with the limits for a Class A digital device, pursuant to part 15 of the FCC Rules. These limits are designed to provide reasonable protection against harmful interference when the equipment is operated in a commercial environment. This equipment generates, uses, and can radiate radio frequency energy and, if not installed and used in accordance with the instruction manual, may cause harmful interference to radio communications. Operation of this equipment in a residential area is likely to cause harmful interference in which case the user will be required to correct the interference at his own expense. Do Not Change of Modify Any Components Any changes or modifications, especially to the wireless components, not expressly approved by BTE Technologies, Inc. could void the user s authority to operate the equipment. Acceptable Antenna(s) This device has been designed to operate with the antenna(s) listed below and having a maximum gain of 2.7 dBi. Antennas not included in this list or having a gain greater than 2.7 dBi are strictly prohibited for use with this device. The required antenna im-
pedance is 50 ohms. Acceptable antenna(s) include:
1. Linx Technologies 916MHz 1/4 Wave Whip Antenna (ANT-916-CW-QW) To reduce potential radio interference to other users, the antenna type and its gain should be so chosen that the equivalent isotropically radiated power (e.i.r.p.) is not more than that permitted for successful communication. Preventing interference between the wireless components Interference, which can result in an inability to acquire accurate data, may occur in the following scenarios:
a. The antennas of any wireless components are within 3 feet of each other (e.g. the antenna on the new DAQ Box is within 3 feet of the antenna on the Heart Rate Transmitter). b. There is not a direct line of sight between the antennas of the wireless compo-
nents. In addition, any metal that is between the antennas will cause interference. You may prevent interference by maintaining your system in the following manner:
a. Do not allow the Heart Rate Transmitter to fall on the floor. b. Regularly check the USB cable and power cable that are attached to the new DAQ Box. c. Verify the antennas are in good working order and properly secured. You may also prevent interference by using the following guidelines:
a. Place the new DAQ Box in a location that ensures the antenna of the new DAQ Box will always be at least 3 feet from the antenna on the Heart Rate Transmitter. b. Verify there is a direct line of sight between the DAQ Box antenna and the Heart Rate Transmitter antenna. 4
1 | Users Manual 1 | Users Manual | 2.33 MiB |
BTE Technologies Evaluation and Rehabilitation System Manual 2 Customer Service BTE strives to provide exceptional customer service. To access a Customer Service Representative:
Phone 800.461.6888 (9am-6pm EST Monday thru Friday) Cell 416.717.5789 (After-hours service) Fax 416.398.9108 Email service@bteco.com 3 C l a s s A D i g i t a l D e v i c e T h i s e q u i p m e n t h a s b e e n t e s t e d a n d f o u n d t o c o m p l y w i t h t h e l i m i t s f o r a C l a s s A d i g i t a l d e v i c e , p u r s u a n t t o p a r t 1 5 o f t h e F C C R u l e s . T h e s e l i m i t s a r e d e s i g n e d t o p r o v i d e r e a s o n a b l e p r o t e c t i o n a g a i n s t h a r m f u l i n t e r f e r e n c e w h e n t h e e q u i p m e n t i s o p e r a t e d i n a c o m m e r c i a l e n v i r o n m e n t . T h i s e q u i p m e n t g e n e r a t e s , u s e s , a n d c a n r a d i a t e r a d i o f r e q u e n c y e n e r g y a n d , i f n o t i n s t a l l e d a n d u s e d i n a c c o r d a n c e w i t h t h e i n s t r u c t i o n m a n u a l , m a y c a u s e h a r m f u l i n t e r f e r e n c e t o r a d i o c o m m u n i c a t i o n s . O p e r a t i o n o f t h i s e q u i p m e n t i n a r e s i d e n t i a l a r e a i s l i k e l y t o c a u s e h a r m f u l i n t e r f e r e n c e i n w h i c h c a s e t h e u s e r w i l l b e r e q u i r e d t o c o r r e c t t h e i n t e r f e r e n c e a t h i s o w n e x p e n s e . D o N o t C h a n g e o f M o d i f y A n y C o m p o n e n t s A n y c h a n g e s o r m o d i f i c a t i o n s , e s p e c i a l l y t o t h e w i r e l e s s c o m p o n e n t s , n o t e x p r e s s l y a p p r o v e d b y B T E Te c h n o l o g i e s , I n c . c o u l d v o i d t h e u s e r s a u t h o r i t y t o o p e r a t e t h e e q u i p m e n t . A c c e p t a b l e A n t e n n a ( s ) T h i s d e v i c e h a s b e e n d e s i g n e d t o o p e r a t e w i t h t h e a n t e n n a ( s ) l i s t e d b e l o w a n d h a v i n g a m a x i m u m g a i n o f 2 . 7 d B i . A n t e n n a s n o t i n c l u d e d i n t h i s l i s t o r h a v i n g a g a i n g r e a t e r t h a n 2 . 7 d B i a r e s t r i c t l y p r o h i b i t e d f o r u s e w i t h t h i s d e v i c e . T h e r e q u i r e d a n t e n n a i m -
p e d a n c e i s 5 0 o h m s . A c c e p t a b l e a n t e n n a ( s ) i n c l u d e :
1 . L i n x Te c h n o l o g i e s 9 1 6 M H z 1 / 4 Wa v e W h i p A n t e n n a ( A N T- 9 1 6 - C W- Q W ) To r e d u c e p o t e n t i a l r a d i o i n t e r f e r e n c e t o o t h e r u s e r s , t h e a n t e n n a t y p e a n d i t s g a i n s h o u l d b e s o c h o s e n t h a t t h e e q u i v a l e n t i s o t r o p i c a l l y r a d i a t e d p o w e r ( e . i . r. p . ) i s n o t m o r e t h a n t h a t p e r m i t t e d f o r s u c c e s s f u l c o m m u n i c a t i o n . P r e v e n t i n g i n t e r f e r e n c e b e t w e e n t h e w i r e l e s s c o m p o n e n t s I n t e r f e r e n c e , w h i c h c a n r e s u l t i n a n i n a b i l i t y t o a c q u i r e a c c u r a t e d a t a , m a y o c c u r i n t h e f o l l o w i n g s c e n a r i o s :
a . T h e a n t e n n a s o f a n y w i r e l e s s c o m p o n e n t s a r e w i t h i n 3 f e e t o f e a c h o t h e r ( e . g . t h e a n t e n n a o n t h e n e w D A Q B o x i s w i t h i n 3 f e e t o f t h e a n t e n n a o n t h e H e a r t R a t e Tr a n s m i t t e r ) . b . T h e r e i s n o t a d i r e c t l i n e o f s i g h t b e t w e e n t h e a n t e n n a s o f t h e w i r e l e s s c o m p o -
n e n t s . I n a d d i t i o n , a n y m e t a l t h a t i s b e t w e e n t h e a n t e n n a s w i l l c a u s e i n t e r f e r e n c e . Yo u m a y p r e v e n t i n t e r f e r e n c e b y m a i n t a i n i n g y o u r s y s t e m i n t h e f o l l o w i n g m a n n e r :
a . D o n o t a l l o w t h e H e a r t R a t e Tr a n s m i t t e r t o f a l l o n t h e f l o o r. b . R e g u l a r l y c h e c k t h e U S B c a b l e a n d p o w e r c a b l e t h a t a r e a t t a c h e d t o t h e n e w D A Q B o x . c . Ve r i f y t h e a n t e n n a s a r e i n g o o d w o r k i n g o r d e r a n d p r o p e r l y s e c u r e d . Yo u m a y a l s o p r e v e n t i n t e r f e r e n c e b y u s i n g t h e f o l l o w i n g g u i d e l i n e s :
a . P l a c e t h e n e w D A Q B o x i n a l o c a t i o n t h a t e n s u r e s t h e a n t e n n a o f t h e n e w D A Q B o x w i l l a l w a y s b e a t l e a s t 3 f e e t f r o m t h e a n t e n n a o n t h e H e a r t R a t e Tr a n s m i t t e r. b . Ve r i f y t h e r e i s a d i r e c t l i n e o f s i g h t b e t w e e n t h e D A Q B o x a n t e n n a a n d t h e H e a r t R a t e Tr a n s m i t t e r a n t e n n a . 4 TABLE OF CONTENTS Important Information ..................................................................................... 9 Conventions and Symbols Used.................................................................... 12 Assembling the Equipment Upon Arrival ...................................................... 13 Functional Range of Motion (FROM) Pegboard Assembly .......................... 26 The Basics in Using the ER System .............................................................. 31 Installing the Software .................................................................................... 32 Administration Menu....................................................................................... 40 Clinic Information ............................................................................. 40 Practitioner Information ................................................................... 41 Environmental Settings.................................................................... 42 User Manager .................................................................................... 44 Import and Exporting in ODES ........................................................ 45 Heart Rate Comments ...................................................................... 48 Job Demand Templates.................................................................... 48 Protocol Hibernation ........................................................................ 49 Remove Current Case ...................................................................... 50 Calibrating the Equipment .............................................................................. 51 Calibration of the Hand Grip ............................................................ 52 Pinch Grip Calibration ...................................................................... 54 Algometer Calibration ...................................................................... 55 FOCUS Calibration ........................................................................... 59 Universal Task Master Calibration .................................................. 60 Weight Verification ........................................................................... 64 Auto Calibration................................................................................ 66 Calibration Reports .......................................................................... 67 Adding a Client ................................................................................................ 67 Adding a Client Case ...................................................................................... 69 Finding a Client/Case ...................................................................................... 77 Adding a Test to a Client ................................................................................ 78 Removing a Test from a Client ....................................................................... 79 Additional ODES 2004 Software Features..................................................... 80 File Menu ........................................................................................... 80 Database Utilities ......................................................................... 80 Compacting and Repairing a Database ....................................... 82 Backing Up Your Database.......................................................... 82 Restore Database ........................................................................ 83 Log Off and Exit ........................................................................... 83 Calibration Menu............................................................................... 83 Calibrate Equipment..................................................................... 83 Verifying Calibration ..................................................................... 85 Calibration Reports ...................................................................... 85 Statistics Menu ................................................................................. 86 Employer Information ................................................................... 86 Client Status Information.............................................................. 86 Client Information......................................................................... 87 Referral Information ..................................................................... 87 5 Insurance Information .................................................................. 87 Statistical Inquiries ....................................................................... 87 Real Time Analysis ...................................................................... 88 Exporting Data ............................................................................. 90 Snapshots .................................................................................... 93 Forms Menu ...................................................................................... 95 Utilities Menu .................................................................................... 95 Heart Rate Monitor....................................................................... 95 Heart Rate Report ........................................................................ 96 Sitting and Standing Tolerance .................................................... 96 Post Offer of Employment Software Menu ..................................... 98 POET Receipts ............................................................................ 98 Set Standards .............................................................................. 99 POET Standards Report .............................................................. 100 POET Summary Report ............................................................... 103 POET Detailed Summary Report ................................................. 106 Export POET Results ................................................................... 111 Digital Capture Menu ...................................................................... 112 Help Menu........................................................................................ 113 Help Manuals ............................................................................... 113 About............................................................................................ 113 Templates......................................................................................................... 115 Super Protocols............................................................................................... 119 Self Reports Menu ........................................................................................... 120 Dallas Pain Questionnaire.............................................................. 120 McGill Pain Questionnaire ............................................................. 120 The Neck Disability Index (NDI) ..................................................... 120 The Oswestry Questionnaire ......................................................... 121 Patient Review Questionnaire ....................................................... 121 Superficial Tenderness .................................................................. 121 Symptom Intensity Rating.............................................................. 122 Waddell Signs ................................................................................. 123 Physical Demands Analysis .......................................................... 123 Creating Custom Self Perception Tests ....................................... 123 EPIC Hand Function Sort (Optional Upgrade)............................................... 125 EPIC Spinal Functional Sort ........................................................................... 126 Cardiovascular Menu ...................................................................................... 128 Astrand ............................................................................................ 128 Bruce Treadmill............................................................................... 129 Cardiovascular Intake .................................................................... 129 Modified Canadian Aerobic Fitness Test...................................... 130 Single State Treadmill .................................................................... 132 Customized Cardiovascular Tests ................................................ 133 Creating a Non-Integrated Work Simulation Protocol ................. 134 Exercise Program/Cervical Conditioning ...................................................... 136 Comments ........................................................................................................ 138 6 Validity Analysis .............................................................................................. 141 Reports............................................................................................................. 141 The BTE Dual Inclinometers ........................................................................... 148 Performing Spinal Range of Motion Evaluations......................... 150 Guidelines to Locating the Landmarks......................................... 150 Cervical Range of Motion............................................................... 151 Thoracic Range of Motion.............................................................. 153 Lumboscaral Range of Motion ...................................................... 155 Determining the Degree of Ankylosis ........................................... 157 Performing Extremity range of Motion Evaluations .................... 157 Using the Small Goniometer Feature............................................ 159 The BTE Goniometer....................................................................................... 160 Performing Range of Motion Tests ............................................... 161 Customizing the Goniometer Tests .............................................. 164 Performing a Range of Motion Test with the Goniometer........... 167 Range of Motion Protocols ............................................................ 168 The Hand Grip.................................................................................................. 180 Using the Hand Grip for a Pre-Programmed Strength Protocol . 181 Protocol Information ...................................................................... 184 Standard Hand Grip ..................................................................... 184 Modified Maximum Voluntary Effort ............................................. 186 Rapid Exchange........................................................................... 188 Creating a New Hand Grip Test ..................................................... 190 The Pinch Grip ................................................................................................. 192 Using the Ping Grip for a pre-programmed Strength Test Protocol 193 Protocol Information ...................................................................... 196 Key Pinch..................................................................................... 196 Tip Pinch ...................................................................................... 199 Palmar Pinch................................................................................ 201 Creating a Custom Pinch Grip Test .............................................. 203 The BTE Algometer ......................................................................................... 205 Using the Pressure Algometer for a Pre-Programmed Strength Protocol
.......................................................................................................... 208 Fibromyalgia Protocol .................................................................... 222 ER Platform...................................................................................................... 225 Standard Accessories .................................................................... 226 Multiplanar Accessory Housing Joint........................................... 228 ER Shelves ...................................................................................... 231 Adjusting the Height and Orientation of the ER Arms ................ 236 Isometric Strength Testing ............................................................................. 241 Work Simulation Tests .................................................................................... 244 Integrated Lifting and Carrying Tests ........................................... 246 EPIC Lifting Capacity Protocol (Optional Upgrade)..................... 251 The Universal Task Master ............................................................................. 255 Functional Range of Motion ........................................................................... 263 BTE Digital Radio Frequency Heart Rate Monitor ........................................ 278 7 Placement for the BTE Digital Radio Frequency HR Monitor ..... 279 Body Positioning ............................................................................ 280 Heart Rate Receiver Testing .......................................................... 282 Recommended Care and Maintenance Schedule ......................................... 283 Transporting the Equipment .......................................................................... 285 End User License Agreement......................................................................... 286 Troubleshooting .............................................................................................. 289 Data Acquisition Box.......................................................................289 Inclinometer and Goniometer .........................................................290 Hand Grip, Pinch Grip, Algometer, and FOCUS............................291 UTM ...................................................................................................296 Heart Rate Monitor...........................................................................297 BTE Training Programs .................................................................................. 298 8 Important Information BTE Technologies Inc. - Baltimore 7455-L New Ridge Road Hanover, MD 21076 Telephone:
Facsimile:
(410) 850-0333 or (800) 331-8845
(410) 850-5244 BTE Technologies Inc Denver 2390 East Crescent Parkway, Suite 120 Englewood, CO 80111 Telephone Facsimilie
(720) 266-0123 or (800) 206-2972
(720) 266-0120 Internet Support Web Site:
www.BTETech.com Customer Service Telephone:
Email:
(800) 331-8845 service@bteco.com Copyright Information Information in this document is subject to change without notice. Companies, names and data used in examples are fictitious unless otherwise stated. No part of this document may be reproduced or transmitted in any form or by any means, electronic or mechanical, for any purpose, without the express written consent of BTE Medical Inc. BTE may have patents or pending patent applications, trademarks, copyrights or other intellectual property rights covering the subject matter in this document. The furnishing of this document does not give you license to these patents, trademarks, copyrights or other intellectual property except as expressly provided in any written license agreement from BTE Medical Inc. 2003 BTE Technologies Inc. All rights reserved. 9 Credits The following individuals were involved in the development of this manual. Elizabeth Chapman B.Sc.Kin.,CK Sarah Graham, B.Sc.Kin.,CK Jeries Hanoun, M.B.A David Lithwick B.Sc., B.A. Navin Ramrattan Tobi Weightman B. HSC Paul Zhang M.Sc. Customer Service Manager Kinesiologist Media Manager Chief Technology Officer Production Manager Customer Service Representative Electrical Engineer Technical Specifications The following outlines the electrical components of the BTE Evaluation and Rehabilitation System:
Input Voltage:
Europe - 220/230/240VAC North America 110VAC 50/60 Hz Input Current:
Europe - 4 Amp North America 8 Amp The BTE Evaluation and Rehabilitation System has been certified by Entela (File No. 8771). All the tools
(applied parts) for the system are Type B. The system has been manufactured to be used in normal conditions. Do not use the system beside high magnetic fields, or x-rays. Cell phone usage within 30 feet of the system may have an impact on the accuracy of the heart rate monitor readings. The BTE tools are to be used only in the ports and manner specified in this manual. Any modifications or use of non-BTE parts can cause damage to the product. Contact BTE Medical Inc for replacement parts if required. Safety Considerations BTE Medical makes every effort to design and manufacture products, which meet and exceed the highest safety standards. The following information provides recommendations for safe use of the equipment. The BTE Evaluation and Rehabilitation System must only be operated on a level surface. The recommended maintenance program for your system is outlined in a later section of this manual. This program will ensure your equipment will function properly and safely for many years. If at any time your system is not working safely, the evaluator should contact the BTE Medical Customer Service Department for assistance. Never attempt to repair the electrical components of the system. Disconnect the power source for any other repairs. This equipment is to be used and/or supervised by qualified healthcare professionals who has knowledge in anatomy, exercise physiology, biomechanics, psychology, pathology, and an understanding of work, rehabilitation and disability management principles. Prior to use of this equipment it is recommended the evaluator read the information in this manual as well as obtaining certification from BTE Medical. Prior to 10 testing any clients it is suggested a sample test be completed with a co-worker familiar with the system to improve your comfort with the system. Prior to initiating system use with a client, it is recommended that the physical health questionnaire be completed with the client along with an intake interview to determine if there are any medical contraindications. Resting blood pressure and heart rate should be measured to ensure they are within safe limits for testing as per relevant research and guidelines. If any medical contraindications are identified clearance should be obtained from the clients primary care practitioner prior to initiating functional testing or rehabilitation. During functional testing, the clients heart rate and other physiological parameters as appropriate should be monitored. Testing should be stopped if the heart rate is above safe limits as outlined in relevant research and guidelines or if other physiological parameters are above safe limits. Body mechanics are a good indicator when a client is performing an unsafe activity and is at risk of injury. It is the evaluators responsibility to monitor the clients body mechanics and either alert the client to alter their movement or terminate testing. The equipment has been designed with double locks on all the attachments to the Evaluation and Rehabilitation (ER) System arms. The evaluator must ensure that both the locking pin and the tightening mechanisms are secure before allowing a client to push or pull on an accessory attached to the ER arm. When using the weights for calibrating or for functional testing or rehabilitation, care needs to be taken to prevent injury. When stepping on and off the platform care needs to be taken to prevent tripping. The information presented in this manual is given in good faith and is to the best of our knowledge accurate. However, anyone who uses this information in any way does so entirely at his or her own risk. Neither BTE Medical Inc., its officers nor their representatives can accept any responsibility for any damage or injury incurred as a result of information presented here except under the terms of the product warranty. 11 Conventions and Symbols Used This instructional manual will use several common conventions to assist in the reading and understanding of the material presented. The following is a summary of the typographical conventions:
Words you type appear in quotations. Buttons you click on with the mouse appear in a bold font. If a task requires you to choose from a menu, the manual separates menu commands with a vertical bar. Therefore, this manual uses File | Save As to indicate that you should open the File menu and choose the Save As command. In addition to typographical conventions, the following icons are used to set off various pieces of information and to make them easily recognizable:
The New Term icon appears when a new term is addressed and will include a definition to help reinforce that term. The Troubleshooting icon may appear at the end of some sections. This offers suggestions to help you through your troubleshooting. The majority of the troubleshooting tips can be found in the appendix of the manual. The Tips icon will provide you with tips that offer shortcuts and quick solutions to common problems. You will find the Important Icon when it is mandatory or strongly advised that you carry out an action before progressing to the next. Type B Classification. This label indicates that the equipment provides a particular degree of protection against electrical shock, particularly regarding allowable leakage current and the reliability of the protective earth connection. The Hanoun Evaluation and Rehabilitation system meets or exceeds the IEC 60601-1, Ed 2:88 +A1:91 and A2:95, IEC 60601-1-1, CAN/CSA-C22.2 No. 601.1-
M90/UL 2601-1(1997). Attention, Consult Accompanying Documents. This symbol is located on the data acquisition box adjacent to the LED indicator. 12 Assembling the Equipment Upon Arrival Your ER System will arrive on several skids. The shipping company will place the ER Platform (including the base and post) in the location you specify to them. The post is attached to the base by four screws with an Allen key. The Computer Management Stand is to be placed to the right of the system. The FROM pegboard may be placed anywhere in close proximity to the system (no more than 20 feet away). All the equipment must be assembled on a level surface. The following is the recommended order in which to assemble your equipment:
Place the ER Stand where you would like to have it Assemble the Computer Management Stand to the right of the ER Stand Assemble the FROM pegboard Assemble tools on Computer Management Stand Connect the computer It is recommended while unpacking the equipment that you review your packing slip, to make sure you have received all the required parts. If there is anything missing from the shipment please contact Customer Service immediately so replacements can be provided. Computer Management Stand Setup The computer management stand is partially assembled when you receive it. To complete assembly you will need to attach three shelves at the front of the stand and one shelf at the bottom back of the stand in order for it to be fully operational. Required Tools and Equipment:
8 X 1 screws Allen Key Phillips or square head screwdriver Dismount/Assembly of Computer Stand To identify the front of the stand locate the Hanoun sticker at the top. The back of the stand is distinguished by a random series of holes. To dismount the Computer Stand from the skid unscrew and loosen the bolts near the bottom rails (as shown below). There is a bolt near each wheel. When the bolts are removed, slide the stand off the skid. Bolts that secure stand to skid. Shelf 1 is the shelf with the keyboard drawer attached to it. This shelf will support the computer monitor. It needs to be screwed to the top set of rails on the stand. Shelf 1 with keyboard 2 of the 1 screws are inserted into the rails along the inside of each side panel through holes in the holes in the top. Shelves 2 and 3 are identical in nature. Shelf 2 is attached to the two rails in the middle of the front of the stand with 2 of the 1 screws. This shelf will support the computer printer. Shelf 2, middle. Shelf 3 is attached to the bottom rails of the front of the stand with 2 of the 1 screws. This shelf will support the computer tower. 14 Shelf 3 (bottom, front). Shelf 4, the smallest of the shelves, is attached to the bottom rails on the back of the stand with 2 of the 1 screws. This shelf will support all of the masked weights. Shelf 4 (back). Close up of back, bottom shelf. The front of the completed Computer Management Stand with the 4 shelves attached should look like the following:
15 Shelf 1 Shelf 2 Shelf 3 The next step in the set up of the Computer Management Stand is the installation and mounting of all the other equipment. As mentioned earlier the computer monitor rests on the top shelf, the printer and computer speakers rests on the middle shelf, and the computer tower rests on the bottom shelf of the front of the stand. The back of the stand and both sides of the stand also hold numerous pieces of equipment. The right side of the stand (when facing the front of the stand) holds the two FOCUS shelves as shown below. The shelf with the elbow attachment is mounted below the shelf with the straight pin attachment. Shelf with straight pin attachment. Shelf with elbow attachment. The left side of the stand holds the Data Acquisition Box, the Inclinometer, the Goniometer, the Handgrip Dynamometer, the Pinchgrip Dynamometer, the Algometer, the Universal Task Master (UTM), the FOCUS load cell, and the Heart Rate Monitor. The first piece of equipment to be installed on the left side of the stand is the Data Acquisition Box. The one narrow end of the Data Acquisition Box with the power switch faces the ground. Power switch. 16 The Data Acquisition Box is secured to the stand by mounting clips and tightened with an Allen key. The Allen key is provided with your system. The power cord for the Data Acquistion Box is fed through the side of the computer management stand to the power bar. The serial cord attaches to the back of the data acquisition box and is fed through the side of the computer management stand and connected into the serial port in the computer. Mounting Clips. All the power cords for the testing equipment on that side are plugged into this Data Acquisition Box. As you will notice, each cord is labeled with a number and/or a letter, which corresponds to the same number and/or letter on the top of the Data Acquisition Box. Provided for you, and already mounted above the Data Acquisition Box, are clips for each cord coming out of the Data Acquisition Box. This prevents constant bending of the cords at the connection to the box and prevents wear and tear on the cords. Each piece of testing equipment on the left side of the stand has its own specific mounting apparatus. Use the picture below as a guide to see where each piece of equipment fits. The coiled power cords for the equipment should be plugged into the appropriate location on the Data Acquisition Box. When plugging the equipment into the Data Acquisition Box make sure the pins are lined up properly to avoid damaging the connectors. 17 The back of the Computer Management Stand is designed to hold all of the attachments for the FOCUS and UTM. This includes all of the different kinds of handles (straight bar, wide handles, palmar handles, etc.) Use the picture below to see the optimum placement of the various attachments. The smaller shelf on the back of the stand holds the masked weights. Connecting ER to the Computer Diagnostic System 18 In order to connect the ER to the Computer Diagnostic System you will need the following items:
ER Stand Computer 3 Black Coiled two-way Connector Cables (labeled 3E, 1B and 2T) One Data Acquisition Box One Computer Serial Cable One black AC power cord One heart rate monitor cable (with one round and one square end) When you are ready to begin, identify all of the above components, and then follow these steps:
19 Attaching the Upper Accessory Arm Cable Upper Cable (2T) on upper arm 2T insertion on the base of the ER system Base of the ER system 20 Attaching the Lower Accessory Arm Cable:
1B Cable for Lower Arm 1B insertion at the base of the ER System Base of ER System Connecting the FOCUS Load Cell Head to the Junction Box Load Cell Head connects to the 3E port on the junction box 3E cord connects to port on the junction box 3E insertion on the junction box at base of the ER stand Base of ER Stand 21 Connecting the Junction Box Components (Load Cell, Upper Shelf and Lower Shelf) to the Computer Stand This is the #3 cable which is attached to the number 3 port on the Data Acquisition Box. Port #3 This is the number 2 cable, which is plugged into the number 2 port on the back of the Data Acquisition Box. 22 This is the number 1 cable, which is plugged into port number 1 on the back of the Data Acquisition Box. A black plastic wrap is then used to secure the loose wires. Connecting the UTM to the Data Acquisition Box Within the packaging of your system, you will find one more gray serial cord with blue markings on it. This cable will be used to connect the Universal Task Master to the front of the Data Acquisition Box. Locate the back of the Universal Task Master (marked with a blue dot). One end of the serial cord is connected to this side of the UTM. To allow for communication between the UTM and the Data Acquisition Box, the other end of the serial cord (also marked with a blue dot) must now be connected to the TM port on the Data Acquisition Box. 23 See below for the placement of the cables from the right and left load cells. Match the blue dots to attach the cable that connects to the Data Acquisition Box. Match dots and connect cord You have now connected the Data Acquisition Box to the computer stand. The Data Acquisition Box should now be in communication with the UTM. Setting Up Your Data Acquisition Box Take a moment to view the Data Acquisition Box. You will notice that the front of the box has nine outlets and a green light bulb. In order to use your ER System, connect the Data Acquisition Box to both the computer and the ER System. In order to do so, locate the gray serial cords marked with red dots and a black power supply cord supplied with your system. The serial cord connects the Data Acquisition Box to the serial port on the back of your computer. Connect the female end of the serial cable to the back of your Data Acquisition Box. For your convenience, a red dot has been placed over the correct insertion for the cable -- simply match the red dots together. 24 The same is true on your computer tower. Simply take the opposite end of the serial cord and connect it to the proper port on the back of the CPU this is also identified with a red dot for your convenience. Do not plug the serial cable into a converter and then into a USB port in the computer. To connect the power supply to your Data Acquisition Box, insert the single prong or pin into the PS port located at the rear of you Data Acquisition Box. The opposite end of the power supply should be plugged into a power adapter. Switch the Data Acquisition Box on -- the green light on the front of the box will light up to indicate that the box is receiving power. Red Light When on means a tool has shorted out the Data Acquisition Box On/Off Switch FP= Foot Pedal PS= Power Supply Cable Serial Cable connects to serial port in computer Attachments The following is a list of ports that each integrated tool connects to:
1 Bottom Shelf 2 Top Shelf 3 FOCUS Load Cell 4 Hand Grip 5 Pinch Grip 6 Algometer 12 Inclinometers 12G Goniometer 12 HR receiver TM Universal Task Master You have now connected almost all of the basic components necessary for communication between the ER hardware and ODES software. The final step is to plug the power cord to the power outlet. 25 Functional Range of Motion (FROM) Pegboard Assembly List of Parts:
6 MTM Panels 1-6 (Each has Zone A, B, and C) 2 Brackets Top/Bottom 24-1/4 blk. washer 24-1/4 x 20 x 1 BHCS 30- Pin blk 1 5/32 Allen Key Installation 1. Locate your 5/32 Allen Key, 24 black washers and 24 1/ screws. 26 Locate the top and bottom brackets Top Bracket Bottom Bracket 27 Arrange the MTM Panels on the floor in the proper sequence. The order is as follows (from left to right):
Panel 6, 1, 2, 3, 4, and 5. Place the top and bottom brackets so that the middle four MTM panels can be attached. You may want to move panel 6 and 5 aside for the time being. Panels 1-4 need to be attached using the 5/32 Allen Key, the 1 screws and the washers. Attach the top bracket to the panels prior to attaching the bottom bracket. Once the top and bottom brackets have been attached, you are now ready to attach panel 5 and 6. This should be done one panel at a time, starting with panel 6 on the left. Screw one bolt into the top bracket and one bolt into the bottom bracket in order to line up the panel with the bracket. You may then attach the second set of bolts in order to set the panel in place. Repeat this procedure for panel 5 on the right hand side. 28 You may now tilt the FROM board into an upright position and place the 30 black pegs in one of the zones to prepare for testing. Once upright the FROM board can be located near the ER system, up to 20 feet away from the computer. 29 Once you have set up your system please complete the registration form and fax it to Customer Service at (416) 398-9108. If you have any difficulty assembling or using the system our Customer Service department can provide you with assistance by calling (800) 461-6888 X2. Please take the time to review the rest of this manual to better understand the Hanoun hardware and software. It is strongly recommended that evaluators using this system receive appropriate training and get certified as Hanoun Evaluators. Information on training can be obtained in the appendix of this manual, by contacting your sales representative or by registering on-line at www.hanoun.com. 30 The Basics in Using the ER System If your system was purchased with a computer, the ODES software comes pre-installed and all the required software components should be unlocked prior to shipping. The following information will provide those evaluators with information on installing the software. Instructions for Software Installation Prior to loading the ODES software onto a computer please check to make sure your computer meets the minimum recommended software and hardware requirements. COMPONENT REQUIREMENT Computer Windows Memory Disk Space Components Network Motherboards 500 MHz Processor Window 98 Second Edition, ME, XP or 2000 is required to run the ODES program. We do not suggest XP Home Edition. Go to www.microsoft.com to get the latest service patches for your operating system. 256 MB of RAM is recommended 500 MB of free disk space 800 x 600 screen An SVGA high resolution color monitor A PS/2 mouse or compatible pointing device USB port for the Data Acquisition Box A color ink jet or laser printer Speakers In order to connect your computer to other computers via a network, cables and a Windows-compatible network adapter
(network card) are required.
**we prefer**
Intel Chipset Motherboards Intel Pentium CPUs
**Please note that we do not provide technical support for USB**
**Palm Pilot type software will interfere with the data acquisition device**
31 Installing Please ensure that you have exited all programs prior to loading ODES 2004. Insert the ODES 2004 disk into the CD-ROM drive and wait a few moments. A screen will appear giving you a variety of choices. You may view a PowerPoint presentation about our systems (Human Performance Programs), install ODES 2004, view the ODES manuals or visit our website. To install the software, click on Install ODES 2004 After choosing to install ODES, you must accept the license agreement to continue the installation process. 32 Click on Next to continue the installation process, or click Cancel if you need to close any currently running programs before continuing. Follow the instructions on the page in order to complete the installation. Please ensure that the following form is filled out correctly. The serial numbers need to be typed exactly as they are seen on the machine
(i.e. FCE). You can locate this serial number on your registration form or packing slip. Please call our customer service department or your dealer if you have trouble locating the machine serial number for your unit. Click Next to continue. The next page allows you to select the directory on your hard drive into which ODES files will be installed. For most installations, click Next. Click on Browse if you wish to install the ODES41 folder somewhere other than the C-drive on your computer. If the indicated amount of free space that would be available after installation is low or even below zero (most computers require at least 500,000K for normal operation), Cancel the installation and create the necessary space on the drive you selected by removing files, or uninstalling unused programs. 33 You may now choose to either Run Help From CD, or Install Help Files to Hard Drive. Generally, it is recommended that you select Run Help From CD to save hard drive space on your computer. The help files include a variety of manuals, marketing materials, and sample reports, which can help, get you started. Once you have made your selection click Next. You are now ready to install ODES 2004 onto your hard drive. Click on Next. 34 A page will appear which shows you how the installation is progressing. 35 During this process, a window entitled Hanoun Products will open. You may close this window ODES will still continue installing in the background. Once the installation process is complete, your system will update its system configurations. A pop-up window will appear to notify you of this. After updating its configurations, a window will appear notifying you that the installation has been completed successfully. Click Finish. 36 You will need to restart your computer before you can begin to use ODES. Click OK. Once your computer has restarted, a new icon will appear on your desktop. To access ODES, simply double click on the following icon:
You will now be required to register your software with the Customer Service Department at Hanoun Medical Inc. A pop-up window will ask you to contact Hanoun Medical to receive your password. Call
(800) 461-6888 X2 and a Customer Service Representative will assist you. Once you are successfully registered with Hanoun Medical Inc., you may begin to use our software. Upon entering ODES, a log-in window will appear, prompting you for a password for the user name odes. This password is always the same (hanoun), but can be modified through the Administration Menu if you choose to do so later. The password is case sensitive and must be entered in lower case. 37 After the password (hanoun) has been entered, the program will launch. It will now ask you to confirm the location of your ODES database, Odes_Data2000.mdb. Double click on this icon in order to proceed. The following introductory screen will now appear welcoming you to ODES. Once the program is initiated, the ODES main page will appear, which will allow you to access any feature of the ODES software. 38 The next step is to set up and become familiar with the Administrative features of the software. 39 Administration Menu Clinic Information The ODES software allows an evaluator to store Clinic Information and Logos, in order to personalize reports. ODES also has the ability to save multiple Clinic IDs. To enter a clinic logo, double click on the Clinic Logo blank field. Locate the saved logo file on your hard drive. The logo can be in any graphic file format (.jpg, .gif etc.) and should be 8.1 cm x 2.0 cm, so that it doesnt become distorted when attached to a report. To add a new clinic location, click New. When printing a report, the name and logo for the default clinic location will be included. To change the default location, click Next or Previous to select the correct location and check the Set as default clinic box. 40 Practitioner Information The ODES software allows an evaluator to store practitioner information and digital signatures, in order to personalize reports. To add a practitioner, you must fill out the following fields: name, designation, occupation, and registration number (if applicable). Then click Add to add the practitioner to the database (the name will now appear at the bottom of the page). To add a digital signature, you must first scan the signature and save to your hard drive in a graphic file format (.jpg, .gif etc.). Then, check the allow digital signature box, create and confirm a password
(optional), and double click the Hanoun icon in order to locate the signature file on your hard drive and associate the signature with the practitioner. 41 To edit the health practitioner information, highlight the name to edit from the list and click on Edit. Once the changes have been made click on Add. Environmental Settings This page allows you to check communications between your Data Acquisition Box and your computer, change device settings, alter your voices, modify calibration options and turn on or off shelf heights. Clicking Auto will inform you whether the DAC Box is communicating with your computer or not. It is recommended you do this before first attempting to calibrate your tools. If the DAC Box is not communicating with your computer, refer to the Troubleshooting section of this manual. 42 The Device Settings section indicates which data acquisition box channel the various tools should be plugged into, based on the set-up of the software. The following settings are used in normal set-ups:
F >> FOCUS Load Cell = 3 P >> Pressure Algometer = 6 LS >> Lower Shelf = 1 I >> Inclinometer = 12 PG >> Pinch Grip = 5 HG >> Hand Grip = 4 US >> Upper Shelf = 2 G >> Goniometer = 14 (12G on the Data Acquisition Box) CI >> Cervical Isometric = 15 (Multi-Cervical System) CE >> Cervical Flexion/Extension = 11 (Multi-Cervical System) CR >> Cervical Rotation = 10 (Multi-Cervical System) CS >> Cervical Seat = 9 (Multi-Cervical System) ULI >> UTM Left Isometric = 14 URI >> UTM Right Isometric = 15 UBR >> UTM Bar Rotation = 13 ULR >> UTM Left Handle Rotation = 11 URR >> UTM Right Handle Rotation = 12 ULD >> UTM Left Handle Distance = 9 URD >> UTM Right Handle Distance = 10 Evaluator systems should change the F and P settings to 6 so that the algometer will not need to be shifted between the two ports. The software looks for the Algometer in Port 6 for the Superficial Tenderness Protocol, Fibromyalgia Protocol, and any new tests created under the strength or work simulation section of the ODES software where the Algometer was chosen as the tool. The static muscle strength tests and any pre-programmed work simulation tests (i.e. static push and pull) are looking for the single FOCUS load cell, which is normally plugged into Port 3. Evaluator system users should change their device settings in Administration Environment Settings so that both the FOCUS and Pressure Algometer settings are set to Port 6. This will prevent the Evaluator from having to calibrate the Algometer in Port 6 and Port 3 (as the FOCUS). To do this open Administration Environment Settings and double click on the word Device Settings until it turns red. 43 Using your mouse click the number 3 beside F until the number displayed is 6. Once you close the Environment Settings page your settings will be saved. When you calibrate your equipment, you will notice the button for the Algometer is missing and you will only be required to calibrate the Algometer as the FOCUS. The Global Settings section allows evaluators to specify the country they are in, and the units of measurement to be used in printed reports. Currently the only available language reports may be printed in is English. The Backup Reminder should be set to 7 days for a stationary system, and 1 day for a portable system. The backups should be saved on floppy disks (or, in the case of very large databases, a CD or ZIP disk) and kept separate from your system in case of fire, theft or other equally damaging events. The Verify or Calibrate Reminder should be set to 7 days. It is recommended that you calibrate your Hanoun system once a week, and verify it before each day of testing. This will ensure your tools are accurate in their measurement. The accuracy of your equipment is extremely important, particularly if your report will be used in a litigious case. The Reminder can be set up as Remind only or Must Be Done. If you have Microsoft Office or Works Suite installed on your computer, you may wish to use the Word Spell Check function on your reports. You also have the option of using the Hanoun Medical Spell Checker, which is installed with ODES. The ER and UE systems are the only Hanoun systems that automatically read shelf heights. All other systems should have the Shelf Height switch set to No. ODES features different voices (Mary, Mike and Sam) to provide variety for the evaluator, handle cultural issues related to gender, and distinguish between computers in environments with multiple testing stations. The evaluator has the option of turning off All Sounds by clicking the left-most button. The center button controls Voice Response, which refers to the computers announcements of the clients name, shelf heights for tests etc. Note that turning off Voice Response does not affect the computers Start Test announcements, or count downs for rest periods. The Voice Command button is currently inactive at this time. Voice Speed can also be changed by adjusting the dial beneath these buttons. User Manager You may add multiple users to the ODES software, with a variety of security levels. Enter a users name, password and select a security level from the dropdown menu, then click Add. Available security levels are:
Administrator (Has full use of system);
High (No access to User Manager);
Medium High (All screens but User Manager and being able to remove cases);
Medium (All screens but Administration);
Low Medium (All screens but Administration and Reports. Also unable to remove assigned protocols to a client or delete tests)
Low (All screens but no access to client notes, Administration or Reports. Also unable to edit, delete or create tests.)
Lowest (Only access to client information and client case information) 44 To edit the users security level, highlight their name on the right hand side of the screen and click on Edit. Once the changes have been made click on Add. To delete a user, highlight their name and click on Remove. Import and Exporting in ODES The ODES software allows you to import and export data from one database to the other through the import/export function. This feature is useful for those companies that have multiple evaluators who may be providing services off-site or wish to complete reports at home. This allows the company to keep a central database. To access the Import/Export functions go to Administration/Import, Export & Archive The following screen will appear 45 First select whether you would like to import to your current database or export data from your current database to another one. To import or export data from another database, select import. Click on the Browse button to locate the database you wish to import or export the data from. Highlight the database you wish to import or export the data from and click on the Open button. The database information will be now listed. You will be required to include the ODES Database Password if you are importing/exporting from an ODES database that is in a zipped format. Select the Client Import Criteria from the selection provided:
All Clients o This will import/export the clients as well as all new templates, custom tests, and super protocols.
Selected Clients o A list of clients will appear and you will be required to highlight which ones you would like to import/export. These clients will be imported/exported as well as all new templates, custom tests, and super protocols.
Starting Date o A date from and to will need to be entered. This will import/export all the clients with the starting date (which is outlined in case information) in these date ranges. It will also import/export all new templates, custom tests, and super protocols.
Status o A list of the different status options will be available for you to choose from. Status is selected for each client through case information. It will also import/export all new templates, custom tests, and super protocols.
Employer 46 o A list of employers will be provided for you to select from.
No Clients o This selection will allow you to import/export all templates, custom tests, and super protocols. Next provide details on how you want this data handled:
Remove client information from original database after successfully copying information
Confirm before client information is updated to the database
Do not update existing clients
Compress data (if you are saving it to a floppy or e-mailing the database afterwards)
Erase Disk First (available only if you are exporting to a floppy drive) Include client pictures (from case information) Once all the parameters are set up click on the Start button. A screen will come up to give you the time to complete the task. At the bottom of the screen a progress bar will give feedback on the progress of the update. The software will indicate if it was success or not. It is important to note that with importing and exporting the software will check the tests and if you have made any changes to the standard tests (i.e. changed test or report descriptions or any other parameters) it will considered this a new test and you will find duplicates of tests in your system. If this happens simply put the duplicates under protocol hibernation or delete them, providing you are certain the one you are 47 deleting is the duplicate. Deleting tests means also deleting any test data in clients files so be sure before you delete. It is recommended if you are going to be importing data obtained off-site to your main database that you export the main database (no clients) to the local database you will be using. When you import the data from your local database to the main database there will be no duplicates, as the software will recognize it as the same database. Heart Rate Comments This feature allows you to save common heart rate comments for later use. To add a comment, enter it in the blank field at the top of the screen and click Add. The comment will then be listed on a dropdown menu when the heart rate is captured during testing. To edit a comment highlight it, then edit the text as it appears in the top field and click Edit. To remove a comment, highlight it and click Remove. Job Demand Templates From this page, you may add new Job Demand Templates, and import, export, edit or remove existing templates from ODES. To add a new Job Demand Template, click New. Enter the job title and source of the information (i.e. job site analysis, Dictionary of Occupational Titles, self report etc.) The Section Header is optional. If Section Headers are used however, the Job Demand Templates will be grouped by Section Header (i.e. lifting, positional tolerance, mobility) when the templates are printed. Include details on job tasks, units of measurement, and the job demand level (OCCasional 1-33%;
FREQuent 34-66%; CONstant 67-100%). Click Save once you have added all the needed information. Job Demand Templates can be exported for use on another computer with ODES installed, or imported from another computer with ODES. This reduces the need to re-enter data previously collected. To import templates, click Import and select the location on the computer from which you will be receiving the templates, and well as the location on your computer where the imported templates will be saved. You 48 must also indicate whether you will be importing all the templates in the source ODES database, or just the current template. Print the Job Demands Templates by clicking Print. The report can also be printed by clicking Export to create the report as a Word document (if you have Microsoft Office installed on your computer), or by creating a report Snapshot (see the Snapshot section of this manual). To edit a Job Demand Template, select the job from the dropdown menu, click Edit and make any required changes. To remove a Job Demand Template, select the job from the dropdown menu and click Remove. To use a Job Demands Template, from the Job Demands screen in ODES for a paryicular client, select the job from the dropdown menu and click Populate. This will add the Header, job task, job demand level, units and information source to the appropriate fields. Complete the Ability Demonstrated fields, and determine whether there is a job match or not. To add a Job Demand template from the Job Demands screen, click on Add to Template. Protocol Hibernation This feature allows you to place existing protocols, which you may not use often, into a separate folder thereby allowing you to free space within the protocol pages. You can add and remove protocols from this feature without losing data or deleting testing information. Protocol hibernation can also be accessed through the protocol pages. 49 To hibernate a test, highlight the test on the left hand side of the screen and click on Put into Hibernation. To bring a protocol back into the normal list of tests to slect, highlight the test from the right hand side of the screen and click on Awaken FromHibernation. Remove Current Case You may delete client cases by selecting the client/case that you would like to delete, and then clicking Remove Current Case. This information cannot be retrieved. A warning will appear prior to deleting data. Calibrating the Equipment Before you will be able to use your system you must calibrate and verify the equipment. Prior to calibrating any device, please ensure that the Data Acquisition Box has been set up successfully and is communicating with your computer. You can check to see if this is the case by going to Administration | Environment Settings from the ODES main menu. It is important to note that calibration should be performed on a weekly basis and verified daily . Prior to an assessment that may be challenged legally, both calibration and verification of all devices being utilized for the assessment should be performed. If the following message appears when ODES is launched, the pinch grip, hand grip, FOCUS System, and Pressure Algometer must be calibrated or verified before testing. The message will alert you as to which tools need to be calibrated. Please note that NO testing can be performed unless the equipment is calibrated and verified. This is especially true if you select the Must be done option in Administration
Environment Setting. No tests can be performed until the calibration is complete. 50 To calibrate your equipment, go to Calibration Calibrate Equipment (If there is more than one type of Hanoun system used with this database, go to Calibration Calibrate FOCUS). Calibration should take place once every week. Tips for Manual Calibration Ensure that the weights are stable and do not wobble. Ensure that the device is in a safe area away from the computer to prevent accidents
(i.e. weight falling on the computer) Calibration of the Hand Grip 51 Please ensure that the Hand Grip is plugged into PORT 4 on the Data Acquisition Box. After selecting the manual calibration option and the tool you wish to calibrate, the calibration page will display as follows. The above screen shows the last day of successful calibration (in this case it was April 17th), the type of calibration and the directions involved in manual calibration. In order to calibrate, first locate the correct attachment for the Hand Grip. The first step in manual calibration of the Hand Grip is to place the tool in the square base attachment.Click OK in order to zero the Hand Grip. Next, attach the ring-shaped calibration tool to the rungs on the Hand Grip dynamometer (leave the hand grip handle attached) while the tool is lying on its back. Notice that the attachment connects to the top rung of the Hand Grip on one side and the second rung from the top on the other. This creates a flat surface for weight to be placed upon. The calibration tool weight s 0.3 pounds. 52 To finish calibrating, locate a weight in order to complete this portion of the calibration process. Use a minimal weight of 10 lbs in order to calibrate the device. Enter the amount of weight you have chosen in the blank field. Make sure to add in the weight of the calibration tool. 53 Once the weight is steady, click OK to begin the calibration. Do not hold the weight. It must be free standing. Once the device has been successfully calibrated, a page will be displayed requesting that the individual who completed the calibration enter their name. This can be done either manually or, if your name exists as a supervising practitioner in the database page, it will appear in the drop down menu. Pinch Grip Calibration Please ensure that the Pinch Grip is plugged into PORT 5 on the Data Acquisition Box. After selecting the manual calibration option and the tool you wish to calibrate, the following page will appear. This page allows you to calibrate the Pinch Grip manually. It lists the last day of successful calibration (in this case it was never done), the type of calibration and the directions involved in manual calibration. In order to calibrate, you must first locate the correct attachments for the Pinch Grip. Pinch Grip Calibration Tool = 0.3 pounds Pinch Grip Calibration Block The first step in manual calibration of the Pinch Grip is to place the Pinch Grip inside the calibration block as above. Click OK to indicate that no force is being applied. Place the calibration tool through the block, as above, and apply a minimum weight of 10 pounds. 54 You should also note that the calibration tool for the Pinch Grip has a weight of 0.3 lbs. This weight must be taken into consideration when calibrating the Pinch Grip. Once the weight is steady, click OK to begin the calibration. Once the device has been successfully calibrated, a window will appear requesting the name of the individual who just completed the calibration. This can be done either manually or, if your name exists as a supervising practitioner in the database, it will appear in the drop-down menu. Algometer Calibration Please ensure that the Algometer is plugged into PORT 6 on the Data Acquisition Box (unless you have changed the device settings to Port 3. Refer to the algometer section for further details). 55 This page allows you to calibrate the Algometer manually. It indicates the last day of successful calibration (in this case it was never done), the type of calibration and the directions involved in manual calibration. In order to calibrate, you must first locate the correct attachments for the Algometer. The following are the attachments necessary for manual calibration of the Algometer:
56 Flat Round Pad:
Calibration Tool Bolt:
Algometer and bolt:
Attach the flat round pad to the base of the Algometer. Once attached, the Algometer can now stand on this round pad. The extra bolt located with your attachments can now be added to the top of the Algometer Attach the second calibration tool. Once the bolt is inserted and tightened you may click OK on the screen to signify that no force is being applied to the Algometer. 57 You are now ready to attach the calibration tool in order to finish manually calibrating the Algometer:
Calibration Tool The calibration tool (above) has a weight that needs to be taken into account. The Algometer calibration tool weighs 0.3 pounds. Add this value to the total amount being applied to the tool. For example, the Algometer requires that a minimum of 25 pounds be used. If you choose to calibrate with this weight plus the calibration tool, the total amount of weight to enter in the blank field would be 25.3 lbs. Place the weight being used on top of the attachment. Once the weight is steady, click OK to complete calibration. 58 Once the device has been successfully calibrated, a screen will come up requesting the name of the individual who just completed the calibration. FOCUS Calibration Please ensure that the FOCUS Load Cell is plugged into PORT 3 on the Data Acquisition Box. To calibrate the accessory arm heights and the FOCUS Load Cell, select the FOCUS icon from the main calibration page. This page allows you to calibrate the FOCUS load cell and accessory arm heights manually. It indicates the last day of successful calibration (in this case it was last done June 11, 2002), the type of calibration and the directions involved in manual calibration. Follow each step in progression and click the corresponding OK button. Begin by attaching the Multiplanar Accessory Housing Joint. Ensure that no accessories are attached to the Multiplanar Accessory Housing Joint. When you calibrate the load cell, you must place your calibration weight on the Multiplanar Accessory Housing Joint while no accessories are attached to it and it is positioned up. Enter the amount of weight in the blank field on the FOCUS calibration page. 59 Click OK adjacent to the Load Cell Calibration instructions. Each of the two ER accessory arms is calibrated separately. Follow the instructions listed under Bottom Shelf Height or Lower Accessory Arm to calibrate the lower accessory arm, then click OK. Once the device has been successfully calibrated, a screen will come up requesting the name of the individual who just completed the calibration. Universal Task Master Calibration Please ensure the Universal Task Master is plugged into TM on the Data Acquisition Box. From the ODES main menu on the top menu bar, go to the Calibration | Calibrate Task Master. 60 ODES will display a sequence of tasks for calibrating the UTM. The UTM rotation is to be calibrated first. Follow the instructions on each line and click OK once the task has been performed. This moves the OK button to the next instruction line. Step #1:
Set Bar Rotation Angle to Zero Degrees (Handles are closer to the ceiling) View from top of UTM. Step #2 Set Bar Rotation Angle to 180 Degrees (Handles are closer to the floor) 61 Use this locking mechanism to rotate the bar. The bar rotates forward and down. Step #3 and #5: Set the Left Handle to the smallest setting. The same picture illustrates the right handle to the smallest setting. Step #4 and #6: Set Left Handle to the largest setting. The same picture illustrates the right handle to the largest setting. 62 Steps #7-#10: For supination/pronation: use the locking mechanism on the side of the load cells in order to move the handles into either supination or pronation positions. Remove the handles and click OK for NO force on the pressure scale. 63 Just before calibration of the Force Measurements, shown in the screen below, make sure to remove the left and right handles from the UTM. Enter the amount of weight that will be used to calibrate the left and right force scales in the appropriate fields before you click OK. You must use a minimum of 25 pounds and for convenience use the same weight for the right and left side. Calibrate one load cell, and then the other. Once all of the tasks in the calibration have been completed, and no problems arose, the software will ask you to enter the name of the individual who performed the calibration. Weight Verification After calibrating the tool through either automatic or manual calibration, it is recommended that the accuracy of the device be verified. Verification should be completed prior to testing each day or after the equipment has been set up. To verify go to Calibration | Verify Calibrations in the top task bar; or from Verify in the bottom right-hand corner of the Calibration page, after calibration has been completed. 64 Whichever method is used, the same page will appear:
From here, select the tool to be verified (in this case the Hand Grip) and you will be brought to the verification page. This page allows you to select the equipment being verified, shows the most recent date of passed verification and allows you to conduct the verification procedure. It is important to note that when verifying, a weight different than what was utilized for calibration be selected. For example, if a 15 lb weight was used to calibrate, use 10 lbs to verify. The verification page on your computer will now ask you to enter the amount of weight you are using for verification. A different weight should be used and entered into the blank field on the page. Make sure to 65 add in the value for the calibration tool if applicable. Set up the tool as you would for calibration. Click on Start Verification to start the process. Once the verification has taken place, the computer will notify you if the verification has been passed or failed. Regardless of passing or failing the verification, the computer will provide you with the difference between the actual and measured values. In order to be successful, the actual and measured values need to be within 0.2% over the full scale of 500 lbs (FOCUS Load Cell, UTM or Algometer) or within 0.1% over the full scale of 200 lbs (Hand grip, Pinch grip). If the tool does not verify, click on Start Verification again. If the tool still does not verify on the second try, re-calibrate the tool. Auto Calibration For Evaluator and CIRES systems, auto calibration can be set up. A floppy disk will be provided with the system for this purpose. Follow the instructions on the disk to install this feature. Depending on how the system is utilized, auto calibration will be effective for up to 3 months. Following this time period, the factory settings are no longer accurate and manual calibration should be done. To auto calibrate, click Auto, then click the tool you wish to calibrate and follow the instructions. When auto calibration is set up it will include the voltage reading based on the tool you selected. Once you have completed calibration, a window will prompt you to enter your name. If your name has been entered under Administration Practitioner Information, you will be able to select it from the drop down menu. 66 Calibration Reports To print or view the calibration and verification reports go to Calibration Calibration Reports. Printed reports include the following information:
Name of person who performed calibration/verification
Date when the calibration/verification occurred
Actual weight, measured weight and deviation from accuracy of each device calibrated You may specify the print range for this report. Adding a Client In order to utilize the software, a client must first be entered. It is a good idea to create a sample client to start with. To do so, simply double click on Client Information located in the center of the main screen of ODES. This will then take you to the Client Information page where you can find an existing client or case, or create new clients or cases. 67 Click on New Client to create a new client file. Enter a clients general information into the form. This icon allows you to access a calendar Once all of the clients general information is entered, click on Close, located in the bottom right hand corner. The minimum information required includes name, gender, birth date (click on the calendar icon to the right of the birth date to access a calendar) and dominant hand. This data is required for tests that compare the clients objective measurements with a normative database. You will be returned to the client information page where you will now see the name of the newly entered client. 68 You will now need to create a new case for your client. Click on New Case. Adding a Client Case Within the client case screen you can enter information regarding ICD-9 codes, referral source, family physician, current medications, employer, insurance company, etc. Check in the drop down menu to see if the contact has been added previously. Adding in Family Physician/Specialist/Attorney/Referral Source/Insurance Company/Employer To enter in a new contact, double click onthe white box. A new window will appear which will allow you to add in contact information. The contacts name will appear in the drop-down menu for that particular contact type. This data will be saved in your database so the information will only have to be entered once. 69 Client Photos ODES has the ability to store and incorporate client photos into reports. After a picture has been taken using a digital camera and saved to your hard drive, you may click on the large white box in the upper right hand corner of the Client Case page, or click on Picture at the bottom right hand corner of the page. This will allow you to find the client photo you wish to insert. Click on Browse and locate the picture through Windows Explorer and then Insert the photo into ODES. The picture of the client will be seen in the top right hand corner of the Client Case page (in this example a picture of the inclinometers) and on the main screen of ODES. 70 Evaluator 1 and 2 The Evaluator 1 and 2 fields allow the evaluator(s) to enter their name and credentials into the Client Case page. Check in the drop down menu to see if the evaluators name has already been entered. To enter a new Evaluator, double click in desired field. Enter in the Evaluators name, designation, occupation and registration number. This information will be included in the front of the report, and beneath the signature sign-off line (if a signature is requested when printing the report). Please note this is not a feature of all reports printed in ODES. Click the Allow Digital Signature checkbox if you would like to add your signature to the software. This is a useful tool if you are anticipating e-mailing reports. Double click on the Hanoun logo and locate your scanned signature on your hard drive. The file must have been saved as a bitmap (extension .bmp). A password can be added to this section to prevent unauthorized use of the evaluators signature. To add a password, enter it in the Password field, and again in the Confirm Password field. If you do not wish to add password protection, leave these fields blank. Click on Close to return back to the clients case information screen. 71 Client Status The client status field is useful for keeping track of the number and type of assessments you have completed. Client status can be used as a criterion under Statistical Queries. From the drop down menu a number of selections are available. To add, edit or remove status information, double click on the blank Status field. You may now add, remove or edit client status information. On the Client Case page this information will be available in a drop-down menu. A list of client medications can be added to the Client Case page by double clicking in the white box below the Current Medications field. A new Current Medications window will appear. Enter the medication information into the appropriate fields and click Add to associate medications with your client. If the client is taking a medication that has previously been entered, select the name of the medication from the drop-down menu and enter the remaining information by either typing it or selecting it from a drop-down menu. Click Add in order to associate the medication with the client. Medications 72 Start/End Time The assessment start time and date are automatically logged on the Client Case page when you click on New Case. In order to record an end time, simply double click in the corresponding blank field once the assessment is completed. The current time will be entered into the field. You may also manually enter a time. Once this is done the evaluation time will be displayed on the cover sheet of your report. Adding in ICD-9 Codes ICD-9 codes can be stored within ODES for later use. Double click the blank ICD-9 Codes box on the Client Case page. The ICD-9 Code Assignment window will appear. To add a new ICD-9 code, double click on the ICD-9 Codes in Database field, add the code and description into the appropriate fields in the Codes Edit window, then click Add. Once the ICD-9 code has been added to the database, it will be saved and available from the drop-down menu for future clients. Once entered, the ICD-9 codes are also available for use in the note templates. To assign an existing ICD-9 code to your client, select the code from the Codes in Database drop-down menu and click Add. 73 Areas of Complaint A clients areas of complaint may be obtained by having the client complete the Pain Diagram or the Ransford Pain Diagram. To enter this information into the database, double click on the large Area of Complaint Information box or click Add in the Area of Complaint Information section of the Client Case page. A pain diagram will be displayed, which will allow you to enter in location information and pain descriptions. 74 After clicking on the diagram location where the client presents a complaint, complete the chart below. Once you have entered the information click Add, and it will appear on the Client Case page. Locking Cases This feature allows the evaluator to prevent other individuals from modifying a case. In order to utilize a locked case, a password must be entered. Please note that it is your responsibility to remember this password. If forgotten, our technical support/customer service staff at Hanoun Medical Inc. will not be able to help you retrieve it. Click Lock Case at the bottom of the Client Case page and you will be prompted to enter and confirm a password. Click OK when you are done. Once locked, you will see the Lock Case button change to Unlock Case. 75 Once the Client Case page is completed, you may click the Close button located at the bottom right hand corner of the page. This will bring you back to the Client Information page. A case number will now be associated with your client. Click the Close button at the bottom right hand corner of the page in order to return to the main menu. Your client will now be listed in the drop-down menu underneath the Client Information button. To quickly get into the client information screen, double click on the clients name. To quicker access the clients case information, double click on the case number. 76 Finding a Client/Case ODES allows you to search by client name or client case. Click on Find a Client or Find a Case to access these options. You may search using any of the fields. To see the search results, click the binoculars icon located at the upper right hand corner of the page. Click on the arrow button to the left of the clients name to open their file. 77 Adding a Test to a Client Once you had added your client into ODES you can assign tests to the client. From the main screen of ODES click on either Self Reports, Cardio, ROM Tests, Strength Tests, Work Sim Tests, or Clinical Test. You can either highlight the test on the left hand side of the screen and click on Add to Client or double click on the test on the left hand side of the screen and it will be automatically assigned to the client. Once the test has been assigned to the client it will appear on the right hand side of the screen under the heading Tests Assigned to Client. To change the order the tests will be completed in, highlight the test on the left hand side of the screen and use the up and down arrows under the title Change Protocol Order. To perform the test assigned to a client, highlight the test on the right had side of the screen and click on Perform Test or double click on the test on the left hand side of the screen and the test screen will open. 78 Removing a Test from a Client To remove a test from a client, highlight the test on the left side of the screen and click on Remove From Client. 79 Additional ODES 2004 Software Features Exploring The ODES Taskbar:
File Menu Database Utilities This function allows you to switch between active databases, create a new database or rename an existing database. To open an existing database, go to File Database Utilities, locate the correct database in the search results section, either by Browsing or Searching. To open the database, double click it so that the name appears in Database Location, and then click Open. A window will appear asking you to confirm that you have selected the correct database. 80 To rename a database, locate the database and double click it in the Search Results. The name of the database will appear under Database Location. Change the name here, then click Rename. The following window will appear to confirm the change. To create a blank database, change the name of the database in the database location field. This will be the name of your new database. Then, click Use Blank and confirm that this is the database you wish to create. If you choose to remove a database, it will not be recoverable by you or BTE Medical Inc. All information will be eliminated. If you still wish to proceed, double click the database you wish to remove and then click Remove. You will be asked to confirm this action. 81 Compacting and Repairing A Database This feature repairs any small errors that may occur due to networking. Go to File Compact &
Repair Database to use this feature. It is recommended you compact and repair your database every one to two months. Backing Up Your Database To back up your database go to File Backup Database. This feature ensures that if your computer is stolen or the hard drive fails you will be able to recover your client information and testing data. We suggest backing up at the end of each day. This feature allows you to back up all impairment ratings once selected, all client information and protocol information. This feature will back up all client files. You may also associate a password with the back up please note that BTE cannot help you if the password is forgotten. It is recommended you back up your database to floppy disks at the end of each day. If you are using a laptop or will be transporting your computer, back up prior to moving the system. A back-up reminder can be set in the Environmental Settings Menu to remind you to perform this function. 82 Restore Database To restore a previously backed up database go to File Restore Database. This feature allows you to restore a database that has been backed up to a floppy disk or hard drive. It will replace databases of the same name, however, so it is important to know what you are restoring before you overwrite any information. After you restore a database, you must use the Database Location field to find the newly restored database. Impairment ratings can be included in this process. Passwords are only required if you indicated so at the time of data backup. Log Off and Exit The Log Off option is to be used if you are going to be using ODES on and off throughout the day. By logging off rather than exiting, the speed of ODES will be enhanced. To exit the software either click on exit from this menu, click on Exit from the main screen of ODES or click on the x at the top right hand corner of the screen. Calibration Menu For calibration of each tool, please see the Getting Started section of the manual. Calibrate Equipment To calibrate your equipment, go to Calibration Calibrate Equipment (If there is more than one type of BTE system used with this database, go to Calibration Calibrate FOCUS). Calibration should take place once every week. 83 For Evaluator and CIRES systems, auto calibration can be set up. A floppy disk will be provided with the system for this purpose. Follow the instructions on the disk to install this feature. Depending on how the system is utilized, auto calibration will last up to 3 months. Following this time period, the factory settings are no longer accurate and manual calibration should be done. To auto calibrate, click Auto, then click the tool you wish to calibrate and follow the instructions. When auto calibration is performed it will include the voltage reading based on the tools you selected. Once you have completed calibration, a window will prompt you to enter your name. If your name has been entered under Administration Practitioner Information, you will be able to select it from the drop down menu. For all other systems, manual calibration is always used. Click Manual, select the tool you would like to calibrate, and follow the instructions. It is recommended you calibrate your system once a week. A reminder to calibrate may be set through Administration Environment Settings. 84 Verifying Calibration To verify your calibrations, go to Calibration Verify Calibrations (If there is more than one type of BTE system used with this database go to Calibration Verify FOCUS). Verification should take place at the beginning of each day in order to make sure that the results are accurate. Click the tool you wish to verify and follow the instructions. Once you have completed verification, a window will prompt you to enter your name. If your name has been entered under Administration
Practitioner Information, you will be able to select it from the drop down menu. Calibration Reports To print or view the calibration and verification reports go to Calibration Calibration Reports. Printed reports include the following information:
Name of person who performed calibration/verification Date when the calibration/verification occurred Actual weight, measured weight and deviation from accuracy of each device calibrated You may specify the print range for this data. 85 Statistics Menu Employer information Statistics Employer Information provides a summary of all Employers that are stored within the Case Information section of the ODES database. The report can be printed, exported to a snapshot file format or exported to Microsoft Word (if Word is installed on the computer). Client Status Information Statistics Client Status Information provides a summary of all Client Statuses. If the status of a client has been added to the database in the Client Case page, the client will be added to this report. You may sort by last name or by the status of the client. The report can be printed, exported to a snapshot file format or exported to Microsoft Word (if Word is installed on the computer). Client Information 86 Statistics Client Information provides a summary of all client information that has been added to the database. The report can be printed, exported to a snapshot file format or exported to Microsoft Word (if Word is installed on the computer). Referral Information Statistics Referral Information provides a summary of all referral sources that have been entered into the database. The report can be printed, exported to a snapshot file format or exported to Microsoft Word (if Word is installed on the computer). Insurance Information Statistics Insurance Information provides a summary of all insurance companies that have been entered into the database. The report can be printed, exported to a snapshot file format or exported to Microsoft Word (if Word is installed on the computer). Statistical Queries This function is located under Statistics Statistical Queries. The ODES software allows its users to query for information regarding existing clients in each of the following headings:
Case Manager Employer Physician Attorney Referral Source Insurance Company Insurance Company Supervising Practitioner Status Pre/Post Offer of Employment Start and End Dates Injury Locations This provides detailed information on length of treatment, common injuries and the number of clients being referred from a specific source. 87 Under report type, select Detailed to obtain a list of the clients, and select No Details to obtain the summary without client names. You may also choose multiple criteria to make your search more specific. The report can be printed, exported to a snapshot file format or exported to Microsoft Word (if Word is installed on the computer). Real Time Analysis Real Time Analysis is accessed by going to Statistics Real Time Analysis. It allows you to analyze the data from each individual client in detail. It also allows you to compare individual or multiple trials of any strength test recorded in the database. 88 Real Time Analysis is a useful function for:
Research Job Demands You can see whether your client was able to obtain their required goal and whether or not they were able to sustain it over time (i.e. their percentage of decrease after peak value was obtained) Client Progress/Tracking Using Real Time Analysis In order to utilize the Real Time Analysis feature, select the protocol to analyze.You must specify whether you wish to analyze only one trial or all of the trials relating to a specific protocol in a specific client. You may also analyze the selected protocol within a certain time frame. The top graph depicts the actual values obtained in the trials or test selected 89 Peak Force, Peak Time and
% Decrease are then used to analyze your data. You When analyzing multiple tests, you can choose to graph trial 1, trial 2, trial 3 or the average may also isolate your data values. in milliseconds to peak and milliseconds from peak Exporting Data ODES also allows its Multi-Cervical Users participating in International research with the Melbourne Protocol to export raw data into a program outside of ODES. This allows you to work with the data in a spreadsheet format if so desired. ER Users may also use this function, but are limited to exporting only NDI data. You may select individual or multiple fields to export from ODES, depending on the specificity of your needs. You may isolate the data to be exported by Client Range, Units of Measurement, Status, Gender, Age Range, and/or Date 90 Using The Export Function Select the type of testing data you wish to export Select the fields you wish to include when exporting Specify your target population or target dates Select a file name and a directory your data will be saved as a text file here. The file name that you chose will now be written in the File Name to Export line 91 Once the data has been successfully exported, this message appears Locating Your Exported Data In order to locate the data that you just exported from ODES, you must first close the ODES software and return to your Windows desktop. Open the program that youexported the data to (i.e. Excel) Go to the Data tab, select Import External Data Import Data Find your text file open it and follow directions 92 You information will now be put into Microsoft Excel Spreadsheet format (see below):
Snapshots The snapshot function allows users to create PDF-like files from reports that can be emailed without compromising the validity of the document. A snapshot viewer executable file is bundled with the report file, which will allow individuals without ODES to view the reports (i.e. insurance companies, other offices, etc.). In order to use this function, you must first preview the report you want to send as a snapshot. Once in the print preview for your report, select Export Create a Report Snapshot. The report will now be exported into a report snapshot, and you will see the following message:
93 In order to access the snapshot file for emailing, printing or saving to a floppy disk, you must first return to the ODES main page. Select Snapshot and the following page will appear. You may search for your snapshot by selecting Current Client, Today or All. In order to perform any function with the snapshot, you must double click the snapshot you wish to use so that it appears in the Report Snapshot field. You may now E-Mail the snapshot you selected, save it To Floppy disk, Remove it or View it. If you choose to E-Mail it, ODES will ask you if you wish to include the snapshot viewer. If you are emailing the file to someone who has not viewed a snapshot before or does not have ODES, you must include the snapshot viewer. Make sure that they are aware the viewer will be included in the email, as some firewalls and virus-checking software will block or screen .exe files. 94 Forms Menu A variety of questionnaires and forms are available for printing from the Forms menu. The client can fill out these forms and the information can be entered into the software manually later on. Utilities Menu Heart Rate Monitor This feature opens a window, which allows you to monitor a clients heart rate even outside of a testing page. Click Capture to initiate the Heart Rate Report. The software will then record the date, time, and heart rate of the client, as well as what the client was doing when the heart rate was captured (i.e. Before starting the Standard Hand Grip Test). If Capture is selected on a non-
testing page, the evaluator can enter information regarding the clients activities at the time. Standard entries can be set up under Administration Heart Rate Comments. Prior to clicking OK on the page to close it, make sure there are no errors, as the data cannot be corrected later. You may also double click the question mark to manually enter the clients heart rate. Input the value and hit the Enter key. 95 Heart Rate Report This report provides the evaluator with any heart rate information that has been manually entered into testing pages, or cardiovascular intake pages. It includes date, time, comments and the heart rate value. This report is not integrated with the report section of the software and must be printed from here and included as an appendix to the report. Sitting and Standing Tolerance t the top of the ODES Menu you will see the following icons:
These icons can be used to track both the sitting and standing tolerances of a client. In order to time a client sitting, click the sitting icon. Once the client has finished sitting, click the stop button. In order to time a client standing, click the standing icon. Once the client has finished standing, click the stop button. 96 When the assessment is complete, you may print off a sitting/standing tolerance report by going to Utilities Sitting/Standing Tolerance Report. The following is an example of what you will see. The report includes total sitting or standing time, date, time and duration each position was maintained. 97 Post Offer of Employment Software (Optional Upgrade) The Post Offer of Employment software feature allows the evaluator to set the employment standards for an employer, generate a letter acceptable for the Human Resources department, and the ability to generate statistics on the hiring of a particular employer. To access the Post Offer of Employment Test software feature click on POET from the drop down menu. If you are going to create any customized test particular for the employer you are going to be working with, it is recommended you create the tests before setting the standards. POET Receipts This software feature allows the creation of a receipt in the event the client is required to pay for the POET test. Select the payment type, and the amount. From the drop down menu the supervising practitioners listed in ODES will be available. To enter in another name that the money was received by type it in. 98 Set Standards Select Set Standards from the drop down menu. Select the employer from the drop down menu. The employer must have been entered in a clients case at least once for it to be available from the drop down menu. Next select the tests you are going to include in the Post Offer of Employment Test for this particular employer from the drop down menu. 99 From here you would include the External ID, if the results were being exported to a FAT file for synchronization with the employers computer system. Include the standards for the particular test in the white box (in this example it is 0). Next you are required to select the comparison method for the standard you entered. The following are the options available:
Compare the score for each column with the standard for that column Compare the left hand score with the standard for the left hand, and compare the right hand score with the standard for the right hand Compared the combined maximum of the right and left hand scores with the left hand standard Compare the hand that scored the higher of the two hands with the higher of the two standards. Compare the hand that scored the lower of the two hands with the lower of the two standards Compare the dominant hand score with the higher of the two standards. Compare the non-
dominant hand score with the lower of the two standards Then select from the drop down menu whether The evaluee must fail all or only one of the standards defined above to fail this individual test. Once set up, select the next test from the drop down menu to be included in the Post Offer of Employment Test and set up the standard. Continue until all the standards have been set up for this particular employer. POET Standards Report Once completed click on Print from the Set Standards screen or select POET Standards Report from the POET drop down menu from the main screen of ODES. 100 Click on Next to be taken to the next screen. Select the particular employer from the drop down menu and click Next. 101 If a Super Protocol was set up for the Post Offer of Employment Test, select it from the drop down menu at the top of the screen and then click on Select Tests. You can review the tests that are included then in the list below and the tests assigned to the particular Super Protocol you selected should be highlighted. Alternatively, you can select the particular tests from the list of tests. Once this step has been completed click on Next. Select whether you want to Preview the report or Print the report. Then click on Finish. The following is an example of the report. Click on the printer icon to send the print job to the default printer. Click on Print Options to select which printer to send the report to. Click on Close to close out of this screen and return to the main screen of ODES or click on Export to export the report to Microsoft Office Word (if installed on computer) or to export the report to a Snapshot (see section of creating snapshots for further details). 102 POET Summary Report The POET summary report will allow you to generate statistics on the number of POET tests completed for a particular employer for a particular date range. It will provide details on the number of tests completed and the number and percentage of males and females that passed and failed the tests. To generate a POET Summary Report select this option from the POET drop down menu. Click on Next to take you to the next screen. Select the appropriate employer from the drop down menu and the click on Next. 103 Select the statuses you would like to collect data on. The status is assigned to the clients case. Examples of statuses that are used for Post Offer of Employment Tests are: Candidate, Present Employee, Recall, Did Not Test, No Show. Select Include employees with no status, if you would like to include the data where the evaluator forgot to assign a status. Click on Next to continue to the next screen. If a Super Protocol was set up for the Post Offer of Employment Test, select it from the drop down menu at the top of the screen and then click on Select Tests. You can review the tests that are included then in the list below and the tests assigned to the particular Super Protocol you selected should be highlighted. Alternatively, you can select the particular tests from the list of tests. Once this step has been completed click on Next. 104 Next select the data range you wish to select the data from. Select whether you want to Preview the report or Print the report. Then click on Finish. 105 The following is an example of the report. Click on the printer icon to send the print job to the default printer. Click on Print Options to select which printer to send the report to. Click on Close to close out of this screen and return to the main screen of ODES or click on Export to export the report to Microsoft Office Word (if installed on computer) or to export the report to a Snapshot
(see section of creating snapshots for further details). POET Detailed Summary Report The POET Detailed Report is used to generate a letter to provide to the employer to indicate whether the client met the job demands or not. Prior to completing this report make sure your clinic information and logo are included under Administration Clinic Information. Click on Next to take you to the next screen. 106 Select whether you want to report to include the current client or all the clients for a particular employer. Select the appropriate employer and click on Next. 107 Select the status of the client(s) and then click on Next. 108 If a Super Protocol was set up for the Post Offer of Employment Test, select it from the drop down menu at the top of the screen and then click on Select Tests. You can review the tests that are included then in the list below and the tests assigned to the particular Super Protocol you selected should be highlighted. Alternatively, you can select the particular tests from the list of tests. Once this step has been completed click on Next. Next select the data range you wish to select the data from and click Next to continue to the next screen. 109 Select whether you want to Preview the report or Print the report. Then click on Finish. The following is an example of the report. Click on the printer icon to send the print job to the default printer. Click on Print Options to select which printer to send the report to. Click on Close to close out of this screen and return to the main screen of ODES or click on Export to export the report to Microsoft Office Word (if installed on computer) or to export the report to a Snapshot
(see section of creating snapshots for further details). 110 Export POET Results This feature is used to export data to a FAT file to synchronize the data to the employers computer Select the Super Protocol for the employer to be exported and the date range of tests completed. Either type in the Export File Path or click on Browse to select where to export the file to. Type in what you would like to call the Export File. Select to append the current date to the file name if you would like todays data added to the file name to distinguish when the export was completed and prevent a mix up of files. 111 Digital Capture Menu For those evaluators with access to a digital camera, a variety of pictures can be saved to your computer and input to the ODES software. You may use this feature to show a client performing tasks or exercises. Comments and headings can be added to each picture prior to printing them. Take the picture with the digital camera. Download the picture to your hard drive using your camera software. Use the binoculars button to locate the picture, then click Insert. Once inserted, the file name will be included below the photo. Include a page title and the top of each new page. Include any comments by clicking Comments. Click Remove to remove a picture. To insert a new page, click New. Each page will hold nine pictures. To delete a page click Delete. To print an entire page of pictures and comments, click Print. 112 Help Menu Help Manuals If you have loaded the Adobe Acrobat reader and help manuals onto your hard drive from the ODES installation disk, you will be able to access them by going to Help Help Manuals. If you have not loaded the Acrobat reader and Manuals to your hard drive, a window will prompt you to insert the ODES CD into your disk drive. To load the Adobe reader go to www.adobe.com to down the reader. About To access information on your system go to Help About. On this page, details on the ODES software version you are using can be obtained. If the system has not been unlocked, Days Remaining indicates for how long you will be able to use the system. The ODES software can be unlocked by calling BTE Customer Service. Once unlocked, Days Remaining will display as Unlimited. Machine # is set to None unless the system has been purchased on a utilization basis. The Serial # for the system is also included here. The System Info button located at the bottom of this window will also provide you with statistics on your system, such as amount of memory and operating system. To manually update the database after installing software updates go to Help About. Hold the Shift key down, and hit the Z key three times. 113 114 Templates Each of the note pages in ODES has a template section that allows the evaluator to create any number of templates. Using this feature the evaluator can have any field from the client and case information automatically populate a template when applied to the clients file. For example, the clients name, date of injury and injury locations could be brought into the note exactly where you designed the template to put them. This feature speeds up reporting time, improves efficiency and hence, profitability. There are a variety of headings under which templates can be created. These include:
History Examination Diagnosis X-Rays/Lab Referral Impairment Return To Work Custom Note Testing Analysis Recommendations Progress Analysis Cover Letter There are also a variety of pre-programmed templates in the ODES software. To access or create a new template in any of the above categories, you must first choose a note from the list above and then click the template button located in the bottom right-hand corner of any page. This will bring you to a page where the pre-programmed templates are located. You may delete, add or edit templates here. To utilize an existing template, click the template you wish to use. You will be brought back to a blank page. Place your cursor where you would like to paste the information and click the paste 115 icon. Your template will now fill in the appropriate information for your client. In order to alter any remaining fields that have not been filled, use your tab button and make the necessary changes. Creating a Custom Template To create a custom template click the template button on the note page to which you wish to add the template (i.e. History, Examination, etc.) Click NEW to create a new template. 116 Click Edit then select the new template (in this case Template 86) in order to add text and change the template name. ODES has multiple pre-programmed fields in order to help you build your template. These fields include names, times, dates, results, status, etc. 117 Begin by writing what you wish to include in the report, but use the merge fields in order to automatically query data. To use the merge fields, select the field from the Insert Field dropdown menu and click Insert. This will place the merge field in the template at the spot where your cursor was located. The merge field will have square brackets around it. You may create your own merge field by typing the possible options and placing square brackets around each one. This is useful in situations where there are a limited number of options (i.e. arrived [on time][late] for the assessment). Once finished, click Close, then click Cancel Edit on the Template page. Select your template and paste it into place You may now use the tab key on your keyboard to find and replace any outstanding fields on the template. Remember that you will need to choose the appropriate comments in certain 118 circumstances (i.e. normal, above normal or below normal). Click on delete to remove a selection or click on tab again to allow the selection to stay. Super Protocols Super Protocols can be created when you require a standardized protocol for testing (i.e. Post Offer of Employment Testing). They can also be used if you want to decrease the amount of time required to select specific tests for a specific injuries. You can create a Super Protocol in the same manner you would create a template. Select a client and click Super Protocol from any testing page. Click New Test and then Edit the protocol to include the tests applicable to your needs. Select the applicable tests from the lists on the left-hand side of the page and Add them to the Super Protocol. The order of testing can be changed by selecting one of the included tests and using the Change Order arrows to move it up or down within the list. Once you have added all the applicable tests and arranged them in the desired order finish the process by clicking Lock Super Protocol. You will be prompted to enter and confirm a password to lock the Super Protocol. To apply a Super Protocol, select a client then click Super Protocol from either the ODES main menu or from a page where tests are selected. Click the Super Protocol you wish to use. The tests for that protocol will automatically be added to your client once you have performed the first test. Click Next Protocol to go to the next test in sequence. 119 Self Reports Menu Self Reports can be printed from the Forms menu or from the test page if the evaluator would like the client to them out on paper, with the exception of the Spinal Function and Hand Function reports. The client may also complete the reports on the computer. To view the results after the client has completed a report, click Show. To hide the results, if the client can see the computer screen, click Hide. Dallas Pain Questionnaire The DPQ was developed to assess the amount of chronic pain affecting four aspects of the clients life: daily activities, work-leisure activities, anxiety-depression and social interest. The DPQ has 16 sections, divided between the four aspects. The questionnaire utilizes a Visual Analogue Scale (a pain-free state being to the left and the most painful state being to the right). The Visual Analogue Scales are 10 cm long. The questionnaire must be answered by placing an X on the Visual Analogue Scale at the appropriate pain rating McGill Pain Questionnaire The McGill Pain Questionnaire (MPQ) is a tool that has been widely recognized as a reliable instrument to measure the pain experience, and has been translated into many languages and widely researched. Pain descriptors cover four aspects: sensory, affective, evaluative and miscellaneous. The MPQ has been demonstrated to be a good instrument for clinical work and research. At the bottom of the report you have the option of including the score on the report or not. The Neck Disability Index (NDI) The Oswestry Low Pain Index was modified to produce a 10-item scaled questionnaire entitled the Neck Disability Index (NDI). The NDI is designed to inform the doctor as to how the clients neck pain has affected their ability to manage in everyday life. It has been offered as a self-
reporting instrument for the ADL (Activities of Daily Living) assessment of sufferers of disabling neck pain, particularly from whiplash injuries. The NDI demonstrates a high degree of test-retest 120 reliability and internal consistency. The evaluator has the option of printing a progress graph for the NDI once a minimum of two tests have been completed. The graph can be printed by clicking New Test from the testing page, then clicking Progress. Alternatively, the NDI progress graph will be included with a Progress Report if that report is printed (see the Reports section). The Oswestry Questionnaire The Oswestry LBP Questionnaire is divided into ten sections designed to assess limitations in various activities of daily living. Each section contains six statements relevant to the problems suffered by people with low back pain. This self-administered questionnaire avoids interviewer bias and ensures uniformity of presentation while the combination of closed questions and self-
administration gives a reliable format. The evaluator has the option of printing a progress graph for the Oswestry LBP once a minimum of two tests have been completed. The graph can be printed by clicking New Test from the testing page, then clicking Progress. Alternatively, the Oswestry LBP progress graph will be included with a Progress Report if that report is printed (see the Reports section). Patient Review Questionnaire The Patient Review Questionnaire takes a look at a clients progress over the course of a rehabilitation program. In addition, this questionnaire also takes into account changes in medication relating to neck pain over the course of the program. This questionnaire was designed for the Melbourne Protocol with the BTE Multi-Cervical Unit. Once the patient has completed multiple Client Review Questionnaires, a progress report can be created illustrating whether improvement has occurred over time. This report is in the form of a graph. Superficial Tenderness The superficial tenderness test allows for an objective analysis of chronic pain with disorders such as fibromyalgia. Please refer to the Algometer section of this manual for more details. 121 Symptom Intensity Rating The Symptom Intensity Rating Questionnaire is a tool in which the client rates their symptoms throughout a treatment program. Upon completion of more than one questionnaire, a graphical progress report can be printed. This questionnaire was designed for the Melbourne Protocol using the BTE Multi-Cervical Unit. 122 Waddell Signs The Waddell Signs test is a standardized assessment of behavioral responses to examination. When completing the Waddell tests, select positive or negative as per the test protocol. The score for the test can be found at the bottom of the page. Physical Demands Analysis This portion of the software is designed to gain additional information from your client regarding their pre-injury employment. It requires your client to describe their duties at work (as they perceive them to be). Go to the Self Report section of the software, select Physical Demand Analysis and click Perform. You may print a blank form for the client to fill out. Creating Custom Self Perception Tests The ODES software allows you to customize your own self-perception tests (such as questionnaires). In order to do so, you must go to the Self Reports page and click NEW TEST. This will bring you to a template page where you can begin to create your new self-perception test. 123 You will be able to include section titles, which will let you add a score to them in the test screen. Add in the name for the Final Score Column. If you are entering ratings based on a research article, select the Rating Column and add in the name for the Rating Column. To add a rating complete the rating entries box and include the rating to and from. Click on Add to include the rating. You may also include any examiner or report descriptions here. Examiner descriptions are only seen in the testing screen. Report descriptions are only seen on the printed report. 124 EPIC Hand Function Sort (Optional Upgrade) The purpose of the 62-item Hand Function Sort (HFS) is to quantify the disabled person's perception of their ability to perform work tasks that involve the hands and upper extremities. The HFS can be useful to provide a baseline measure of the client's perception of their functionality in everyday tasks prior to the onset of intervention. This allows progress to be noted as it occurs, extending the benefits of treatment beyond the clinic's walls into the client's life at home, at work, and in the community. In the HFS, drawings of handling and fingering tasks are supplemented by drawings that depict common activities of daily living. The drawings have been selected by experts in rehabilitation from among hundreds of tasks that persons with upper extremity impairments report as presenting significant challenges. The client is instructed to "Look at each drawing and read the description. On a separate answer sheet, indicate your current level of ability to perform the task."
The answer sheet provides a 5-point rating from "Able" to "Restricted" to "Unable." Operational definitions of these adjectives are provided in the standardized instructions. There is also a sixth rating, depicted as "?", which indicates "I don't know."
The HFS is not timed and usually requires 8 to 10 minutes to complete. It can be administered by a technician by following the standardized instructions 125 Once the test is performed with a client, the results will be shown in a chart. The HFS is easily scored and yields a single "Rating of Perceived Capacity" which ranges from zero to 248. Three "internal validity check" drawings are included which are similar to drawings presented earlier. Normative values for both healthy and disabled males and females are provided in the HFS examiner's manual. Additionally, the Rating of Perceived Capacity score can be cross-referenced to the U.S. Department of Labor's Physical Demand Characteristic of Work system. The normative values allow the evaluator to compare functional test results, the HFS score, and the target job's demands, providing a crucial three-way cross-validation of findings. EPIC Spinal Function Sort The purpose of the 50-item Spinal Function Sort (SFS) is to quantify the disabled person's perception of their ability to perform work tasks that involve the spine. This can be useful to provide a baseline measure of the client's perception of their functionality prior to the onset of intervention. The client is instructed to "Look at each drawing and read the description. On a separate answer sheet, indicate your current level of ability to perform the task."
126 The answer sheet provides a 5-point rating from "Able" to "Restricted" to "Unable." Operational definitions of these adjectives are provided in the standardized instructions. There is also a sixth rating, depicted as "?", which indicates "I don't know."
The test is not timed and usually requires 8 to 10 minutes to complete. A technician can administer it by following the standardized instructions. Once the test is performed with a client, the results will be shown in a chart. The SFS is easily scored and yields a single "Rating of Perceived Capacity" which ranges from zero to 200. Two "internal validity check" drawings are included which are similar to drawings presented earlier. Normative values for both healthy and disabled males and females are provided in the SFS examiner's manual. Additionally, the Rating of Perceived Capacity score can be cross-referenced to the U.S. Department of Labor's Physical Demand Characteristic of Work system. This allows the evaluator to compare the FCE results, SFS score, and the target job's demands, providing a crucial three-
way cross-validation of findings. 127 In a multi-site study of the California Functional Capacity Protocol (Matheson, et al, 1996), the authors demonstrated that SFS test results are closely linked to work capacity performance measures. Furthermore, the SFS provided the best single indicator of client effort. Cardiovascular Menu A variety of cardiovascular tests are included in the software for you to utilize. Astrand The Astrand protocol is a bike ergometer test used to determine a clients aerobic capacity. The software can be used in two ways. The test can be completed away from the system and the KPM/min and final heart rate entered. The software will calculate the aerobic capacity for the client. Alternatively the test can be completed on an integrated fashion with ODES. The evaluator can click on Start Timer and if the client has the heart rate monitor on, the heart rate will be captured each minute after the first three minutes of the test until the clients stead state heart rate is obtained. Click on Capture to add the heart rate value to the Heart Rate Report. 128 Bruce Treadmill The Bruce Treadmill test is used to determine a clients aerobic capacity. Both the modified and standard protocol is available in the ODES software. Click on Standard or Modified on the top right hand corner of the screen to switch to the other protocol. Click on Start Timer when starting the test. Click on Pause Timer if the test must be paused to clarify to the client what they are required to do or for safety reasons. To stop the test click on Stop Timer and the aerobic capacity will be calculated. Click on Capture to add the heart rate value to the Heart Rate Report. Cardiovascular Intake Cardiovascular Intake allows for the recording of the clients resting heart rate and blood pressure. If the client is wearing the heart rate monitor, double click on the white box under the title, resting rate (min) and the value will be entered in the box. The software will alert you if the value is indicates a high resting heart rate or blood pressure by the text turning red in the result section of the screen. 129 Modified Canadian Aerobic Fitness Test The Modified Canadian Aerobic Fitness Test is used to determine a client aerobic capacity and the number of METs they can work at by stair climbing. Prior to completing the test the resting heart rate and blood pressure need to be entered under Cardiovascular Intake. As well make sure the client has completed a PAR-Q or health questionnaire to identify any contraindications to cardiovascular testing. The client should be wearing the heart rate monitor during testing. If the heart is being captured manually, double click on the heart. Enter the number in and hit enter for the heart rate to be entered into the software. To provide a demonstration for the client, double click on either the single or double step stick figure diagram. Click on Cadence Off if you are using a metronome or tape to prompt the client. Begin testing at the appropriate level as indicated on the screen (i.e. Cadence 84 steps/minute and 2 steps with this example). At the end of each 3-minute interval the heart rate is entered. The computer will alert you as to whether to continue testing or not. Measure blood pressure as per the protocol at the 2:00 to 2:30 minute mark, the 3:30 to 4:00 minute mark and prior to them leaving your clinic. 130 The test will stop automatically when they have completed the protocol or click on Unable to Continue if the client voluntary stops the test. Click on Pause if you need to clarify instructions for the client. Once testing is completed the computer will calculate the clients VO2 and MET level. 131 Single Stage Treadmill The Single Stage Treadmill test is used to determine a clients aerobic capacity and MET level. The test is based on the treadmills speed and grade and so it is important the treadmill is calibrated regularly. Refer to your treadmill user manual for more details on this or contact the manufacturer. Prior to completing the test complete the Pre-Testing Heart Disease Questions. Contact the clients physician for medical clearance if any of the answers are yes. During testing the client is not allowed to hold onto the handrails of the treadmill for balance. Each stage is 4 minutes long with the heart rate and blood pressure being measured during the final minute of each stage. Begin the first one to two minutes of the test by selecting a comfortable pace for the client. Increase the speed to between 2.0 and 4.5 mph depending on the condition of the client. Increase the incline the grade by 5% maintaining a final speed of warm up stage. Stage two begins when the grade reaches 5%. Decrease the grade and speed for stage three. The following is the screen when the test is completed. 132 Customized Cardiovascular Tests From the Cardiovascular menu you may also create your own cardiovascular test by clicking New Test. 133 Include the parameters for the test based on the protocol you have selected. Click on Close to save the protocol. Creating a Non-Integrated Work Simulation Protocol Within ODES you have the ability to create either a non-integrated work simulation test. After clicking New Test, located on the Work Simulation Protocol screen, the following menu will be displayed:
From this menu, select Custom Work Simulation Protocol. This type of test allows you to create any non-integrated work simulation protocol, such as: carrying, lifting, balancing, climbing, walking, dynamic pushing/pulling, etc. 134 Include the test name, test description, report description, initial settings (if any), number of trials, and column header name fields. If the test is timed, select Create a timer for this test and optionally link it to a column. Once the timer has been selected below the Column Header Names you will have access to buttons below the graphic locations called Timer Linkage. Click on the one where you would like the time linked to. Once the button has been clicked it will say Timer On. You are also able to incorporate standards based on research into your test by entering ratings. First select which column you will be using the value obtained to compare against the standards. Select this from the drop down menu titled Link to Column. Select whether the value is numeric or a time. Include a caption so that you will be able to enter in the ratings (i.e. Percentile, Rating etc). Now you can enter in all the normative data and related it to age and sex if indicated in the research. Click on Close to save the test. 135 Exercise Program/Cervical Conditioning a) Exercise Program ODES comes with a variety of pre-programmed exercises you can. include within your clients program. You may click Perform Test to conduct the exercise, or print out a Report to allow the client to track their progress manually. You can customize your report to include any of the following pieces of information:
136 Click on Perform Test to enter information for the clients exercise. The initial weight, sets, repetitions and other parameters can be entered in and the goals for the exercise. To add in a new exercise or work simulation protocol click on New. 137 Fill out the required parameters and click on Close to save the information. Comments All testing screens allow for evaluator comments to be added in. A box will be available on the screen or a Comments button can be clicked on. To enter notes, place your cursor in the larger blank text box. Type any information that you wish to include. If you wish to include to date prior to entering your note, click Insert Date n (located on the tool bar). The date will now appear in the text box. 138 You may also enter information into a template. This allows you to save popular phrases so that you do not have to re-enter them time and time again. To create a template, enter the information you wish to save in the smaller text box and then click Add to List:
The new template will now appear in a dropdown menu. 139 Your information To insert this information into your note, select the template you wish to include from the menu and click Insert Into Note. The information will now appear in the notes section (the upper text box):
Validity Analysis 140 This section of the ODES software analyzes the validity of the testing performed on each client. Validity analysis compares results to expected results for all tests completed by a client, or for selected tests. This information provides details on what the expected result of the tests should have been, according to research and the actual result. Click Use All to collect information from all client tests; to select individual tests, use the dropdown menus. Click Add Validity Item to add a new test to the current analysis. Once the information has been reviewed, the total number of deviations will be displayed at the bottom of the page, and you may add comments regarding the consistency of the performance. Since this feature is not integrated with ODES reporting, click Print to print out the validity analysis. Reports ODES has the ability to create a variety of different reports. 141 Each report has different features. For example, a summary report only contains the actual raw data that is collected from testing (no verbal comments or information). On the other hand, a FOCUS Assessment will include all notes, comments and testing data that the evaluator wishes to include. Custom reports will let you change the name of the report. All information will be automatically pulled from the tests, making report writing efficient and time saving. To create a new report simply choose the type of report you wish to use, ensure that the start and end dates for the notes and protocols are correct and click Next. You now have the option of including notes. You can add individual notes, or include all notes at once by clicking Select All. The notes will be printed in the order in which they are listed, with the exception of Diagnosis and Recommendation notes, which are always printed first. This page also lets you modify page numbering, and whether dates are included in the margins. If the supervising practitioner has a digital signature in the system, you will be able to include a signature line and/or digital signature to the report. The next page allows you to choose which tests you wish to include in the report. 142 Finally, you can include contact information, change page specifications, include job demands and injury locations, etc. You may then preview your report, or send it directly to the printer. Types of Reports:
Cervical Assessment:
Allows you to select date range of data Allows you to add and remove client notes from the report Allows you to alter page numbers Allows you to enter dates in the margins beside client notes Allows you to select all or only specific tests to include on the report Allows you to print or preview the report 143 MCRP Assessment:
Allows you to select date range of data Allow you to add and remove client notes from the report Allows you to alter page numbers Allows you to address the report to the following: Referral, Insurance Company, Attorney, Client, Physician, Employer, Case Manager Allows you to include injury diagram and/or chart on the report Allows you to put the job demand on a separate page Allows you to add or remove page numbers from the report Allows you to include clients name at the bottom of each page of the report Allows you to print or preview the report MCRP Discharge Assessment:
Allows you to select date range of data Allow you to add and remove client notes from the report Allows you to alter page numbers Allows you to address the report to the following: Referral, Insurance Company, Attorney, Client, Physician, Employer, Case Manager Allows you to include injury diagram and/or chart on the report Allows you to put the job demand on a separate page Allows you to add or remove page numbers from the report Allows you to include clients name at the bottom of each page of the report Allows you to print or preview the report MCRP Progress Assessment:
Allows you to select date range of data Allows you to put the job demand on a separate page Allows you to add or remove page numbers from the report Allows you to include clients name at the bottom of each page of the report Allows you to print or preview the report MCRP General Progress Assessment Allows you to select date range of data Allows you to alter pages numbers Allows you to add and remove client notes from the report Allows you to add specific tests to your report Allows you to address the report to the following: Referral, Insurance Company, Attorney, Client, Physician, Employer, Case Manager Allows you to include injury diagram and/or chart on the report Allows you to put the job demand on a separate page Allows you to add or remove page numbers from the report Allows you to include clients name at the bottom of each page of the report Allows you to print or preview the report Allows you to create a custom title for the report MCRP Reassessment Allows you to select date range of data Allows you to alter pages numbers Allows you to add and remove client notes from the report Allows you to add specific tests to your report 144 Allows you to address the report to the following: Referral, Insurance Company, Attorney, Client, Physician, Employer, Case Manager Allows you to include injury diagram and/or chart on the report Allows you to put the job demand on a separate page Allows you to add or remove page numbers from the report Allows you to include clients name at the bottom of each page of the report Allows you to print or preview the report FCA Progress Assessment (non integrated) This report is designed to include only Non-Integrated tests that have been performed. It is specifically used to track the progress of multiple assessments Allows you to select date range of data Allows you to alter pages numbers Allows you to add and remove client notes from the report Allows you to add specific non-integrated tests to your report Allows you to address the report to the following: Referral, Insurance Company, Attorney, Client, Physician, Employer, Case Manager Allows you to include injury diagram and/or chart on the report Allows you to put the job demand on a separate page Allows you to add or remove page numbers from the report Allows you to include clients name at the bottom of each page of the report Allows you to print or preview the report FCA (non integrated) Allows you to select date range of data Allows you to alter pages numbers Allows you to add and remove client notes from the report Allows you to add specific non-integrated tests to your report Custom Report (non integrated) This report is designed to include only Non-Integrated tests that have been performed. Allows you to select date range of data Allows you to alter pages numbers Allows you to add and remove client notes from the report Allows you to add specific non-integrated tests to your report Allows you to address the report to the following: Referral, Insurance Company, Attorney, Client, Physician, Employer, Case Manager Allows you to include injury diagram and/or chart on the report Allows you to put the job demand on a separate page Allows you to add or remove page numbers from the report Allows you to include clients name at the bottom of each page of the report Allows you to print or preview the report Allows you to create a custom title for the report FOCUS Assessment Allows you to select date range of data Allows you to alter pages numbers Allows you to add and remove client notes from the report Allows you to add specific tests to your report 145 Allows you to address the report to the following: Referral, Insurance Company, Attorney, Client, Physician, Employer, Case Manager Allows you to include injury diagram and/or chart on the report Allows you to put the job demand on a separate page Allows you to add or remove page numbers from the report Allows you to include clients name at the bottom of each page of the report Allows you to print or preview the report Focus Assessment With Summary The main difference with this report is that a summary chart of all raw data precedes all of the testing information. Allows you to select date range of data Allows you to alter pages numbers Allows you to add and remove client notes from the report Allows you to add specific non-integrated tests to your report Allows you to address the report to the following: Referral, Insurance Company, Attorney, Client, Physician, Employer, Case Manager Allows you to include injury diagram and/or chart on the report Allows you to put the job demand on a separate page Allows you to add or remove page numbers from the report Allows you to include clients name at the bottom of each page of the report Allows you to print or preview the report Allows you to create a custom title for the report FOCUS Custom Report Allows you to select date range of data Allows you to alter pages numbers Allows you to add and remove client notes from the report Allows you to add specific non-integrated tests to your report Allows you to address the report to the following: Referral, Insurance Company, Attorney, Client, Physician, Employer, Case Manager Allows you to include injury diagram and/or chart on the report Allows you to put the job demand on a separate page Allows you to add or remove page numbers from the report Allows you to include clients name at the bottom of each page of the report Allows you to print or preview the report Allows you to create a custom title for the report FOCUS Progress Report This report is specifically used to track the progress of multiple assessments Allows you to select date range of data Allows you to alter pages numbers Allows you to add and remove client notes from the report Allows you to add specific non-integrated tests to your report Allows you to address the report to the following: Referral, Insurance Company, Attorney, Client, Physician, Employer, Case Manager Allows you to include injury diagram and/or chart on the report Allows you to put the job demand on a separate page Allows you to add or remove page numbers from the report Allows you to include clients name at the bottom of each page of the report Allows you to print or preview the report 146 Allows you to create a custom title for the report FOCUS Summary Report Allows you to select the date range of data Allows you to print preview all raw data obtained for a specific client Individual FOCUS Tests This report includes only specific tests that you select. Allows you to select date range of data Allows you to alter pages numbers Allows you to add and remove client notes from the report Allows you to add specific non-integrated tests to your report Allows you to include injury diagram and/or chart on the report Allows you to put the job demand on a separate page Allows you to add or remove page numbers from the report Allows you to include clients name at the bottom of each page of the report Allows you to print or preview the report 147 The BTE Dual Inclinometers The dual inclinometers are used to evaluate spinal range of motion, which allows for sections to be tested in isolation. You may choose to use a single inclinometer; however, the evaluator must be aware of the value's origin. For example, if you were to assess lumbosacral flexion by placing a single inclinometer on the appropriate landmark and have the client flexing from a standing position, the inclinometer will measure the combined lumbosacral and hip flexion. The single inclinometer can be used to evaluate range of motion of the extremities. The small goniometer feature can be used to evaluate the range of motion of the smaller joints in the hand and foot. The basic premise of the dual inclinometers function is to calculate the amount of rotational displacement of both the sensors and subtract (or add) the two values to arrive at a true range of motion value. Components Connecting Cable Button to start measurement Remote Sensor Master Sensor The dual inclinometers consist of three separate components. First, there are two sensors, referred to as the Master and Remote sensors. There are also two cords that accompany the BTE Dual Inclinometers. A Foot Pedal is also available to start and stop measurements using the Inclinometer. One cord connects the Master and Remote sensors together to allow the calculation of angular displacements. The ends of this cord connect to the ports at the top of each sensor. The other cord is permanently attached to the Master sensor at one end and fits into the BTE Data Acquisition Box at the other end. This cord functions to direct all calculated angles into the ODES diagnostic software system. The BTE Dual Inclinometers are self-calibrating and never need to be manually calibrated. The Dual inclinometers are connected to the Data Acquisition Box by a long cord from the Master sensor, which connects to PORT 12 on the Data Acquisition Box. When using the BTE Dual Inclinometers to measure range of motion, they must always be positioned in the same plane and with the hinges facing each other. The following figures demonstrate correct and incorrect orientation for the Dual Inclinometer placement. 148 The Master sensor has a round black button at its top. When performing a test, this button is pressed at the start and end of a test range. The difference between the two readings is calculated and entered into the ODES diagnostic software system. The Inclinometers will not measure accurately if the hinges are at opposite ends as in this picture. As well the Inclinometers cannot operate in the coronal plane of movement. The BTE Dual Inclinometers can also be used as a Small Goniometer when they are attached to each other. The Dual Inclinometers can be joined to each other as demonstrated in the figure below. The Master and Remote sensors attach at their bottom corners, where they form right angles. When attached, the Dual Inclinometers can be used as a Small Goniometer to measure finger and thumb range of motion. To start measuring using the Inclinometers click on the button on the Master or on the foot pedal. To stop taking the measurement click once again. The Master and Remote sensors of the Dual Inclinometers have internal magnets. As a result, it is strongly suggested that these are NOT placed on computer hard drives, since doing so may result in erasure of data files!
149 Performing Spinal Range of Motion Evaluations Most importantly, in order to do effective range of motion evaluations with consistency, ensure that the same landmarks are used each time. Following is a table of landmarks for spinal evaluations:
Area to be Assessed Cervical Spine Thoracic Spine Lumbosacral Spine Sacral/Hip Flexion/Extension Gross Combined hip and spinal flexion/extension Straight Leg Raise Superior Landmark Occiput T1 T12 Sacral midpoint T1
-- Not Applicable --
Inferior Landmark T1 T12 Sacral Midpoint Lateral Thigh Sacral Midpoint Anterior Lower Leg It is important to have the client wear appropriate clothing that exposes, or provides for, easy access to the landmarks. You may wish to stock such items as cloth or paper client gowns for this reason. Guidelines to Locating The Landmarks Occiput - Locate the Occipital protuberance and place the lowest portion of the Inclinometer directly above it. T1 - This is usually the larger of the two protruding spinous processes at the base of the cervical spine near the height of the shoulders. It is easily identified when the client flexes their cervical spine. T12 - Follow the lower ribs posteriorly to the spinous process. Sacral Midpoint Follow the iliac crests posteriorly to the PSIS, medially into the sacral sulcus and then medially to the midline. While maintaining one hand at the midline at this level, locate the sacrococcygeal joint. Now locate the midpoint between these two landmarks. Lateral Thigh-Locate the Greater Tuberosity and place the tip of the Inclinometer just inferior. Anterior Lower Leg-Locate the Tibial Tubercle and follow the anterior ridge of the tibia inferiorly approximately two-thirds down the lower leg. For Single Unit Use-Place distally to the joint being assessed in the plane of movement. If there is compound joint movement use the Dual Inclinometer method of landmarking. For Dual Unit Use-Place one unit distally and one unit proximally to the joint being assessed, ensuring to not include the other joint(s) that are involved in the compound movement. Align the sensors in the plane of movement. 150
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These are only guidelines and in most cases these landmarks will work without any problems. However, there are clients who do have anomalies from birth or from injury that may make landmarking in this way difficult. In these cases, document any known anomaly discovered in the process of landmarking so that it may be duplicated for accurate comparison. Cervical Range of Motion Flexion With the client in a seated position, manually landmark the T1 spinous process using a washable marker. Align the sensors in the sagittal plane and place one of the Inclinometers on the T1 spinous process. Place the other over the calvarium. Take the initial reading. Have the client maximally flex the head. Take the final reading.Return the client to a neutral position and repeat these steps two more times. Alternatively, the evaluator may place the Inclinometer on top of the head. 151 Extension With the client in a seated position, manually landmark the T1 spinous process using a washable marker. Align the sensors in the sagittal plane and place one of the Inclinometers laterally on the T1 spinous process. Place the other over the calvarium. Take the initial reading. Have the client maximally extend the head. Take the final reading. Return the client to a neutral position and repeat these steps two more times. Lateral Flexion With the client in a seated position, manually landmark the T1 spinous process using a washable marker. Align the sensors in the coronal plane and place one of the Inclinometers laterally on the T1 spinous process. Place the other over the calvarium. Take the initial reading. Have the client maximally laterally flex the head to one side. Take the final reading. Return the client to a neutral position. Repeat these steps two more times to the same side and then repeat 3 times to the opposite side. Alternatively the superior, or upper-most Inclinometer may be placed on the top of the head. 152 Rotation Only with cervical rotation do you use a single Inclinometer. Have the client lie in a supine position (this will stabilize the client's shoulders). The shoulders should be exposed, to allow the evaluator to note excessive shoulder rotation. Align the sensor in the transverse plane and place the Inclinometer at the superior portion of the head. Take the initial reading. Have the client maximally rotate their head to one side. Take the final reading. Return the client to a neutral position. Repeat these steps two more times to the same side and then repeat 3 times to the opposite side. Thoracic Range of Motion Since thoracic is quite dependent on the individual's posture, it is best to have the client use a military type stance. This will minimize the client's kyphosis. 153 Flexion With the client in a seated or standing position, manually landmark the T1 and T12 spinous processes using a washable marker. Align the sensors in the sagittal plane and place one of the Inclinometers on the T1 spinous process. Place the other at the T12 Spinous Process. Take the initial reading. Have the client maximally flex the thoracic spine. Take the final reading. Return the client to a neutral position and repeat these steps two more times. Minimal Kyphosis With the client in a seated or standing position, manually landmark the T1 and T12 spinous processes using a washable marker. Align the sensors in the sagittal plane. Take the initial reading by zeroing the Inclinometers against a true vertical surface such as a wall, then place one of the Inclinometers on the T1 spinous process. Place the other on the T12 Spinous Process. Take the final reading. Return the client to a neutral position and repeat these steps two more times. Rotation With the client in a standing position, instruct them to forward flex until the thoracic spine is in as horizontal a position as possible. Manually landmark the T1 and T12 spinous processes using a washable marker. Aligning the sensors in the axial and vertical planes, place one of the Inclinometers on the T1 spinous process and place the other at the T12 Spinous Process. Take the initial reading. Have the client maximally rotate the thoracic spine to one side. Take the final reading. Return the client to a neutral position. Repeat these steps two more times to the same side and then repeat 3 times to the opposite side. 154 Lumbosacral Range of Motion Flexion With the client in a standing position, manually landmark the T12 spinous process using a washable marker. Align the sensors in the sagittal plane and place one of the Inclinometers on the T12 spinous process. Place the other at S1 spinous process. Take the initial reading. Have the client maximally flex the lumbar spine. Take the final reading. Return the client to a neutral position and repeat these steps two more times. Extension With the client in a standing position, manually landmark the T12 spinous process using a washable marker. Align the sensors in the sagittal plane and place one of the Inclinometers on the T12 spinous process. Place the other at S1 spinous process. Take the initial reading. Have the client maximally 155 extend the lumbar spine. Take the final reading. Return the client to a neutral position and repeat these steps two more times. Lateral Flexion With the client in a standing position, manually landmark the T12 spinous process using a washable marker. Aligning the sensors in the coronal plane, place one of the Inclinometers on the T12 spinous process and place the other at the sacral midpoint. Take the initial reading. Have the client maximally laterally flex the lumbar spine to one side. Take the final reading. Return the client to a neutral position. Repeat these steps two more times to the same side and then repeat 3 times to the opposite side. Straight Leg Raise Have the client lie in a supine position. Aligning the Master sensor in the sagittal plane, place it along the anterior lower third of the tibia. Take the initial reading. Perform a straight leg raise. Take the final reading at the end range. Return the client's leg to the resting position and repeat these steps two more times. 156 The straight leg raise on the tightest side should be within 10 degrees of the total hip motion (i.e. hip flexion + hip extension). Determining the Degree of Ankylosis When the degree of ankylosis needs to be documented, the steps listed above must be slightly adjusted. The first reading should be taken against a wall or on a tabletop. Next, place the client in as close to a neutral position as possible. Place the two Inclinometers at the appropriate landmarks. Then take the second reading. This is the degree of ankylosis. Performing Extremity Range of Motion Evaluations While ideally the integrated goniometer would be used for the larger extremity joints, the dual or single Inclinometer method may also be used to assess them. Below are some examples that may be applied to any of the larger extremity joints. Shoulder Flexion With the client in a standing position, manually landmark the lateral upper arm. Using only the Master sensor, align it in the sagittal plane. Click the button on the Master sensor to take the initial reading. Have the client maximally flex the shoulder. Click the button on the Master sensor a second time to take the final reading. ODES will automatically document the final true range. Return the client's shoulder to the neutral position. Repeat these steps two more times on the same side and then repeat 3 times for the other side. 157 Elbow Flexion With the client in a standing position, manually landmark the lateral forearm with the hand in a supinated position. Using only the Master sensor, align it in the sagittal plane. Click the button on the Master sensor to take the initial reading. Have the client maximally flex the elbow. Click the button on the Master sensor a second time to take the final reading. ODES will automatically document the final true range. Return the client's elbow to the neutral position. Repeat these steps two more times on the same side and then repeat 3 times for the other side. Wrist Pronation With the client in a standing position, manually landmark the distal radial head with the wrist in a neutral position. Using only the Master sensor, align it in the coronal plane. Click the button on the Master sensor to take the initial reading. Have the client maximally pronate the wrist. Click the button on the Master sensor a second time to take the final reading. ODES will automatically document the final true range. Return the client's wrist to the neutral position. Repeat these steps two more times on the same side and then repeat 3 times for the other side. 158 Using the Small Goniometer Feature When assessing motion in the smaller joints of the digits in the hand or foot, the Dual Inclinometers may be interlocked to form a small goniometer. Once interlocked tight together they form a perfectly level and zeroed surface. As with the landmarking instructions above, place the goniometer so that one Inclinometer is on the proximal side and the other on the distal side of the joint being assessed. Digit Ankylosis If there is joint ankylosis that is to be documented, the following steps are required to obtain the measurement. The first reading should be taken with the goniometer interlocked and placed against a wall or on a tabletop. Next place the client's joint in as close to a neutral position as possible. Place the inclinometer appropriately, then take the second reading. This is the degree of ankylosis. Digit Range of Motion Evaluation To document small digit range of motion, manually landmark the joint being assessed proximally and distally while in a neutral position, with the client in a seated or lying position. Align the sensors in the plane of movement (generally sagittal) and position the Inclinometers. Click the button on the master sensor to take the initial reading. Have the client maximally flex (or extend / abduct / adduct / etc. as the case requires) the digit. Click the button on the Master sensor a second time to take the final reading. ODES will automatically document the final true range. Return the client's digit to the neutral position. Repeat these steps two more times on the same side and then repeat 3 times for the other side. 159 The BTE Goniometer The goniometer calculates the amount of displacement in degrees to arrive at a true range of motion value. The goniometer is used to evaluate extremity range of motion. The large goniometer setup may also be used to evaluate range of motion of the large joints, such as the knee, hip and shoulder. The small goniometer setup can be used to evaluate the range of motion of the smaller joints in the hand and foot. When performing impairment evaluations, the American Medical Association states that the goniometer is necessary for evaluating the extremities. Components of the Goniometer The goniometer includes the long and short arms as well as a foot pedal. The BTE Goniometer is self-calibrating and never needs to be manually calibrated. Connecting the Goniometer The goniometer is connected to the Data Acquisition Device via PORT 12G. Once the goniometer is connected properly, the red light on the base of the device will light up. See below. 160 To connect the Foot Pedal, locate the FP port on the back of your Data Acquisition Device. To utilize the Foot Pedal, attach its cord to the FP port. Connecting and Disconnecting the Goniometer Arms:
The small and large goniometer arms can be easily removed from the device. Simply hold the goniometer in one hand and gently twist the arm off of the device. Once removed, the goniometer will appear as follows:
Performing Range of Motion Tests The following is an example of how to perform a Pre-Programmed Range of Motion Protocol 161 From the ODES home page, click on ROM Test. This will bring you to the Range of Motion Test page. From here, you have access to all of the pre-programmed tests. You can add tests to clients, create new custom range of motion tests, edit tests and delete tests. Allows you to return to the main menu Allows you to add and remove protocols from your client Once a protocol has been selected, you can click here to perform the test Available protocols are listed here Allows you to move protocols, which arent being used, into a temporary folder 162 Once you have chosen a test, the following testing page appears:
Shows the test name and device being utilized Device being used to record readings Shows Test Number Lists protocol instructons Test results are recorded in these fields If the device that you wish to use is not connected properly, or if the DAC box is not communicating with your computer, you will not be able to perform the test. If this is the case, a red X will appear beside the name of the tool you wish to utilize and the picture of the tool will appear as a keyboard. If this happens, please see the trouble shooting section of this manual. If the wrong tool appears in the upper left-hand corner of the screen (for example, the dual inclinometers instead of the goniometer), double click on the name of the tool. This allows you to alternate between the two range of motion tools. 163 Double click here to switch tools Customizing the Goniometer Tests In addition to alternating between testing tools, the range of motion testing screen allows you to test in an AMA or COV format, utilize 1 or 3 trials for each movement, and it allows you to include additional initial settings that you may wish to note. Changing From AMA to COV Format In order to change from AMA to COV format, you must first go into the Range of Motion Protocols page. Click ROM Test from the ODES main menu. Highlight the test you wish to modify and then click Edit. 164 The following page will appear:
Shows which tool is set as the default To switch between COV and AMA, use the Set guidelines radio buttons. The American Medical Association (AMA) guidelines indicate a range of motion test is valid if the measurement is within 5 165 degrees or within 10% of each other. Coefficient of Variance (COV) is a statistical measurement. The current research indicates that a COV 15% or greater is an indication of invalid effort. You can also modify the number of trials from this page. Just select how many trials you wish to have (1 or 3-6). Entering In Additional Settings:
In order to modify the initial settings, open the Edit Test page for the test that you wish to modify. This can be done by going to ROM Test | Edit Test from the ODES main menu. Enter the name of the setting in one of the white fields (as shown below) and the setting will now appear on your testing page for that test. Appears as an option on your testing screen 166 Performing a Range of Motion Test with the Goniometer From the ODES main menu, you must first select or create a client. You will then be able to click ROM Test to enter the Range of Motion Protocols page. Highlight the test that you wish to perform (in this case, right ankle range of motion has been selected). In order to add the protocol to your client, click Add to Client. You will now see youre the selected test appear in the Test Assigned to Client box. To perform this test you may either double-click on the protocol name, or highlight it and click Perform Test. The testing page for the selected protocol will be displayed. In order to begin a test, make sure that the correct tool is listed in the upper left-hand corner of the testing page (underneath the protocol name). In order to perform the test make sure that your cursor is flashing in the space beside Trial #1. 167 You may now begin testing with your goniometer. Press the red button located on the bottom of the device or depress the foot pedal to begin and end each trial. The computer will prompt you during each reading. Range of Motion Protocols The following are the protocols for range of movement as outlined in the ODES software. Ankle PLANTARFLEXION: Client is sitting with the leg to be measured at right angles to the thigh and the foot at right angles to the leg. Motions of the ankles should be measured with the knee at 45 degree flexion in order to relax the heel cord. The goniometers pivot is centered over the outside of the ankle, with the stationary arm parallel to the tibia. Instruct the client to move their foot down (away from their body) as far as they can. Record the maximum flexion (plantar flexion) angle from neutral. FLEXION CONTRACTURE: Flexion contracture is a measure of limited ROM due to muscle contracture. If the client is capable of both plantar flexion and extension (dorsiflexion), do not measure flexion contracture. Otherwise, client should be sitting, with the leg to be measured at right angles to the thigh and the foot at right angles to the leg. Instruct the client to relax the ankle so that it is in its own natural neutral position. The goniometers pivot is centered over the outside of the ankle, with the stationary arm parallel to the tibia. Record the flexion contracture angle. DORSIFLEXION: Client is sitting with the leg to be measured at right angles to the thigh and the foot at right angles to the leg. Motions of the ankles should be measured with the knee in flexion in order to relax the heel cord. The goniometers pivot is centered over the outside of the ankle, with the stationary 168 arm parallel to the tibia. Instruct the client to pull their foot back, towards their body, as far as they can. Record the maximum extension (dorsiflexion) angle from neutral. INVERSION: The client should be seated, with the bottom of the foot to be measured parallel to the floor.
(Note: If the foot cannot be placed in this 0-degree neutral position, consider rating ankylosis instead of range of motion). The goniometers pivot is centered over the back of the heel, with the stationary arm parallel to the tibia. Instruct the client to invert the foot as far as they can. Record the maximum inversion angle. EVERSION: The client should be seated, with the bottom of the foot to be measured parallel to the floor.
(Note: If the foot cannot be placed in this 0-degree neutral position, consider rating ankylosis instead of range of motion). The goniometers pivot is centered over the back of the heel, with the stationary arm parallel to the tibia. Instruct the client to evert the foot as far as they can. Record the maximum eversion angle. Knee FLEXION: The client should be lying supine with the goniometer next to the knee joint; one arm of the goniometer is parallel to the lower leg, and the other is parallel to the femur. Record the maximum flexion angle from the starting point. FLEXION CONTRACTURE: Measuring flexion contracture is similar to measuring ankylosis of the knee in flexion/extension. The client should be lying supine with the goniometer next to the knee joint; one arm of the goniometer is parallel to the lower leg, and the other is parallel to the femur. Record any deviation from 0-degrees. EXTENSION: The client should be lying supine with the goniometer next to the knee joint; one arm of the goniometer is parallel to the lower leg and the other is parallel to the femur. Record the maximum extension angle from the starting point. Hip FLEXION: The client is supine on a firm, flat surface with the opposite joint (the hip that is not being measured) held in flexion until the lumbar spine is flat. (Note: If hip flexion contracture is present, do not measure it at this time.) Place the goniometers pivot at the outside of the hip to be measured. One arm of the goniometer is parallel to the opposite flexed leg and the other parallel to the femur. The evaluator should place one hand on the iliac crest to note the point at which the pelvis begins to rotate. Record the maximum flexion angle. EXTENSION: The client is prone on a firm, flat surface. Place the goniometers pivot at the outside of the hip to be measured. One arm of the goniometer is parallel to the opposite extended leg and the other is parallel to the femur of the leg being measured. Record the maximum extension angle. FLEXION CONTRACTURE: To measure loss of extension of one hip, the contralateral hip if flexed until the lumbar spine is flat on the examining table, as determined by the evaluators hand, which is placed between the lumbar spine and table surface. The thigh to be measured should rest flat on the table; and hip flexion is recorded as flexion contracture. (Note: If the client can extend the hip back to or beyond the neutral position, do not record flexion contracture.) INTERNAL ROTATION: The client should be lying prone, the knee flexed 90-degrees, with the thigh perpendicular to the transverse line across the anterior superior spines of the pelvis. The stationary arm of the goniometer is parallel to the flat surface, and the other is along the tibia. Instruct the client to rotate the leg away from the midline of the trunk with the thigh as the axis of rotation, thus producing inward rotation of the hip. Record the maximum internal rotation angle. 169 EXTERNAL ROTATION: The client should be lying supine, the knee flexed 90-degrees, with the thigh perpendicular to the transverse line across the anterior superior spines of the pelvis. The stationary arm of the goniometer is parallel to the flat surface, and the other is along the tibia. Instruct the client to rotate the leg toward the midline of the trunk with the thigh as the axis of rotation, thus producing outward rotation of the hip. Record the maximum external rotation angle. ABDUCTION: (Note: If the client has limited motion due to abduction contracture, do not measure abduction.) The client should be lying supine on a flat surface with the leg to be measured extended at a right angle to a transverse line across the anterior superior spines of the pelvis. The contralateral hip should be passively held in flexion. The outward motion of the extremity is measured from the starting position. Record the maximum abduction angle. ADDUCTION: (Note: If the client has limited motion due to adduction contracture, do not measure adduction.) The client should be lying supine on a flat surface with the leg to be measured extended at a right angle to a transverse line across the anterior superior spines of the pelvis. The contralateral hip should be passively held in flexion. In measuring adduction, the evaluator should ensure adequate elevation of the opposite extremity to allow the leg to pass under it. ABDUCTION CONTRACTURE: The client should be lying supine on a flat surface with the leg to be measured extended at a right angle to a transverse line across the anterior superior spines of the pelvis. The contralateral hip should be passively held in flexion. The outward motion of the extremity is measured from the starting position. Record the smallest abduction contracture angle. Great Toe MP EXTENSION: The client is in a seated position. The knee is flexed to 45-degrees and the ankle and Metatarsophalangeal (MTP) joint are in the neutral position. The small goniometer is placed under the MTP joint, and its angle is read as a baseline. The client extends (dorsiflexes) the toe maximally, and the angle subtending the maximum arc of motion is read. Subtract the baseline angle and record the angle of MP extension. MP FLEXION: The client is in a seated position. The knee is flexed to 45-degrees and the foot and Metatarsophalangeal (MTP) joint are in the neutral position. The small goniometer is placed over the MTP joint, and its angle is read as a baseline. The client flexes (plantarflexes) the toe maximally, and the angle subtending the maximum arc of motion is read. Subtract the baseline angle and record the angle of MP flexion. IP FLEXION: The client is in a seated position. The knee is flexed to 45-degrees and the ankle and Interphalangeal (IP) joint are in the neutral position. The small goniometer is placed over the IP joint, and its angle is read as a baseline. The client flexes (plantarflexes) the toe maximally, and the angle subtending the maximum arc of motion is read. Subtract the baseline angle and record the angle of IP flexion. Lesser 2 Toe MP FLEXION: The client is in a seated position. The knee is flexed to 45-degrees and the ankle and Metatarsophalangeal (MTP) joint are in the neutral position. The small goniometer is placed over the MTP joint, and its angle is read as a baseline. The client flexes (plantarflexes) the toe maximally, and the angle subtending the maximum arc of motion is read. Subtract the baseline angle and record the angle of MP flexion. MP EXTENSION: The client is in a seated position. The knee is flexed to 45-degrees and the ankle and Metatarsophalangeal (MTP) joint are in the neutral position. The small goniometer is placed under the 170 MTP joint, and its angle is read as a baseline. The client extends (dorsiflexes) the toe maximally, and the angle subtending the maximum arc of motion is read. Subtract the baseline angle and record the angle of MP extension. IP FLEXION: The client is in a seated position. The knee is flexed to 45-degrees and the ankle and Metatarsophalangeal (MTP) joint are in the neutral position. The small goniometer is placed over the MTP joint, and its angle is read as a baseline. The client flexes (plantarflexes) the toe maximally, and the angle subtending the maximum arc of motion is read. Subtract the baseline angle and record the angle of MP flexion. IP EXTENSION: The client is in a seated position. The knee is flexed to 45-degrees and the ankle and Metatarsophalangeal (MTP) joint are in the neutral position. The small goniometer is placed under the MTP joint, and its angle is read as a baseline. The client extends (dorsiflexes) the toe maximally, and the angle subtending the maximum arc of motion is read. Subtract the baseline angle and record the angle of MP extension. Toe Lesser 4 MP FLEXION: The client is in a seated position. The knee is flexed to 45-degrees and the ankle and Metatarsophalangeal (MTP) joint are in the neutral position. The small goniometer is placed over the MTP joint, and its angle is read as a baseline. The client flexes (plantarflexes) the toe maximally, and the angle subtending the maximum arc of motion is read. Subtract the baseline angle and record the angle of MP flexion. MP EXTENSION: The client is in a seated position. The knee is flexed to 45-degrees and the ankle and Metatarsophalangeal (MTP) joint are in the neutral position. The small goniometer is placed under the MTP joint, and its angle is read as a baseline. The client extends (dorsiflexes) the toe maximally, and the angle subtending the maximum arc of motion is read. Subtract the baseline angle and record the angle of MP extension. IP Extension: The client is in a seated position. The knee is flexed to 45-degrees and the ankle and Metatarsophalangeal (MTP) joint are in the neutral position. The goniometer is placed under the MTP joint, and its angle is read as a baseline. The client extends (dorsiflexes) the toe maximally, and the angle subtending the maximum arc of motion is read. Subtract the baseline angle and record the angle of MP extension. Toe Lesser 5 MP FLEXION: The client is in a seated position. The knee is flexed to 45-degrees and the ankle and Metatarsophalangeal (MTP) joint are in the neutral position. The small goniometer is placed over the MTP joint, and its angle is read as a baseline. The client flexes (plantarflexes) the toe maximally, and the angle subtending the maximum arc of motion is read. Subtract the baseline angle and record the angle of MP flexion. MP EXTENSTION: The client is in a seated position. The knee is flexed to 45-degrees and the ankle and Metatarsophalangeal (MTP) joint are in the neutral position. The goniometer is placed under the MTP joint, and its angle is read as a baseline. The client extends (dorsiflexes) the toe maximally, and the angle subtending the maximum arc of motion is read. Subtract the baseline angle and record the angle of MP extension. Shoulder In assessing motion, the examiner should first observe what an individual can and cannot do by asking them to move each joint of the extremity, from the shoulder down, through its full range of motion. Both 171 extremities should be compared. Individual joints are then evaluated separately. In determining the range of motion of individual joints, the examiner must evaluate both the active and passive motion. FLEXION: The client should be standing erect, with the arm to be measured at the side of the body. Place the goniometers pivot on the outside of the shoulder joint to be measured with the stationary arm perpendicular to the ground. The movable arm will remain parallel to the humerus. Instruct the client to move the arm in a forward upward motion in the anterior sagittal plane of the body. Record the maximum forward flexion angle. EXTENSION: The client should be standing erect, with the arm to be measured at the side of the body. Place the goniometers pivot on the outside of the shoulder joint to be measured with the stationary arm perpendicular to the ground. The movable arm will remain parallel to the humerus. Instruct the client to move the arm in an upward motion in the posterior sagittal plane of the body. Record the maximum backward extension angle. ABDUCTION: The client should be standing erect, with the arm to be measured at the side of the body, palm in. Place the goniometers pivot in front of the shoulder joint to be measured with the stationary arm perpendicular to the ground.; The movable arm will remain parallel to the humerus. Instruct the client to move the arm in an upward motion away from the side of the body in the coronal plane as far as possible. Record the maximum abduction angle. ADDUCTION: The client should be standing erect, with the arm to be measured at the side of the body, palm in. Place the goniometers pivot in front of the shoulder joint to be measured with the stationary arm perpendicular to the ground. The movable arm will remain parallel to the humerus. Instruct the client to move the arm toward the midline of the body, and beyond it in an upward plane as far as possible. Record the maximum adduction angle. INTERNAL ROTATION: The client should be supine on a flat surface, with the arm to be measured in 90-
degrees of abduction, the elbow in 90-degrees of flexion, and the forearm in neutral. Place the goniometers pivot at approximately the lateral epicondyle with the stationary arm perpendicular to the floor. The movable arm will remain in alignment with the ulna. Instruct the client to move the arm as far as possible in a rotational orientation so that the palm goes down, toward the floor. Record the maximum internal rotation angle. EXTERNAL ROTATION: The client should be supine on a flat surface, with the arm to be measured in 90-degrees of abduction, the elbow in 90-degrees of flexion, and the forearm in neutral. Place the goniometers pivot at approximately the lateral epicondyle with the stationary arm perpendicular to the floor. The movable arm will remain in alignment with the ulna. Instruct the client to move the arm as far as possible in a rotational orientation so that the back of the hand goes back, toward the floor. Record the maximum external rotation angle. Elbow In assessing motion, the examiner should first observe what an individual can and cannot do by asking them to move each joint of the extremity, from the shoulder down, through its full range of motion. Both extremities should be compared. Individual joints are then evaluated separately. In determining the range of motion of individual joints, the examiner must evaluate both the active and passive motion. FLEXION: The client should be standing with the arm to be measured flexed at the elbow in a forearm supination, and 90-degrees of shoulder forward flexion. The goniometers pivot should be centrally placed lateral to the lateral epicondyle with the stationary arm in alignment to the lateral aspect/midline of the humerus, and the movable arm in alignment to the lateral aspect/midline of the radius. Record the maximum flexion angle. 172 EXTENSION: The client should be standing with the arm to be measured extended at the elbow in forearm supination, and 90-degrees of shoulder forward flexion. The goniometers pivot should be centrally placed lateral to the lateral epicondyle with the stationary arm in alignment to the lateral aspect/midline of the humerus, and the movable arm in alignment to the lateral aspect/midline of the radius. Record the maximum extension angle up to the 0-degree/neutral position. SUPINATION: The client should be sitting on a flat surface, or standing with the arm to be measured in midposition with the palm vertical in relation to the floor (thumbs up position), with the upper arm close to the side of the body, and the elbow flexed at 90-degrees. The goniometers pivot should be placed medial to the ulnar styloid process. The stationary arm of the goniometer should be parallel to the anterior midline of the humerus, and the movable arm across the volar aspect of the forearm, just proximal to the styloid processes. Instruct the client to turn palm up as far as possible. Record the maximum supination angle. PRONATION: The client should be sitting on a flat surface, or standing with the forearm to be measured in midposition with the palm vertical in relation to the floor (thumbs up position), with the upper arm close to the side of the body, and the elbow flexed at 90-degrees. The goniometers pivot should be centrally placed lateral to the ulnar styloid process. The stationary arm of the goniometer should be parallel to the anterior midline of the humerus, and the movable arm across the dorsal aspect of the forearm just proximal to the styloid processes of the radius and ulna. Instruct the client to turn palm down as far as possible. Record the maximum pronation angle. Wrist In assessing motion, the examiner should first observe what an individual can and cannot do by asking them to move each joint of the extremity, from the shoulder down, through its full range of motion. Both extremities should be compared. Individual joints are then evaluated separately. Similarly, movements of the digits are first evaluated as a unit by having the client make a complete fist, and then individually by extending the digits fully over several repetitions. In determining the range of motion of individual joints, the examiner must evaluate both the active and passive motion. FLEXION: The client should start with the elbow flexed, the forearm positioned in neutral pronation/supination, and the wrist to be measured in neutral flexion/extension and radioulnar deviation. The fingers should be relaxed to avoid active finger flexion. The goniometers pivot is placed over the dorsal surface of the wrist joint using the capitate as a reference. Align the stationary arm with the dorsal midline of the forearm using the lateral epicondyle of the humerus as a reference. Align the movable arm in between the dorsal heads of the index and middle metacarpals. Record the maximum wrist flexion angle. EXTENSION: The client should start with the elbow flexed, the forearm positioned in neutral pronation, and the wrist to be measured in neutral flexion/extension and radioulnar deviation. The goniometers pivot is placed over the volar surface of the wrist joint at the level of the capitate with the stationary arm in alignment with the volar midline of the forearm, and the movable arm in between the volar heads of the index and middle metacarpals. Record the maximum wrist extension angle. RADIAL DEVIATION: The client should start with the hand to be measured in forearm pronation and the wrist in neutral flexion/extension and radioulnar deviation. The goniometers pivot is placed over the middle dorsal aspect of the wrist in line with the capitate. Align the stationary arm with the dorsal midline of the forearm using the lateral epicondyle of the humerus for a reference. Align the moving arm with the dorsal midline of the third metacarpal. Instruct the client to move the hand towards the thumb in the same plane as the table. Record the maximum radial deviation angle. ULNAR DEVIATION: The client should start with the hand to be measured in forearm pronation and the wrist in neutral flexion/extension and radioulnar deviation. The goniometers pivot is placed over the middle dorsal aspect of the wrist in line with the capitate. Align the stationary arm with the dorsal midline 173 of the forearm using the lateral epicondyle of the humerus for a reference. Align the moving arm with the dorsal midline of the third metacarpal. Instruct the client to move the hand towards the little finger in the same plane as the table. Record the maximum ulnar deviation angle. Thumb In assessing motion, the examiner should first observe what an individual can and cannot do by asking them to move each joint of the extremity, from the shoulder down, through its full range of motion. Both extremities should be compared. Individual joints are then evaluated separately. Similarly, movements of the digits are first evaluated as a unit by having the client make a complete fist, and then individually by extending the digits fully over several repetitions. In determining the range of motion of individual joints, the examiner must evaluate both the active and passive motion. MP EXTENSION: The clients hand should be flat on a table with the volar head of the metacarpal supported at the tables edge, and neutral wrist flexion/extension and radioulnar deviation. Place the goniometers pivot over the dorsal head of the metacarpophalangeal (MPJ) joint with the stationary arm in alignment with the dorsal midline of the metacarpal and the movable arm in alignment with the dorsal midline of the proximal phalanx. Instruct the client to extend, or straighten the MPJ as far as possible. Record the maximum MP extension angle. MP FLEXION: The clients hand should be flat on a table with the volar head of the metacarpal supported at the tables edge, neutral wrist flexion/extension and radioulnar deviation. Place the goniometers pivot over the dorsal head of the metacarpophalangeal (MPJ) joint with the stationary arm in alignment with the dorsal midline of the metacarpal and the movable arm in alignment with the dorsal midline of the proximal phalanx. Instruct the client to flex the MPJ as far as possible. Record the maximum MP flexion angle. PIP EXTENSION: The clients forearm should be pronated, the wrist in neutral flexion/extension and radioulnar deviation, and the metacarpophalangeal joint in 0-degrees of extension. If possible, place the hand to be measured flat on a table with the volar head of the proximal phalanx supported at the tables edge. Place the goniometers pivot over the dorsal head of the proximal interphalangeal joint (PIP) with the stationary arm in alignment with the proximal phalanx and the movable arm in alignment with the middle phalanx. Instruct the client to extend, or straighten the PIP joint as far as possible. Record the maximum PIP extension angle. PIP FLEXION: The clients forearm should be pronated, the wrist in neutral flexion/extension and radioulnar deviation, and the metacarpophalangeal joint in 0-degrees of extension. If possible, place the hand to be measured flat on a table with the volar head of the proximal phalanx supported at the tables edge. Place the goniometers pivot over the dorsal head of the proximal interphalangeal joint (PIP) with the stationary arm in alignment with the dorsal midline of the proximal phalanx and the movable arm in alignment with the dorsal midline of the middle phalanx. Instruct the client to flex the PIP as far as possible. Record the maximum PIP flexion angle. DIP EXTENSION: The clients forearm should be pronated or in neutral pronation/supination, and the wrist in neutral flexion/extension and radioulnar deviation. The metacarpophalangeal joint is positioned in 0-degrees of extension and the proximal interphalangeal joint in approximately 70-90 degrees of flexion. Place the goniometers pivot over the dorsal head of the distal interphalangeal joint (DIP) with the stationary arm in alignment with the dorsal midline of the middle phalanx and the movable arm in alignment with the distal phalanx. Instruct the client to extend, or straighten the DIP joint as far as possible. Record the maximum DIP extension angle. DIP FLEXION: The clients forearm should be pronated or in neutral pronation/supination, and the wrist in neutral flexion/extension and radioulnar deviation. The metacarpophalangeal joint is positioned in 0-
degrees of extension and the proximal interphalangeal joint in approximately 70-90 degrees of flexion. Place the goniometers pivot over the dorsal head of the distal interphalangeal joint (DIP) with the 174 stationary arm in alignment with the dorsal midline of the middle phalanx and the movable arm in alignment with the distal phalanx. Instruct the client to extend, or straighten the DIP joint as far as possible. Record the maximum DIP extension angle. Finger Index 2 In assessing motion, the examiner should first observe what an individual can and cannot do by asking them to move each joint of the extremity, from the shoulder down, through its full range of motion. Both extremities should be compared. Individual joints are then evaluated separately. Similarly, movements of the digits are first evaluated as a unit by having the client make a complete fist, and then individually by extending the digits fully over several repetitions. In determining the range of motion of individual joints, the examiner must evaluate both the active and passive motion. EXTENSION: The clients hand should be flat on a table with the volar head of the metacarpal supported at the tables edge, and neutral wrist flexion/extension and radioulnar deviation. Place the goniometers pivot over the dorsal head of the metacarpophalangeal (MPJ) joint with the stationary arm in alignment with the dorsal midline of the metacarpal and the movable arm in alignment with the dorsal midline of the proximal phalanx. Instruct the client to extend, or straighten the MPJ as far as possible. Record the maximum MP extension angle. FLEXION: The clients hand should be flat on a table with the volar head of the metacarpal supported at the tables edge, and neutral wrist flexion/extension and radioulnar deviation. Place the goniometers pivot over the dorsal head of the metacarpophalangeal (MPJ) joint with the stationary arm in alignment with the dorsal midline of the metacarpal and the movable arm in alignment with the dorsal midline of the proximal phalanx. Instruct the client to flex the MPJ as far as possible. Record the maximum MP flexion angle. PIP EXTENSION: The clients forearm should be pronated, the wrist in neutral flexion/extension and radioulnar deviation, and the metacarpophalangeal joint in 0-degrees of extension. If possible, place the hand to be measured flat on a table with the volar head of the proximal phalanx supported at the tables edge. Place the goniometers pivot over the dorsal head of the proximal interphalangeal joint (PIP) with the stationary arm in alignment with the proximal phalanx and the movable arm in alignment with the middle phalanx. Instruct the client to extend, or straighten the PIP joint as far as possible. Record the maximum PIP extension angle. PIP FLEXION: The clients forearm should be pronated, the wrist in neutral flexion/extension and radioulnar deviation, and the metacarpophalangeal joint in 0-degrees of extension. If possible, place the hand to be measured flat on a table with the volar head of the proximal phalanx supported at the tables edge. Place the goniometers pivot over the dorsal head of the proximal interphalangeal joint (PIP) with the stationary arm in alignment with the dorsal midline of the proximal phalanx and the movable arm in alignment with the dorsal midline of the middle phalanx. Instruct the client to flex the PIP as far as possible. Record the maximum PIP flexion angle. DIP EXTENSION: The clients forearm should be pronated or in neutral pronation/supination, and the wrist in neutral flexion/extension and radioulnar deviation. The metacarpophalangeal joint is positioned in 0-degrees of extension and the proximal interphalangeal joint in approximately 70-90 degrees of flexion. Place the goniometers pivot over the dorsal head of the distal interphalangeal joint (DIP) with the stationary arm in alignment with the dorsal midline of the middle phalanx and the movable arm in alignment with the distal phalanx. Instruct the client to extend, or straighten the DIP joint as far as possible. Record the maximum DIP extension angle. DIP FLEXION: The clients forearm should be pronated or in neutral pronation/supination, and the wrist in neutral flexion/extension and radioulnar deviation. The metacarpophalangeal joint is positioned in 0-
degrees of extension and the proximal interphalangeal joint in approximately 70-90 degrees of flexion. Place the goniometers pivot over the dorsal head of the distal interphalangeal joint (DIP) with the 175 stationary arm in alignment with the dorsal midline of the middle phalanx and the movable arm in alignment with the distal phalanx. Instruct the client to flex the DIP joint as far as possible. Record the maximum DIP flexion angle. Finger Middle 3 In assessing motion, the examiner should first observe what an individual can and cannot do by asking them to move each joint of the extremity, from the shoulder down, through its full range of motion. Both extremities should be compared. Individual joints are then evaluated separately. Similarly, movements of the digits are first evaluated as a unit by having the client make a complete fist, and then individually by extending the digits fully over several repetitions. In determining the range of motion of individual joints, the examiner must evaluate both the active and passive motion. EXTENSION: The clients hand should be flat on a table with the volar head of the metacarpal supported at the tables edge, and neutral wrist flexion/extension and radioulnar deviation. Place the goniometers pivot over the dorsal head of the metacarpophalangeal (MPJ) joint with the stationary arm in alignment with the dorsal midline of the metacarpal and the movable arm in alignment with the dorsal midline of the proximal phalanx. Instruct the client to extend, or straighten the MPJ as far as possible. Record the maximum MP extension angle. MP FLEXION: The clients hand should be flat on a table with the volar head of the metacarpal supported at the tables edge, and neutral wrist flexion/extension and radioulnar deviation. Place the goniometers pivot over the dorsal head of the metacarpophalangeal (MPJ) joint with the stationary arm in alignment with the dorsal midline of the metacarpal and the movable arm in alignment with the dorsal midline of the proximal phalanx. Instruct the client to flex the MPJ as far as possible. Record the maximum MP flexion angle. PIP EXTENSION: The clients forearm should be pronated, the wrist in neutral flexion/extension and radioulnar deviation, and the metacarpophalangeal joint in 0-degrees of extension. If possible, place the hand to be measured flat on a table with the volar head of the proximal phalanx supported at the tables edge. Place the goniometers pivot over the dorsal head of the proximal interphalangeal joint (PIP) with the stationary arm in alignment with the proximal phalanx and the movable arm in alignment with the middle phalanx. Instruct the client to extend, or straighten the PIP joint as far as possible. Record the maximum PIP extension angle. PIP FLEXION: The clients forearm should be pronated, the wrist in neutral flexion/extension and radioulnar deviation, and the metacarpophalangeal joint in 0-degrees of extension. If possible, place the hand to be measured flat on a table with the volar head of the proximal phalanx supported at the tables edge. Place the goniometers pivot over the dorsal head of the proximal interphalangeal joint (PIP) with the stationary arm in alignment with the dorsal midline of the proximal phalanx and the movable arm in alignment with the dorsal midline of the middle phalanx. Instruct the client to flex the PIP as far as possible. Record the maximum PIP flexion angle. DIP EXTENSION: The clients forearm should be pronated or in neutral pronation/supination, and the wrist in neutral flexion/extension and radioulnar deviation. The metacarpophalangeal joint is positioned in 0-degrees of extension and the proximal interphalangeal joint in approximately 70-90 degrees of flexion. Place the goniometers pivot over the dorsal head of the distal interphalangeal joint (DIP) with the stationary arm in alignment with the dorsal midline of the middle phalanx and the movable arm in alignment with the distal phalanx. Instruct the client to extend, or straighten the DIP joint as far as possible. Record the maximum DIP extension angle. DIP FLEXION: The clients forearm should be pronated or in neutral pronation/supination, and the wrist in neutral flexion/extension and radioulnar deviation. The metacarpophalangeal joint is positioned in 0-
degrees of extension and the proximal interphalangeal joint in approximately 70-90 degrees of flexion. 176 Place the goniometers pivot over the dorsal head of the distal interphalangeal joint (DIP) with the stationary arm in alignment with the dorsal midline of the middle phalanx and the movable arm in alignment with the distal phalanx. Instruct the client to extend, or straighten the DIP joint as far as possible. Record the maximum DIP extension angle. Finger Ring 4 In assessing motion, the examiner should first observe what an individual can and cannot do by asking them to move each joint of the extremity, from the shoulder down, through its full range of motion. Both extremities should be compared. Individual joints are then evaluated separately. Similarly, movements of the digits are first evaluated as a unit by having the client make a complete fist, and then individually by extending the digits fully over several repetitions. In determining the range of motion of individual joints, the examiner must evaluate both the active and passive motion. EXTENSION: The clients hand should be flat on a table with the volar head of the metacarpal supported at the tables edge, and neutral wrist flexion/extension and radioulnar deviation. Place the goniometers pivot over the dorsal head of the metacarpophalangeal (MPJ) joint with the stationary arm in alignment with the dorsal midline of the metacarpal and the movable arm in alignment with the dorsal midline of the proximal phalanx. Instruct the client to extend, or straighten the MPJ as far as possible. Record the maximum MP extension angle. MP FLEXION: The clients hand should be flat on a table with the volar head of the metacarpal supported at the tables edge, and neutral wrist flexion/extension and radioulnar deviation. Place the goniometers pivot over the dorsal head of the metacarpophalangeal (MPJ) joint with the stationary arm in alignment with the dorsal midline of the metacarpal and the movable arm in alignment with the dorsal midline of the proximal phalanx. Instruct the client to flex the MPJ as far as possible. Record the maximum MP flexion angle. PIP EXTENSION: The clients forearm should be pronated, the wrist in neutral flexion/extension and radioulnar deviation, and the metacarpophalangeal joint in 0-degrees of extension. If possible, place the hand to be measured flat on a table with the volar head of the proximal phalanx supported at the tables edge. Place the goniometers pivot over the dorsal head of the proximal interphalangeal joint (PIP) with the stationary arm in alignment with the proximal phalanx and the movable arm in alignment with the middle phalanx. Instruct the client to extend, or straighten the PIP joint as far as possible. Record the maximum PIP extension angle. PIP FLEXION: The clients forearm should be pronated, the wrist in neutral flexion/extension and radioulnar deviation, and the metacarpophalangeal joint in 0-degrees of extension. If possible, place the hand to be measured flat on a table with the volar head of the proximal phalanx supported at the tables edge. Place the goniometers pivot over the dorsal head of the proximal interphalangeal joint (PIP) with the stationary arm in alignment with the dorsal midline of the proximal phalanx and the movable arm in alignment with the dorsal midline of the middle phalanx. Instruct the client to flex the PIP as far as possible. Record the maximum PIP flexion angle. DIP EXTENSION: The clients forearm should be pronated or in neutral pronation/supination, and the wrist in neutral flexion/extension and radioulnar deviation. The metacarpophalangeal joint is positioned in 0-degrees of extension and the proximal interphalangeal joint in approximately 70-90 degrees of flexion. Place the goniometers pivot over the dorsal head of the distal interphalangeal joint (DIP) with the stationary arm in alignment with the dorsal midline of the middle phalanx and the movable arm in alignment with the distal phalanx. Instruct the client to extend, or straighten the DIP joint as far as possible. Record the maximum DIP extension angle. DIP FLEXION: The clients forearm should be pronated or in neutral pronation/supination, wrist in neutral flexion/extension and radioulnar deviation. The metacarpophalangeal joint is positioned in 0-degrees of extension and the proximal interphalangeal joint in approximately 70-90 degrees of flexion. Place the goniometers pivot over the dorsal head of the distal interphalangeal joint (DIP) with the stationary arm in 177 alignment with the dorsal midline of the middle phalanx and the movable arm in alignment with the distal phalanx. Instruct the client to extend, or straighten the DIP joint as far as possible. Record the maximum DIP extension angle. Finger Little 5 In assessing motion, the examiner should first observe what an individual can and cannot do by asking them to move each joint of the extremity, from the shoulder down, through its full range of motion. Both extremities should be compared. Individual joints are then evaluated separately. Similarly, movements of the digits are first evaluated as a unit by having the client make a complete fist, and then individually by extending the digits fully over several repetitions. In determining the range of motion of individual joints, the examiner must evaluate both the active and passive motion. MP EXTENSION: The clients hand should be flat on a table with the volar head of the metacarpal supported at the tables edge, and neutral wrist flexion/extension and radioulnar deviation. Place the goniometers pivot over the dorsal head of the metacarpophalangeal (MPJ) joint with the stationary arm in alignment with the dorsal midline of the metacarpal and the movable arm in alignment with the dorsal midline of the proximal phalanx. Instruct the client to extend, or straighten the MPJ as far as possible. Record the maximum MP extension angle. MP FLEXION: The clients hand should be flat on a table with the volar head of the metacarpal supported at the tables edge, and neutral wrist flexion/extension and radioulnar deviation. Place the goniometers pivot over the dorsal head of the metacarpophalangeal (MPJ) joint with the stationary arm in alignment with the dorsal midline of the metacarpal and the movable arm in alignment with the dorsal midline of the proximal phalanx. Instruct the client to flex the MPJ as far as possible. Record the maximum MP flexion angle. PIP EXTENSION: The clients forearm should be pronated, the wrist in neutral flexion/extension and radioulnar deviation, and the metacarpophalangeal joint in 0-degrees of extension. If possible, place the hand to be measured flat on a table with the volar head of the proximal phalanx supported at the tables edge. Place the goniometers pivot over the dorsal head of the proximal interphalangeal joint (PIP) with the stationary arm in alignment with the proximal phalanx and the movable arm in alignment with the middle phalanx. Instruct the client to extend, or straighten the PIP joint as far as possible. Record the maximum PIP extension angle. PIP FLEXION: The clients forearm should be pronated, the wrist in neutral flexion/extension and radioulnar deviation, and the metacarpophalangeal joint in 0-degrees of extension. If possible, place the hand to be measured flat on a table with the volar head of the proximal phalanx supported at the tables edge. Place the goniometers pivot over the dorsal head of the proximal interphalangeal joint (PIP) with the stationary arm in alignment with the dorsal midline of the proximal phalanx and the movable arm in alignment with the dorsal midline of the middle phalanx. Instruct the client to flex the PIP as far as possible. Record the maximum PIP flexion angle. DIP EXTENSION: The clients forearm should be pronated or in neutral pronation/supination, and the wrist in neutral flexion/extension and radioulnar deviation. The metacarpophalangeal joint is positioned in 0-degrees of extension and the proximal interphalangeal joint in approximately 70-90 degrees of flexion. Place the goniometers pivot over the dorsal head of the distal interphalangeal joint (DIP) with the stationary arm in alignment with the dorsal midline of the middle phalanx and the movable arm in alignment with the distal phalanx. Instruct the client to extend, or straighten the DIP joint as far as possible. Record the maximum DIP extension angle. DIP FLEXION: The clients forearm should be pronated or in neutral pronation/supination, and the wrist in neutral flexion/extension and radioulnar deviation. The metacarpophalangeal joint is positioned in 0-
degrees of extension and the proximal interphalangeal joint in approximately 70-90 degrees of flexion. Place the goniometers pivot over the dorsal head of the distal interphalangeal joint (DIP) with the 178 stationary arm in alignment with the dorsal midline of the middle phalanx and the movable arm in alignment with the distal phalanx. Instruct the client to extend, or straighten the DIP joint as far as possible. Record the maximum DIP extension angle. Reference: American Medical Association Guides to the Evaluation of Permanent Impairment, Fifth Edition Digit Ankylosis:
If there is joint ankylosis, which will require documentation, follow these steps:
The first reading should be taken with the goniometer interlocked and placed against a wall or on a tabletop. Next place the client's joint in as close to a neutral position as possible. Place the goniometer appropriately. Then take the second reading. This is the degree of ankylosis. This value is then entered under flexion contracture. Delete the information for that trial and start a range of motion test. 179 The Hand Grip Force Measurement The main force measurement device can accurately document values from 0200 lbs. The device itself is accurate to within 0.5% over a full scale, and when combined with the software and other components is accurate to within 0.6% over the full scale (i.e. within 1.2 pounds at all times). Cables BTE uses high grade cabling to ensure durability of its connections. Protocols The Hand Grip tests can be used to determine a clients handgrip strength relative to a population of the clients age and sex, using a normative database. There are several protocols that are used -- these are listed below. Standard Hand Grip Maximum Voluntary Effort Modified Maximum Voluntary Effort Rapid Exchange Design This tool is made of aluminium and documents values via a pressure transducer. Accessories The Hand Grip comes with the following pieces for calibration:
180 Using the Hand Grip For A Pre-Programmed Strength Protocol:
You are now ready to enter the Strength Test page. Click on Strength Test from the ODES main menu. The following Strength Test Protocol page will appear. From here, all of the pre-programmed tests may be accessed. Tests can be added to clients, new custom isometric strength tests may be created, and tests can be edited or deleted. 181 This is a list of all the tests found in the Strength Test menu. Double click on the test or click here to add it to the tests assigned to the client. In order to edit, create or remove tests, highlight the work simulation protocol then click on the appropriate icon. Protocol Hibernation puts unused protocols in storage without removing data. This is a short cut to return to any of the test menu screens in ODES. The test menu that is in use will appear in yellow. Select this icon to return to the ODES main menu. All of the tests that are assigned to the client will appear in this area. Once a test has been added to a client, and Perform Test has been selected from the bottom right hand corner of the page, the test page will appear. Below is an example of what the test page looks like for the Standard Hand Grip. Choose this icon to Start the Standard Hand Grip Test. Choose this icon to return to the Strength menu. Click on Start HR to start real time heart rate monitoring. There is also the option of entering the heart rate manually by double clicking on the question mark. 182 Located in this area are the standardized instructions for the Hand Grip tests. Notice that trials alternate between the clients right and left hands. If only one hand requires testing, simply remove the check mark beside the hand that is not required. Below is an example of a completed Standard Hand Grip test. The trial, date and time that the test was performed can be found at the top of the testing screen. The test results are displayed in a line graph format. The difference between the left and right hands is represented by both a pie chart and a bar Average, peak COV values and difference between left and right are displayed. The R represents a retest option for each trial that is performed by the client. The above is a completed Standard Hand Grip test. There are three trials on each side, each represented by a different colour. The first trial is blue, the second is pink and the third trial is yellow. Retesting Trials Trials can be retested if the COV is off by more than 15%; if there is an error in technique; due to inconsistent effort; or as a result of poor performance at the start or finish of the trials. There is no set number of times that this option can be utilized. 183 Retest Option R Button The R that corresponds with each trial is located to either the left or right of the initial result obtained. For example, for trial one on the left side of the body, the R is located to the left of the result obtained by the client. To redo this trial, click the R. ODES will then ask if this trial should be retested. Click OK and perform the trial again. It is important to note that once a testing screen is closed or a new trial is created, the measurements that were obtained will be locked and none of these can be retested. Protocol Information Standard Hand Grip:
The Hand Grip Standard test is performed per the BTE Hand Grip Protocol with a JAMAR handgrip dynamometer. This device is utilized to measure handgrip strength in both the right and left hands. Prepare the grip dynamometer by setting the adjustable handle spacing in position 2 (1-1/2 inches), or the second position away from the fixed handle. The device must be presented to the client with the cord attachment on top in order to conform to the metacarpal arch of the hand. 184 The client should optimally be positioned sitting as follows:
Both feet flat on the floor Upper arm next to body Elbow flexed at 90 degrees Forearm neutral (thumb up) Hand & forearm in slight shoulder internal rotation (toward the center front of the torso) Forearm should not be resting on any surface while gripping If possible, have the client remove all rings from his/her fingers, as these can interfere with the performance of this test. Click Start Test at the top of the page. The client is required to perform three trials with each hand with the dynamometer set to position 2, beginning with the right hand and alternating between trials. Voice prompts will guide the tester and the client through the trials. Observe the client closely to ensure he/she understands. 185 It is important that the client does not grip the dynamometer firmly prior to beginning the test to ensure proper calculation of the starting threshold. The voice prompt will announce Start Test Now to indicate when firm pressure should be applied. Instruct the client to begin gripping the device in a smooth motion, steadily maintaining that grip until the prompted Rest Period, then direct the client to switch the device to the contra lateral hand. As with all interfaced test screens, data is automatically analyzed for the standard handgrip strength test. A Comment section is available at the bottom of the screen. Double-click the text box to increase its size if additional space is required. Click the box adjacent to Include Comment in Report if these comments are to be included in the final printed report. A summary of test results and comparison to normal values is provided in the report. Modified Maximum Voluntary Effort:
The Handgrip Modified Maximum Voluntary Effort test page has two grids for real-time graphs of the left and right hand strength curves. Each grid contains three reference lines that represent the normal values as well as upper and lower limits for the client, based on his/her age and gender. These criteria are obtained through the information the evaluator provides on the Client Information page of ODES. The correct gender and date of birth of the client must be entered when performing these tests to ensure accurate and complete data analysis. Hand dominance is also entered on the Client Information page. This is also used in data analysis: right-dominant individuals are considered to be 10% stronger on the right. The MMVE test pages look much like the Handgrip Standard test page(s) with the following exceptions:
The main page has a row of buttons from 1 to 5 to indicate the spacing position on the handgrip dynamometer. The page displayed at the conclusion of testing at each handgrip position has a Summary button. 186 Click button number 1 (from 1 5) at the top of the screen. These buttons represent the choice of spacing positions on the grip dynamometer. The test is performed with one trial of each hand at spacing positions 1, 3, 4 and 5 on the dynamometer, and three trials of each hand for spacing position 2. The Modified Maximum Voluntary Effort Handgrip test is performed per the BTE Handgrip Protocol with a JAMAR handgrip dynamometer. This device is utilized to measure handgrip strength in both the right and left hands. Prepare the grip dynamometer by setting the adjustable handle spacing for the position to be tested:
Position One: 1 inch Position Two: 1-1/2 inches Position Three: 2 inches Position Four: 2-1/2 inches Position Five: 3 inches The test is generally conducted with position one first, and progresses chronologically until position five is completed. The device must be presented to the client with the cord attachment on top in order to conform to the metacarpal arch of the hand. The client should optimally be positioned sitting as follows:
Both feet flat on the floor Upper arm next to body Elbow flexed at 90 degrees Forearm neutral (thumb up) Hand & forearm in slight shoulder internal rotation (toward the center front of the torso) Forearm should not be resting on any surface while gripping Text instructions are given on the test page. Voice prompts will guide the tester and the client through the test. Observe the client closely to ensure he/she understands. It is important that the client does not grip the dynamometer firmly prior to beginning the test to ensure proper calculation of the starting threshold. The voice prompt will announce Start Test Now to indicate when firm pressure should be applied. Instruct the client to begin gripping the device in a smooth motion, steadily maintaining that grip until the prompted Rest Period, then direct the client to switch the device to the contra lateral hand. Repeat these steps for all five-grip positions. The MMVE test is performed over a range of positions effecting varying degrees of difficulty. Therefore, it is possible to determine whether a client has performed with consistent effort by comparing the objective strength values recorded at each position for each hand. Shown graphically, the plots of these values would be expected to create a bell-shaped pattern, paralleling that of the contra lateral hand. A significant-appearing deviation in the size of the curve or the absence of a bell-shaped curve would connote non-compliance of the client with the strength test. ODES immediately plots the data. Graphic representations for both right and left-hand results are found by clicking the Summary button located at the bottom right corner of the page. 187 Click Yes if both graphs follow a bell-shaped distribution. Click No if one or both graph(s) does/do not correspond to the bell-shaped curve. If the evaluator does not click on Summary, the cross validation section of the report (assuming the Rapid Exchange Grip and the Standard Hand Grip tests were completed) will not be included. Rapid Exchange:
The Rapid Exchange Grip test page has two grids for real-time graphs of the left and right-hand strength curves. 188 The Hand Grip Rapid Exchange test is performed with a JAMAR handgrip dynamometer. This device is utilized to measure handgrip strength in both the right and left hands. The Hand Grip Rapid Exchange test is performed by having the client rapidly squeeze the grip dynamometer and move it to the other hand for a series of six trials each for both right and left hands. The adjustable handle component of the grip dynamometer is to be set up in spacing position two. The average maximum force for all six trials is compared to the values obtained for the standard or MMVE handgrip strength test for validity purposes. Prepare the grip dynamometer position as indicated on the screen. If the client has completed the Modified Maximum Validity Effort test, the adjustable handle spacing will be in position 2 (1-1/2 inches), or the second position away from the fixed handle. If the Maximum Validity Effort test was completed the position will be based on the position where the client registered the strongest readings. The device must be presented to the client with the cord attachment on top in order to conform to the metacarpal arch of the hand. The client should optimally be positioned sitting as follows:
Both feet flat on the floor Upper arm next to body Elbow flexed at 90 degrees Forearm neutral (thumb up) Hand & forearm in slight shoulder internal rotation (toward the center front of the torso) Forearm should not be resting on any surface while gripping Click Start Test at the top of the page. Voice prompts will guide the tester and the client through the test. Observe the client closely to ensure he/she understands. Instruct the client to begin gripping the device quickly and with maximum force for a one-second trial duration beginning with the right hand. The client must follow the voice prompts to Switch to Left, and Switch to Right to complete 6 consecutive trials each of both right and left hands. 189 It is important that the client does not grip the dynamometer firmly prior to beginning the test to ensure proper calculation of the starting threshold. The voice prompt will announce Start Test Now to indicate when firm pressure should be applied. The BTE Protocol for Rapid Exchange Handgrip Strength testing will automatically prompt ODES to perform a cross-reference validity check to compare the results of the Rapid Exchange or MMVE to the Standard handgrip results. ODES will automatically calculate and compare the values obtained from strength test performance using the grip dynamometer in position two for all tests. The clients strength values recorded during the Standard or MMVE tests are not expected to show a variance of greater than 15% from those recorded during Rapid Exchange handgrip strength testing. Creating A New Hand Grip Test:
The ODES software allows for the creation of new protocols. In order to do so, enter the page from which tests can be chosen. In this case, enter the Strength Test or Work Sim Test page. At the bottom of the page is a button labelled New Test. After selecting this option, the following page will appear:
Select the Integrated Isometric Work Simulation Protocol or Integrated Strength Test Protocol option in this menu in order to begin customizing the new Hand Grip test. 190 A page will then appear which will allow input of all the essential protocol information. Once all of the vital information has been entered, click Close. The test should now appear in the protocol listing. 191 The Pinch Grip Force Measurement The main force measurement device can accurately document values from 070 lbs. The device itself is accurate to 0.037% over a full scale and, when combined with the software and other components, is accurate to 0.2% over the full scale (i.e. within one pound at all times). Cables BTE uses high grade cabling to ensure the durability of its connections. Protocols The standardized Pinch Grip tests in the ODES software can be used to determine a clients Pinch Grip strength relative to a population of the clients age and sex, using normative data. There are various protocols for performing Pinch Grip testing and these are listed below. Tip Pinch Key Pinch Palmar Pinch Design This tool is made of aluminum and documents values via a load cell device. 192 Accessories The Pinch Grip comes with the following pieces for calibration. Weight of the calibration disc = 0.3 lbs. Using the Pinch Grip For A Pre-Programmed Strength Test Protocol:
The following is an example of how to perform a pre-programmed Strength Test Protocol. From the ODES main menu, click Strength Test. This will bring you to the Strength Protocols page. From here, you have access to all of the pre-programmed tests. You can add tests to clients, create new custom isometric strength tests, edit tests and delete tests. 193 This is a list of all the protocols found in the Work Simulation menu. In order to edit, create or remove tests, highlight the work simulation protocol then click on the appropriate button. This is a short cut to return to any of the test menu screens in ODES. The test menu that is in use will appear yellow. Protocol Hibernation puts unused protocols in storage without removing data. Double click on the test or highlight the test and click here to assign it to the client. Select this button to return to the ODES main menu. All of the tests that are assigned to the client will appear in this area. Once a test has been added to a client, and Perform Test has been clicked in the bottom right hand corner of the page (or the test itself has been double-clicked), the test page will appear. Below is an example of what the test page looks like for the standardized Pinch Grip. Click this button to start the Key Pinch Test. Click this button to return to the Strength menu. Located in this area are the standardized instructions for the Pinch Grip tests. Click Start HR to capture the clients heart rate during the test. You also have the option of entering the heart rate manually by double-clicking on the heart graphic 194 Below is an example of a completed Key Pinch Grip test. The test results are displayed in a line graph format. Average, peak COV values and difference between left and right are displayed. The trial, date and time that the test was performed can be found at the top of the testing page. The difference between the left and right side is represented by both a pie chart and a bar graph. The R represents a retest option for that specific trial. Three trials are performed on each hand, represented by a different color. Trial number one is blue, trial number two is pink and trial number three is yellow. Capturing Clients Heart Rate:
This can be done by either clicking the start HR button, or by double-
clicking on the heart graphic and entering the value manually. Retesting Trials Trials can be retested if the COV is off by more than 15%. In addition, if there is an error in technique, inconsistent effort, or poor performance at the start or finish of a test the trials may also be re-tested. There is no set number of times that this option can be utilized. 195 Retest Option R Button The R that corresponds with each trial is located to either the left or right of the initial result obtained. For example, for trial one on the left side of the body, the R is located to the left of the result obtained by the client. To redo this trial, click on R. ODES will then ask if you would like to redo this trial. Click OK and perform the trial again. It is important to note that once you either close the testing page or create a new trial, the measurements that were obtained will be locked and you will be unable to retest any of the trials. Protocol Information Key Pinch:
The Key Pinch strength test is performed as per the protocol outlined in published research (refer to abstracts on ODES CD). This pinch dynamometer measures strength in the key (lateral) pinch position of both the right and left hands. To access the test from the ODES main menu, go to Strength Test and select Pinch Grip from the list on the left-hand side of the page. Within this testing page, you will find a row of buttons located at the top labelled Key, Tip, and Palmar. These buttons correspond to the three types of Pinch Grip tests. Click Key to perform a Key Pinch Grip Test. 196 The Pinch Grip Key screen has two grids for real-time graphs of the left and right hand strength curves. Each grid contains three reference lines that represent the normal values as well as upper and lower limits for the client, based on their age and gender, and hand dominance. This information is obtained through the information the evaluator provides in the Client Information screen of ODES. The correct gender, date of birth and hand dominance of the client must be entered when performing these tests to ensure accurate and complete data analysis. Instruct the client to hold the Pinch Grip dynamometer between the thumb and the lateral aspect of the index finger, middle phalanx similar to how they would hold a key. 3. The client is in a seated position as follows:
Both feet flat on the floor Upper arm next to body Elbow flexed at 90 degrees Hand & forearm in slight shoulder internal rotation (toward the centre front of the torso) Forearm should not be resting on any surface while pinching Click Start Test to start the Pinch Grip Test. 197 The client is required to perform three trials with each hand, beginning with the right hand and alternating with the contra lateral hand between trials. Voice prompts will guide the evaluator and the client through the test. Observe the client closely to ensure they understand and have assumed correct Key Pinch-type positioning. When beginning the Key Pinch test, have the client grip the pinch gauge loosely. It is important that the client does not grip the pinch gauge firmly prior to beginning the test to ensure proper calculation of the starting threshold. The voice prompt will announce Start test now, at which time the client may begin pinching the device in a smooth motion, steadily maintaining the Key Pinch grip for a three-second trial duration until prompted Rest period, and directed to switch the device to the contra lateral hand. This process is repeated three times. As with all interfaced test pages, data is automatically analyzed for the Key Pinch strength test. The average of the three trials is compared to published population normative values. A Comment section is available at the bottom of the page. You may double-click the text box to increase its size as indicated by the length of your commentary. You have the choice to include or not include your comments in the report by selecting the Include comment in report checkbox A summary of test results and comparison to normative values is provided in the report. 198 Tip Pinch:
The Tip Pinch strength test is performed per the protocol outlined in published research (see ODES CD for abstracts) with a Pinch Dynamometer. This Pinch Grip dynamometer measures strength in the tip (tip-
to-tip) pinch position of both the right and left hands. Click Tip to perform a Tip Pinch Grip Test. The Tip Pinch Grip screen has two grids for real-time graphs of the left and right hand strength curves. Each grid contains three reference lines that represent the normal values as well as upper and lower limits for the client, based on their age, gender and hand dominance. This information is obtained through the information the evaluator provides in the Client Information screen of ODES. The correct gender, date of birth and hand dominance of the client must be entered when performing these tests to ensure accurate and complete data analysis. Instruct the client to hold the Pinch Grip device between the thumb tip and the tip of the index finger as shown below. The client should optimally be in a seated position as follows:
Both feet flat on the floor Upper arm next to body Elbow flexed at 90 degrees Hand & forearm in slight shoulder internal rotation (toward the centre front of the torso) Forearm should not be resting on any surface while pinching Click Start Test to start the Tip Pinch Grip Test. 199 The client is required to perform three trials with each hand, beginning with the right hand and alternating with the contra lateral hand between trials. Voice prompts will guide the evaluator and the client through the test. Observe the client closely to ensure they understand and have assumed correct Tip Pinch-type positioning. When beginning the Tip Pinch test, have the client grip the pinch gauge loosely. It is important that the client does not grip the pinch gauge firmly prior to beginning the test to ensure proper calculation of the starting threshold. The voice prompt will announce Start test now, at which time the client may begin pinching the device in a smooth motion, steadily maintaining the Tip Pinch grip for a three-second trial duration until prompted Rest period, and directed to switch the device to the contra lateral hand. This process is repeated three times. As with all interfaced test pages, data is automatically analyzed for the Tip Pinch strength test. The average of the three trials is compared to published population normative values. A Comment section is available at the bottom of the page. You may double-click the text box to increase its size as indicated by the length of your commentary. You have the choice to include or not include your comments in the report by selecting the Include comment in report checkbox. A summary of test results and comparison to normative values is provided in the report. 200 Palmar Pinch:
The Palmar Pinch Grip strength test is performed per the protocol outlined in published research (see ODES CD for Pinch Strength Protocol) with a Pinch Dynamometer. This Pinch Grip dynamometer measures strength in the Palmar Pinch position of both the right and left hands. Click Palmar to perform a Palmar Pinch Grip Test. The Pinch Grip Palmar screen has two grids for real-time graphs of the left and right hand strength curves. Each grid contains three reference lines that represent the normal values as well as upper and lower limits for the client, based on their age, gender and hand dominance. This information is obtained through the information the evaluator provides in the Client Information screen of ODES. The correct gender, date of birth and hand dominance of the client must be entered when performing these tests to ensure accurate and complete data analysis. Instruct the client to hold the pinch dynamometer between the tip of the thumb and the tips of the index and middle fingers. The client should be in a seated position as follows:
Both feet flat on the floor Upper arm next to body Elbow flexed at 90 degrees Hand & forearm in slight shoulder internal rotation (toward the centre front of the torso) Forearm should not be resting on any surface while pinching Click Start Test to start the Palmar Pinch Grip Test. 201 The client is required to perform three trials with each hand, beginning with the right hand and alternating with the contra lateral hand between trials. Voice prompts will guide the evaluator and the client through the test. Observe the client closely to ensure they understand and have assumed correct Palmar Pinch-type positioning. When beginning the Palmar Pinch test have the client grip the pinch gauge loosely. It is important that the client does not grip the pinch gauge firmly prior to beginning the test to ensure proper calculation of the starting threshold. The voice prompt will announce Start test now, at which time the client may begin pinching the device in a smooth motion, steadily maintaining the Tip Pinch grip for a three-
second trial duration until prompted Rest Period, and directed to switch the device to the contra lateral hand. This process is repeated three times. As with all interfaced test pages, data is automatically analyzed for the Palmar Pinch strength test. The average of the three trials is compared to published population normative values. A Comment section is available at the bottom of the page. You may double-click the text box to increase its size as indicated by the length of your commentary. You have the choice to include or not include your comments in the report by selecting the Include comment in report checkbox. A summary of test results and comparison to normative values is provided in the report. 202 Make sure that you press the next Pinch Grip test (i.e. key, Tip or palmar) before hitting the Start button. If not, you will repeat the same test that was just Creating A Custom Pinch Grip Test:
The ODES software allows for the creation of custom protocols. To do so, from the ODES main menu go to either the Strength Tests or Work Simulation Tests pages from which tests can be chosen. In this case, we have entered the Work Simulation page. Along the bottom is a button labelled New Test. Click New Test to begin creating a new protocol. After selecting this option, the following page will appear:
Click on Integrated Isometric Work Simulation Protocol or Integrated Isometric Strength Protocol, depending on from which page you are creating the new test. A page will be displayed which allows you to input all of the essential protocol information. 203 Select the tool you wish to use for this particular test and add in the protocol name. The maximum trial duration, rest period between trials, and rest period between sides will be based on the type of test you are trying to create. If you are trying to develop a strength test, consideration needs to be made regarding the fatigability of the muscle(s) you are trying to test and the rest period created must be sufficient to regain energy supplies. Generally a 3 second trial duration, with a 5 second rest period between trials and a 5 second rest period between sides are acceptable parameters for testing muscle strength. If developing the test to simulate a specific activity, set the parameters based on the task you are trying to simulate. The closer the test is to the task the more valid the results will be. Once all of the vital information is completed on this screen click Close. Your test should now appear in your protocol listing under the protocol name. 204 The BTE Algometer Force Measurement The main force measurement device can accurately document values from 0500 lbs. The device itself is accurate to 0.037% over the full scale and when combined with the software and other components are accurate to 0.2% over the full scale (i.e. within one pound at all times). Cables BTE uses high grade cabling to ensure the durability of its connections. Protocols The pressure Algometer can be used for manual muscle testing or for evaluating the consistency of a clients self-report of pain. The pressure Algometer is an excellent tool in documenting point-tenderness, especially in chronic pain clients. The pressure Algometer can also be used to develop customized work simulation protocols. Job Site AnalysisThe pressure Algometer can be used to document the weights and forces required at the workplace. This is ideal when you need to determine these measures prior to performing a functional evaluation. 205 Design This tool is made of aluminum and documents values via a load cell device. There is a fixed bolt in one end, and a bolt can be added at the other end so that attachments can be fixed to both ends of the tool. Accessories The pressure Algometer comes with a round pad, a large concave manual muscle testing pad, a small rectangular muscle testing pad, a 1 cm squared point tenderness testing pad, a single handle, a straight bar, a clip, small and large corner accessories, an extension piece, a nylon strap, and a bolt. Depending on the year and the type of system purchased, the accessories below may vary. Round Pad:
Concave Pad:
Rectangular Pad:
Testing Pad:
Tenderness Single Handle: Push/Pull Bar:
Clip:
Small Corner Accessory:
Large Corner Accessory: Calibration Tool
(Pinch Grip or Algometer):
206 wt = 0.4 lbs Strap Attachment:
Bolt:
Extension Piece for Hard to Reach Areas:
Factors To Take Into Consideration:
There are several factors that need to be taken into account when developing an isometric strength test. The evaluator should ensure that the test isolates the targeted muscle group and that it reduces the amount of accessory muscle use. Types of Strength Protocols The ODES 2002 software has many Strength protocols pre-programmed into the software. These tests include:
Spinal strength tests such as Cervical Neutral Flexion, Extension and Side Flexion Upper Extremity strength tests such as Wrist Flexion and Extension, Elbow Flexion and Extension, Shoulder Flexion, Extension, Abduction, Adduction, Internal Rotation and External Rotation Lower Extremity strength tests such as Ankle Plantarflexion and Dorsiflexion, Knee Flexion and Extension, Hip Flexion, Extension and Abduction The software also permits the user to customize a Strength test. 207 Using the Pressure Algometer for A Pre-Programmed Isometric Strength Protocol:
Click Strength Test from the main menu of ODES. This will bring you to the Strength Test page. From here, you have access to all of the pre-programmed strength tests. You can add tests to clients, create new custom isometric strength tests, edit tests and delete tests. This is a list of all the tests found in the Strength Test menu. Highlight the test and click here or double click on the test name to assign it to a client click this button to return to the ODES main All of the tests assigned to the client will appear in this area. In order to edit, create or remove tests, click on the appropriate button. Protocol Hibernation puts unused protocols in storage without removing data These are short cuts to return to any of the test menu pages in ODES. The test menu that is in use will appear in yellow. 208 Once a test has been assigned to a client, and Perform Test has been selected at the bottom right-hand corner of the page (alternately, you may double click on the test name), your test page will appear. Click this button to Start the Strength test. Click this button to return to the Strength menu. Located in this area are the default or custom instructions for the corresponding test. It should be noted that once the Start button is selected, a message will appear stating that the force meter needs to be zeroed. This is seen in the picture below. As there are many attachments for each load cell, ODES will account for the weight of the accessory attachment during each test. No force should be applied to the force meter. 209 It is important to note that only one device can be linked with a static test. For example, if you have done a static shoulder abduction strength test with the FOCUS unit, you will always have to use this device for this test. This ensures that the data being recorded remains objective. If you have a larger system (a FOCUS platform and an Algometer) you should create duplicate copies of the tests. This will allow you to utilize both pieces of equipment the FOCUS and Algometer (since both devices can measure static strength). For example, you could name the existing cervical strength test in the database Cervical Strength FOCUS and create another identical test and name it Cervical Strength Algometer. Each test would utilize a different tool. In order to understand this further, please see the troubleshooting section at the end of this manual. If you have a smaller system (such as the Evaluator or CIRES) you will only have an Algometer and will not have to create different tests. Once the Algometer has been zeroed (i.e. no force applied to it), you are ready to begin the strength test. With the static strength tests, all trials are performed on the left side initially and then repeated on the right side. The trial, date and time that the test was performed can be found at the top of the testing page. The test results are displayed in a line graph The a Avg., peak and COV values are listed for right and left comparison. 210 above is The difference between the left and right side is represented by both a pie chart and a bar graph. In addition, the total elapsed time is displayed. The comments button allows the evaluator to enter their observations from the test. The R represents a retest option for each trial that is performed by the client. completed static shoulder abduction strength test. There are three trials on each side, each represented by a different colour. Trial number one is blue, trial number two is pink and trial number three is yellow. Retesting Trials If there is an error in technique, inconsistent effort, or poor performance at the start or finish of a test the trials can be re-tested. There is no set number of times that this option can be utilized. Retest Option R Button The R that corresponds with each trial is located at either the left or right of the initial result obtained. For example, for trial one on the left side of the body, the R is located to the left of the result obtained by the client. To redo this trial, click the R. ODES will then ask you if you would like to redo this trial. Click Yes and perform the trial again. It is important to note that once you either close the testing page or create a new trial, the measurements that were obtained will be locked and you will be unable to retest any of the trials. Checking the Heart Rate:
Recording the Heart Rate can be performed by either clicking the Capture button, or by double clicking on the heart graphic and entering the value manually (once you have entered the heart rate in the white box hit the enter key). Click Start Real Time HR to start the real time heart rate function. 211 Real Time Heart Rate allows you to track the HR in a graph format. This is only for those who have the TEST, evalTECH, or ER Systems.. Creating A New Isometric Strength Protocol The ODES software allows you to create new protocols. To do so, open Strength Test New Test from the ODES main page. After clicking New Test, the following page will appear:
212 From this page, select the Integrated Isometric Strength Protocol option in order to begin customizing your new strength test. The customization page will be displayed, which will allow you to input all of the essential protocol information. Once all of the vital information is completed on this page, click Close. Your test should now appear in your protocol listing. Superficial Tenderness With disorders, such as fibromyalgia, becoming more common in a clinical setting, two different superficial tenderness templates have been added into the ODES software. For superficial tenderness testing, you will need the small square pad attachment for the Algometer. From the main screen of ODES, select Self Reports, located in the upper right-hand corner of the page. 213 Within the Self Reports page, you will see Superficial Tenderness listed as an option. To assign the test to your client, you may either double click on the protocol name, or highlight it and click Add to Client. Once the protocol has been assigned to your client, you can either double click Superficial Tenderness once again, or highlight the test name and click Perform Test. 214 The Superficial Tenderness Testing page will then be displayed. These buttons (below) allow you to Edit and Add new locations to your client for testing. If you choose to add a location to your client, you will be responsible for selecting the location and the units to be used. You may add multiple locations to make your assessment as specific as possible. 215 Results are recorded under the pressure scale heading once the test has begun. The evaluator needs to enter the clients pain scale rating here after each reading. Once all of the locations have been selected and you are ready to perform a superficial tenderness test, you must first re-zero the Algometer (apply no weight). You may now begin testing. Make sure that your cursor is flashing in the first location underneath the Pressure Scale heading. You can re-zero the device at any time by clicking on the re-zero button. You may also create new trials and delete old trials. The ODES software also comes with a pre-programmed fibromyalgia template. To access this template, click Templates on the superficial tenderness page. 216 The template page allows you to create new templates, edit older templates and use the template for fibromyalgia. To access the pre-programmed fibromyalgia template, click on 18 Fibromyalgia Points. You will now enter the testing page for fibromyalgia clients. 217 However, if you wish to create your own standardized protocol for superficial tenderness, you can create a new template. To do so, click Templates, located on the superficial tenderness page. This will bring you to the template page. To create a new template, click New. You will now see another template button appear. 218 To edit/create this template, click Edit. You will now notice that the button changes to green Cancel Edit and that the number template changes color to red (when you place your cursor on it). Click on the template (in this case Template 84) to begin customizing your own protocol. The following page will be displayed. This page allows you to name the protocol, add and remove locations so that you can create a custom superficial tenderness template. If the location you wish to add is not in the current list, you may add additional locations by clicking Edit Locations. If you choose to add new locations (by clicking on the Edit Locations button), the following page will appear. 219 You can now further customize your location list. When you have added all the locations you wish to have in your template, and placed them in the correct order, you may click Close to complete the template. Your template will now appear with the correct title. To finish template creation and to view your new template, click Cancel Edit and then select your template. 220 221 It is important to note, that if locations are added to the client, they will always appear with that case. The maximum number of locations that can be added is 20. If you have already added this many locations to your client, you will not be able to add any more. You will have to create a second case for your client. Fibromyalgia Protocol The Fibromyalgia Protocol was developed specifically to test the 18 points used for diagnosis of this condition. From the main screen of ODES, select Self Reports, located in the upper right-hand corner of the page. Within the Self Reports page, you will see Fibromyalgia Protocol listed as an option. To assign the test to your client, you may either double click on the protocol name, or highlight it and click Add to Client. 222 Once the protocol has been assigned to your client, you can either double click Fibromyalgia Protocol once again, or highlight the test name and click Perform Test. The Superficial Tenderness Testing page will then be displayed. Click on Start Real Time HR if you would like to record the clients heart rate throughout the test. Click on Capture if you would like the heart rate to be captured as part of the Heart Rate Report. 223 Double click on the location you wish to test (Left). In this example the left side of the head is about to be tested. A yellow box will appear and the value being measured by the algometer will appear. To re-zero the algometer click on Re-Zero. Once the force measurement has been obtained indicate whether the client experienced pain, tenderness or nothing. If the client experienced pain, once selected you will be prompted to enter a value for the pain rating. 224 ER Platform ER incorporates a system of fully adjustable shelves, graded rulers and accessories to evaluate numerous occupational task demands. The ODES diagnostic software provides the advantage of objective evaluation through computer integration. The ER Platform has many features and capabilities. Most of the adjustments that the evaluator will perform through the ER Platform will occur on the stand or one of its arms. This manual will demonstrate the versatility of the ER Platform. The evaluator is able to combine various hardware and software features to simulate almost any functional task. Many tests have already been designed and programmed into the ODES software. The ER Platform has markers every 5 inches that can be used independently or in combination to simulate unlimited functional tasks. Standard Accessories These are the standard accessories that are included with the ER. 2 Accessory Arms attached to the ER Platform 2 Lifting Shelves Industry crate Masked weights (2X15lbs, 2X5lbs, 7X10lbs) Multiplanar accessory housing joint (single load cell) Universal Taskmaster Heart rate monitor (chest belt) Heart Rate transmitter Heart rate receiver Goniometer (with short and long arms) Dual Inclinometers Handgrip dynamometer Pinch grip dynamometer Algometer Strength testing pad Narrow palmar grip handle Wide palmar grip handle Narrow double handle Wide double handle Single handle Bar The ER stand has two accessory arms that can be adjusted to any height, within the respective ranges, and rotated in various planes. This enhances the versatility of the ER. All of the ER accessories can be attached to the arms, to create tasks as individualized as the person who is being assessed. Masked Weights The weights can be added to the crate progressively to increase a task demand during functional testing. Different colors at the ends of the weights indicate the weight amounts. 226 The labels are color coded as follows:
Color Yellow White Red Weight 5 lbs. 10 lbs. 15 lbs. Narrow and Wide Handles The narrow and wide handles can be used for push, pull, static lift assessment, or customized tests. Protocols preprogrammed into ODES indicate to the evaluator when to use these handles; however, customized assessment protocols may be developed. Narrow and Wide Palmer Grip Handles The narrow and wide palmar grip handles can be used instead of gripping bars for push, pull, static lift assessment, or customized tests where the hands are in the palmar grip position. 227 Single Handle The single handle can be used for many one-handed or task-specific activities. Straight Bar The straight bar can be used as an alternative to the double handles or during customized tests that require working with a bar or similar object(s). Multiplanar Accessory Housing Joint All accessories are attached to the ER arms through the Multiplanar Accessory Housing Joint. Prior to attaching or removing any accessories, become familiar with the components of the Multiplanar Accessory Housing Joint. The Multiplanar Accessory Housing Joint can be attached to the upper or lower arm of the ER. It contains a load cell, which measures forces applied through many of the ER accessories. The Multiplanar Accessory Housing Joint includes a unique hinge joint in its design. This joint, coupled with the Multiplanar Accessory Housing Joints ability to rotate in horizontal planes parallel and perpendicular to the client, allows for limitless testing possibilities. 228 When facing the ER Stand, located on the right hand side of the upper or lower ER arm is a short black handle. Above this handle is a round silver pin. These two components are used to attach the Multiplanar Accessory Housing Joint to either of the ER arms. Attaching the Multiplanar Accessory Housing Joint 1. Locate the short black handle on the right-hand side of the upper or lower ER arm. The right side refers to the right when facing the ER stand. 2. Grip the handle and rotate it approximately turn in a counter clockwise direction. If this handle is overturned it will disengage and fall off the ER arm. A turn is all that is necessary when attaching the Multiplanar Accessory Housing Joint. 3. Locate the round silver pin (red arrow) above the black handle. Pull the pin outward (further to the right) and twist it gently in any direction. 4. Identify the cylinder at the end of the Multiplanar Accessory Housing Joint. 5. Insert this cylinder into the hollow end of the ER arm. 6. Relocate the silver pin at the end of the accessory arm and twist it gently until it clicks. This sound indicates that the pin has returned to its locked position. Note that the pin may be turned in any direction to lock it. 7. Relocate the short black handle and turn it slightly in a clockwise direction. The handle will come to a stop when it has locked the ER arm attachment mechanism. Removing the Multiplanar Accessory Housing Joint 1. Locate the short black handle on the end of the upper or lower ER arm. 2. Turn the handle slightly in a counter clockwise direction. Only a turn is necessary. Overturning the handle may cause it to fall off. 3. Locate the round silver pin above the short black handle. Pull the pin outward (further to the right) and twist it in any direction slightly. This will unlock the attachment mechanism. 4. Grip the Multiplanar Accessory Housing Joint firmly and pull it out of the accessory arm. 229 Once the Multiplanar Accessory Housing Joint is attached to either of the ER arms, any of the standard accessories can be attached to it. When facing the ER Stand, with the Multiplanar Accessory Housing Joint inserted, there will be two handles on the right hand side of Multiplanar Accessory Housing Joint. The handle on top is used when attaching and removing the various accessories. The handle on the bottom is used when rotating the Multiplanar Accessory Housing Joint in a vertical plane, perpendicular to the floor. The function of this handle will be discussed later. When using the short black handle at the end of the accessory arms, ensure that the handle is not overturned in a counterclockwise direction. Overturning will cause the handle to unscrew and fall off the accessory arm. When turning the handle in the counterclockwise direction to unlock it, only a turn is necessary. Attaching and removing the ER Accessories The figure below is of the Multiplanar Accessory Housing Joint, when viewed from the top. The front of the Multiplanar Accessory Housing Joint can be identified by a cord, which exits near the hinge of the joint. This cord attaches to the ER Data Acquisition Box, to register test results obtained when using the load cell. Inserting an accessory into the Multiplanar Accessory Housing Joint Locate the top handle on the right side of the Multiplanar Accessory Housing Joint. The right side refers to the side of the stand when viewing it from the front (i.e. the viewers right side). Give the handle an approximately turn in a counterclockwise direction. This will loosen the Multiplanar Accessory Housing Joint attachment mechanism. 230 Grip the handle, and pull it outward (further to the right), while maintaining a firm grip on it. This will unlock the accessory housing mechanism, by creating a space in the slot at the end of the Multiplanar Accessory Housing Joint. While holding the handle in this position, gently twist it in any direction. This will keep the handle in an unlocked position while you insert an accessory. Select the accessory to be attached. On the end of the accessory there is a flattened side and a slightly rounded side. Insert the accessory into the opening at the top of the Multiplanar Accessory Housing Joint, with the flat side of the accessory facing to the right (the side with the handle). Grip the handle on the right-hand side of the Multiplanar Accessory Housing Joint and turn until a clicking sound is heard. This indicates that the handle has locked into the accessory. Now turn the handle in a clockwise direction, until it firmly secures the accessory into the Multiplanar Accessory Housing Joint mechanism. Grip the accessory and shake it back and forth. The accessory should be firmly inserted, and not be loose in any way. Removing an accessory from the Multiplanar Accessory Housing Joint Locate the top handle on the right side of the Multiplanar Accessory Housing Joint. Give the handle an approximately turn in a counterclockwise direction. Grip the handle, and pull it outward (further to the right), while maintaining a firm grip on it, then turn it gently in any direction. This will unlock the accessory from the housing mechanism as well as maintain the space in the slot at the end of the Multiplanar Accessory Housing Joint. Grip and pull the accessory until it separates from the Multiplanar Accessory Housing Joint mechanism. Prior to performing any testing on clients, ensure that the Multiplanar Accessory Housing Joint is securely attached to the upper or lower accessory arm, and that any attachment used is firmly secured to the accessory housing mechanism. ER Shelves The ER system comes with two shelves to be used during a variety of functional tests. Each of the two shelves has a different attachment mechanism. One of the shelves has an end that is similar to the end of all other accessories. It is therefore referred to as the Accessory Shelf. This shelf is used as an accessory during functional tests and attaches directly 231 into the Multiplanar Accessory Housing Joint. It can be used to measure force during lifting, carrying or other simulated tasks using the shelf.. The second shelf has an attachment at its base and can be inserted directly into either the upper or lower accessory arm of the ER. This shelf is inserted into the accessory arms of the ER in the exact same manner that the Multiplanar Accessory Housing Joint is inserted into the ER arms. Since this shelf is not attached to the Multiplanar Accessory Housing Joint, it is unable to measure force. This shelf is referred to as the Independent Shelf. The accessory ER shelf attaches to the accessory arm through the Multiplanar Accessory Housing Joint. The independent ER shelf attaches directly to the upper or lower accessory arm. Both shelves have a safety strip at one end. This strip acts as a stopper for objects or weights placed on the shelf during testing, preventing the object or weight from falling off. Attaching the Accessory ER shelf Attach the Multiplanar Accessory Housing Joint to either the upper or lower accessory arm. Locate the top handle (identified below by the arrow) on the right hand side of the Multiplanar Accessory Housing Joint. Gently give the handle an approximately turn in a counterclockwise direction. Pull the handle outward (further to the right) and twist it gently. This will create and maintain a space in the accessory housing mechanism. Lift the accessory ER shelf and observe its end. There is a rounded side and a flattened side on the end of the shelf. Insert the shelf with the flattened side toward the right side of the accessory housing 232 mechanism. The lip on the top of the shelf should be at the back to prevent the lifting crate from being pushed off the back of the shelf. Twist the handle on the Multiplanar Accessory Housing Joint again until a clicking sound is heard. The shelf should be gripped with both hands and shaken gently to ensure that it is firmly secured within the accessory housing mechanism. Removing the Accessory ER shelf Locate the top handle on the right-hand side of the Multiplanar Accessory Housing Joint. Loosen the handle with a half turn in the counterclockwise direction. Pull the handle and twist a turn to release the pin from the shelf. The shelf should be gripped and gently rocked it back and forth until it slides out of the accessory housing mechanism. 233 Attaching the Independent ER shelf Identify the Accessory arm to which the ER shelf will be attached (upper or lower arm).Ensure that the Multiplanar Accessory Housing Joint is not attached to the desired arm. Locate the short black handle on the right hand side of the accessory. Grip the handle and gently give it a turn in a counterclockwise direction. Locate the small silver pin adjacent to the short black handle. Grip the pin and pull it outward (further to the right). Twist the pin gently in either direction. Grip the independent ER shelf and slide its end into the opening of the accessory arms end. Grip the short black handle and turn it clockwise until it locks. Grip the small round silver pin adjacent to the short handle and twist it gently until a clicking sound is heard. Removing the Independent ER shelf Locate the short handle on the right-hand side of the accessory. Turn the handle gently counter clockwise 1/8th of a rotation. Locate the small silver pin adjacent to the short black handle. Grip the small silver pin and pull it outward gently (further to the right). Twist the pin in any direction approximately turn. Grip the Independent ER shelf with both hands and gently rock it back and forth until it slides out of the accessory arm. Horizontal Shelf Rotation Whether the independent ER shelf or the accessory ER shelf is being used, the shelves can rotate in a horizontal plane parallel to the ground. Once the shelf is attached to an ER arm, it may be rotated to the left or right in increments of 45-degree angles. In order to rotate a shelf, follow these instructions:
Ensure that the shelf is firmly attached to an ER arm. Grip the shelf from its bottom and sides and pull upward until a clicking sound is heard or some give is felt in the shelf. Twist the shelf in the direction of desired rotation. A clicking sound will be heard at each 45-degree increment. While the ER shelves can rotate 360 degrees in the horizontal plane, it is not recommended that testing be conducted with the shelf rotated 180 degrees. This places the safety strip at the front of the shelf, and may interfere with the safe placement of weights on the shelf during testing. 234 If any difficulty is experienced attaching the ER shelves, check the ends of the shelves to ensure that the Independent shelf is not attached to the Multiplanar Accessory Housing Joint, or that the Accessory shelf is attached directly to an ER arm. Changing the location and orientation of ER accessories Rotating the Multiplanar Accessory Housing Joint The Multiplanar Accessory Housing Joint can be rotated in the sagittal and coronal planes. This allows you to create task simulations as individualized as your clients needs. Rotating the Multiplanar Accessory Housing Joint in the sagittal plane Locate the handle furthest from you on the right side of the Multiplanar Accessory Housing Joint, near its hinge (The handle closest to you was used to insert and remove accessories). Grip the handle and turn it in a counterclockwise direction, approximately turn. This will unlock the hinge portion of the Multiplanar Accessory Housing Joint. While still gripping the handle, pull it outto the right. While maintaining the handle in an unlocked position (do not let go of the handle), pull the Multiplanar Accessory Housing Joint forward or backward to reach the desired position. The joint will produce a clicking sound at increments of 22.5 degrees. To identify the angular position of the Multiplanar Accessory Housing Joint, observe the ruler on its left side, opposite the location of the handle. Once the Multiplanar Accessory Housing Joint is at the desired angle, release the handle back into the locked position and turn it in a clockwise direction until it is firmly secured. 235 Rotating the Multiplanar Accessory Housing Joint in the coronal plane Once the Multiplanar Accessory Housing Joint is inserted into the appropriate ER arm, locate the short black handle at the end of the ER arm. Turn the handle in a counterclockwise direction approximately rotation. Locate the small silver pin adjacent to the short black handle. Grip the pin and pull it out to the right. While maintaining the pin in an outward position, twist it gently in any direction. Grip the Multiplanar Accessory Housing Joint firmly and rotate it in the coronal plane to the desired angle. A ruler at the junction of the accessory arm and the Multiplanar Accessory Housing Joint indicates the angle of rotation. This ruler has markings at 2-degree increments and labels at 15-
degree increments. Once the Multiplanar Accessory Housing Joint has been rotated to the desired position, grip the small round silver pin and twist it gently until it returns to its locked position (tucked into the left). When you rotate the Multiplanar Accessory Housing Joint to angles of 90-degree increments (i.e. 90, 180, 270, and 360 degrees) the small silver pin will click into place to lock these angles into position. For all other angles, a click will not be heard, and the short black handle must be firmly secured to lock the Accessory Housing Joint in position. Grip the short black handle and turn it in a counterclockwise direction until it is firmly tightened. Prior to performing any testing, ensure that all handles are securely locked. When unlocking handles, only turn is necessary. Overturning will cause the handle to unscrew and fall off. When rotating the Multiplanar Accessory Housing Joint in the coronal plane, ensure that you do not pull out the Multiplanar Accessory Housing Joint or drop it. Adjusting the height and orientation of the ER arms The upper and lower arms of the ER can be moved up, down, and rotated in a horizontal plane parallel to the ER platform. The arms can be used during functional tests in combination or individually. For example, when performing a dynamic lift capacity assessment, you may attach a shelf to the lower accessory arm and have a client lift an object from the floor to the lower shelf. Alternatively, you may choose to attach both shelves, and have a client lift an object from one shelf to the other. The shelves can be used to simulate job-specific tasks facilitated by the ability to adjust the height and orientation of both ER arms. 236 The Multiplanar Accessory Housing Joint, the shelves and all of the accessories can be attached to the end of either of the ER arms. Interchanging different ER accessories or attachments has been described in detail in the previous section on the Multiplanar Accessory Housing Joint. Adjusting the height of the lower ER arm The height of the lower ER arm is controlled by two mechanisms, which are both located on the left side of the ER stand (left is defined as your left when you are facing the ER). If you follow the ER arm to its attachment on the stand, you will notice a long handle with a round black end (wide arrow). This long handle is a general locking and release mechanism for the lower ER arm. If you turn the long handle clockwise you will be locking the lower ER arm and preventing any movement from occurring. If you turn the long handle counterclockwise you will be unlocking the lower ER arm, which allows movements to occur. Immediately in front of the long handle is a round button with the words push to unlock and a picture of a hand on it (curved arrow). This button is a safety locking mechanism for the lower ER arm. Raising or lowering the lower ER arm Identify and grip the long handle at the end of the lower ER arm (where the arm meets the ER stand). This long handle is located on the left side of the ER stand when you are facing the ER. Grip the handle and turn it in a counterclockwise direction. To lock or unlock the lower ER arm movements, it is only necessary to give the handle a turn. 237 Identify the round safety button at the end of the lower ER arm (this button has a symbol of a hand on it). Push and hold down the safety button. While holding down the safety button, raise or lower the ER arm to the desired position, then let go of the button. Grip the long handle and turn it clockwise to securely lock the lower ER arm in its new position. The round button, which reads "push to unlock", is primarily a safety mechanism that prevents the lower ER arm from moving once it has been unlocked with the long handle. When you press and hold this button (provided you have unlocked the ER arm using the long handle), you will be able to raise, or lower, the ER arm. If you let go of the safety button while raising or lowering the ER arm you will hear a grinding sound. This is like an emergency breaking system. Try not to let go of the safety button too often or the mechanism may wear out. When turning the long handle clockwise, its movement will eventually be blocked, because it will be fully locked. However, when turning the long handle counterclockwise, the handle will continue to turn and eventually unwind, falling off the ER stand. This does not happen with proper, regular ER use, since under normal conditions, the handle only requires a slight turn
(1/4 rotation) to efficiently unlock the lower arm. Identifying the orientation and position of ER arms and accessories The ER features a series of graded rulers, which help determine the exact orientation and placement of the accessory arms and accessories. When you face the ER stand you will notice a vertical ruler on the left side, which indicates the height of the lower accessory arm. On the right side is another vertical ruler, which indicates the height of the upper accessory arm. These heights are automatically input into the ER software when the interface system is launched. Both rulers feature safety stoppers at the furthest ends of rotation of the arms to prevent injury when the assessors hand is placed in the vicinity of these rulers. 238 Upper Arm Ruler When you insert an accessory into the Multiplanar Accessory Housing Joint, the height of the accessory arm is recorded as the height of the accessory (from the platform), which is 7.25 inches higher than the actual accessory arm. 14.5 Inches 7.25 Inche Accessory in the UP If you place an accessory in the down position, the accessory will be an extra 14.5 inches lower than the reading on the vertical ruler (twice the height of the accessory Multiplanar Accessory Housing Joint). Therefore, when using accessories in the down position, you must add 14.5 inches to the vertical height to achieve the desired test height. For example, if you use the narrow handle in the down position to perform a static lift test, and your protocol requires a starting height of 6, you would set the vertical height of the accessory arm to 20.5
(=6+14.5). 239 In addition to the graded vertical rulers, there are two graded rulers at the top of the ER stand to measure rotation of the upper and lower arms. Each ruler provides measures in increments of 5 degrees, up to 110 degrees to the left and 110 degrees to the right. The upper ruler indicates the angle of rotation of the lower arm. The lower ruler indicates the angle of rotation of the upper arm. You now have the basic information necessary in preparation for performing functional tests and even designing your own protocols. The following section will demonstrate how to connect the ER to the Computer Diagnostic System, to achieve automatic data acquisition and analysis as well as automatic report generation. Please ensure that you thoroughly read and understand the following section prior to attempting to use the Computer Diagnostic Component. Many areas of difficulty in data acquisition arise from incorrect connections between the software and hardware components of the ER. 240 Isometric Strength Testing The curved strength-testing pad is used to cushion contact surfaces on the client when assessing strength in various postures. Using the accessory housing joint and accessory arms, the strength-testing pad can be positioned in various planes and angles. This allows the assessor complete versatility in the assessment of many joints and many ranges. To complete a static strength test using the FOCUS, click Strength Test from the main menu of ODES. This will bring you to the Strength Test page. From here, you have access to all of the pre-programmed strength tests. You can add tests to clients, create new custom isometric strength tests, edit tests and delete tests. 241 This is a list of all the tests found in the Strength Test menu. Select the test and click here to add it to a client, or double click on it. Click this button to return to the ODES main All of the tests that are assigned to the client will appear in this area. In order to edit, create or remove tests, click on the appropriate button. Protocol Hibernation puts unused protocols in storage without removing data These are short cuts to return to any of the test menu pages in ODES. The test menu that is in use will appear in yellow. Once a test has been added to a client, and Perform Test has been clicked in the bottom right-hand corner of the page (you can also double-click on the test name), your test page will appear. Below is an example of what the typical test page looks like. Click this button to Start the Strength test. 242 Click this button to return to the Strength menu. Located in this area are the default or custom instructions for the corresponding test. It should be noted that once the Start button is clicked, a message will appear stating that the force meter needs to be zeroed. This is seen in the diagram below. As there are many attachments for each load cell, ODES will account for the weight of the accessory attachment during each test. No force should be applied to the force meter. To create a new strength protocol, click New Test and then click Integrated Isometric Strength Protocol. Enter in a protocol name and select the FOCUS for the Integration type. Generally for a strength test the trial duration is 3 to 5 seconds in length with the rest between trails set to 5 seconds to allow the clients energy stores to build up again. A rest period of 5 seconds usually gives the evaluator enough time to set the client up for testing on the other side. The Custom Fields allow for additional information to be 243 entered on the screen and included in the report. Select the rest of the parameters for the test. Once Close is clicked the test will be saved and can be assigned to clients. Work Simulation Tests There are a number of different accessories that can be placed in a variety of positions to simulate various work tasks. Some preprogrammed tests, such as Static Push and Pull Strength tests require these accessories to be placed in various positions and at various heights on the ER stand depending on the task being simulated. To allow the task to be replicated at a future date and to provide further details to the readers of the report, complete the custom fields on the page. Acc. Rot. Angle refers to the accessory rotation angle, which is the angle of the FOCUS in relation to the ER arm. The Accessory Angle refers to the angle of the handle to the FOCUS. The Handle type refers to the attachment in the FOCUS (i.e. straight bar, single handle etc). The Foot Placement refers to the placement of the clients feet (i.e. staggered, together etc) based on the task requirement (i.e. pushing a cart or push controls in a confined space). Click Start Test to start the test. A pop-up window will remind you to ask the client to not touch the device so the FOCUS can calibrate itself with the handle attachment. 244 The trial, date and time that the test was performed can be found at the top of the testing page. The test results are displayed in a line graph Avg., peak and COV values are listed for right and left comparison. The results are displayed in a bar graph. In addition, the total elapsed time is displayed. The R represents a retest option for each trial that is performed by the The comments button allows the evaluator to enter their observations of the test. To create a new work simulation protocol, click New Test and then click Integrated Isometric Work Simulation Protocol. Enter in a protocol name and select the FOCUS for the Integration type. Set the parameters based on the specific job task you are trying to simulate. The Custom Fields allow for additional information to be 245 entered on the screen and included in the report. Select the rest of the parameters for the test. Once Close is clicked the test will be saved and can be assigned to clients. Integrated Dynamic Lifting and Carrying Tests To create new lifting and carrying tests click on New under the Work Simulation section of the software. Click on Integrated Dynamic Protocol. The following screen will open up. Insert a protocol name and select whether you would like the test to be a carrying or lifting test. The below example is for a carrying protocol. Select the lower height settings and enter in the distance required to 246 carry the object. If lifting is selected, the box to include the distance for carrying changes to Measure the Upper Shelf Height. Select whether you would like the tests set up for anthropometric values or not. If anthropometric measurements are selected the option of knee, knuckle, waist, elbow, shoulder, and crown are available for selecting upper and lower shelf heights. If you do not wish to use anthropometric values click on No and enter in specific heights in inches. Confirming Proper Weight use refers to whether you would like the FOCUS load cell to weigh the weight on the shelf or not. If No is selected the software will check to make sure a weight is applied to the shelf but will not be able to determine if that is the exact weight required. If Yes is selected the load cell will determine if the exact weight has been applied to the shelf. The evaluator must ensure that the client remove their handles from the object being lifted entirely for a couple seconds so the software has the opportunity to weigh the weight. You may wish to turn this function off if your client has difficulty understanding instructions. To do this highlight the test from the list on the left hand side of the screen under Work Sim and click on Edit and change it here. Next select the starting weight and the increments of weight you will be increasing by for the lifting protocol. The EPIC Lifting crate provided with the system weighs 10 pounds. If other containers are used for lifting such as a tool box to measure unilateral lifting or carrying, weight the object first. Include a rest period if the protocol you are using or if the job task you are simulating requires it. If Pain Rating is set to Yes, then two boxes will appear on the test screen for the evaluator to enter in pre and post pain ratings. Include the repetitions per weight required before additional weight is added to the lifting container. Include a Maximum Time to Complete Repetitions if the lifting protocol specifies that or if the job task requires a certain amount of lifts to be completed in a specific time. Rating of Exertions refers to the revised Borg scale that is used to determine the clients perception as to how heavy they feel the weight they are lifting is. It is a 10 point scale that ranges from 0=Like Nothing at All to 10= Too Heavy. You can the select to Stop Testing Immediately if exertion is and the various ratings for the scale are available from the drop down menu available. If this is selected in testing, once the client has selected the rating equal to or above the limit you selected (i.e. Extremely Heavy), the test will stop and you will be prompted with a screen asking if you to click Yes to accept the previous safe weight or No to accept the current weight. A heart rate cutoff can be set so that you will be warned if the clients heart is too high. The cut-off can be set based on a percentage of age (Maximum Age Predicted Maximum Heart Rate = 220-Age). Generally this is set to 85% based on the American College of Sports Medicine Guidelines. If a physician for safety concerns sets a specific heart rate cut-off, click on Specific Number and enter the value under Heart Rate Cut-Off. Response to First Heart Rate Cut-Off allows you to set the software parameters if the heart rate goes above the cut-off values you have selected. You can either have the test stop immediately or select an appropriate amount of time to allow the heart rate to recover before continuing with the test. Based on the EPIC Lifting Protocol up to a two minute rest is provided to see if the heart rate will recover. Select Heart Rate Recovery Time After Completion if you would like the software to measure the heart rate after the lifting test is completed to make sure the client recovered sufficiently before starting the next test. If this option is used you must wait for the entire time selected or click on Stop before clicking on Close or Next Protocol. A Maximum Protocol Duration time, Maximum Weight to be lifted, or a predetermined Job Demand level can be programmed into the software so that the test will stop once those parameters are met. 247 The ODES software has pre-programmed into it dynamic lifting and carrying tests:
Dynamic Lifting Floor to Waist Occasional Dynamic Lifting Waist to Shoulder Occasional Dynamic Lifting Floor to Shoulder Occasional Dynamic Lifting Floor to Waist Frequent Dynamic Lifting Waist to Shoulder Frequent Dynamic Lifting Floor to Shoulder Frequent Dynamic Carrying To use these protocols or any you programmed yourself click on Work Sim from the main menu of ODES. Select the protocol from the left hand side of the screen and add it to the client so it appears under Tests Assigned to Client. 248 Either double click on the test name or highlight it and click on Perform Test to go in to the test screen. The following screen will appear if the clients heart rate and blood pressure have not been measured and entered into Cardiovascular Intake. This must be done before you can continue with testing. If this has been done the following screen will appear. The first thing to do is to click on Weight Verification. You will be asked to take the shelf or any attachments off the FOCUS Load Cell and click OK. You will then be prompted to attach the shelf to the load cell and click OK. Make sure the shelf is in completely, the pin in place and tightened. Next you will be prompted to place 20 pounds on the shelf and then click OK twice. If more than one dynamic lifting or carrying protocol is being used for a particular client on the same day, this only needs to be done once. For the next dynamic test selected. Click on Weight Verification and click on the bottom OK to proceed with testing. Once this has been completed you will be brought back to the testing screen and the Weight Verification button changes to the Start button. Make sure the client is wearing the heart rate monitor prior to starting the test. If you are measuring the heart rate manually, double click on the heart. Enter in the value and hit the enter key. 249 For the knuckle to shoulder occasional and frequent tests, the crate starts on the middle shelf with the load cell. Once Start has been clicked on, if the correct weight is in the crate (refer to the Current Weight box on the right hand side of the screen for more details), the computer will say continue. Once the weight is returned to the shelf it will count the repetition. For all the other sub-tests, the crate is placed on the lifting platform. Every time the client lifts the crate onto the load cell they must let go of the crate for a few seconds to allow the system to weigh the crate. Once the weight has been lifted to the load cell and taken off the computer will count the repetition. Based on the parameters set up for the particular test (i.e. repetitions, ratings of exertion, etc) proceed with testing. The software will alert you when the testing will stop if ratings of exertion, heart rate, maximum protocol duration, maximum weight, or job demand level parameters have been met. To stop the test otherwise click on Stop and a screen will appear asking for you to select the reason for stopping the test (i.e. psychophysiological, biomechanical, etc). Once the test has been completed the screen will look like the following. Click on Comments to add any additional comments regarding the test. 250 EPIC Lifting Capacity Protocol (Optional Upgrade) To be able to complete this lifting protocol, the evaluator must attend an EPIC course and complete the certification process by EPIC. As well the clinic must obtain a site license from EPIC to ensure they are using the correct equipment. Please refer to your EPIC Training manual for more details on the specifics on completing the EPIC protocol. To use this component of the software, in the Work Sim section of the software, highlight the test on the left hand side of the screen and add it to the client. Either double click on the test name or highlight it and click on Perform Test to go in to the test screen. The following screen will appear if the clients heart rate and blood pressure have not been measured and entered into Cardiovascular Intake. This must be done before you can continue with testing. An additional warning screen will appear if the clients body mass index is high (this is based on the information you entered in the clients case information) and may have an impact on their body mechanics. This is to alert the evaluator to be cautious with testing. The following is the test screen. 251 Determine which of the six subtests you would like to complete. Automatically all are selected when you open the test screen. Click on them to de-select particular sub-tests. If you de-select an occasional protocol, automatically the frequent protocol and possibly another occasional protocol will be de-selected based on the EPIC protocol. Before completing weight verification set the shelf heights. The shelf heights are based on the height you entered in the clients case information. Next, click on Weight Verification. You will be asked to take the shelf or any attachments off the FOCUS Load Cell and click OK. You will then be prompted to attach the shelf to the load cell and click OK. Make sure the shelf is in completely, the pin in place and tightened. Next you will be prompted to place 20 pounds on the shelf and then click OK twice. If more than one dynamic lifting or carrying protocol is being used for a particular client on the same day, this only needs to be done once. If this has been done previously, click on Weight Verification and click on the bottom OK to proceed with testing. Once this has been completed you will be brought back to the testing screen and the Weight Verification button changes to the Start button. Make sure the client is wearing the heart rate monitor prior to starting the test. If you are measuring the heart rate manually, click on Options and select capturing the heart rate manually. To enter in the heart rate manually, enter in the value and hit the enter key. For the knuckle to shoulder occasional and frequent tests, the crate starts on the middle shelf with the load cell. Once Start has been clicked on, if the correct weight is in the crate (refer to the Current Weight box on the right hand side of the screen for more details), the computer will say continue. Once the weight is returned to the shelf it will count the repetition. For all the other sub-tests, the crate is placed on the lifting platform. Every time the client lifts the crate onto the load cell they must let go of the crate for a few seconds to allow the system to weigh the crate. Click on the Verification On button to turn this 252 feature off. Once the weight has been lifted to the load cell and taken off the computer will count the repetition. When the weight is lifted the required times a screen will appear prompting you to enter in the client rate of perceived exertion, whether they can lift the weight 8 to 12 times per day, whether they can lift more weight, and the rating for their horizontal displacement and stance. Once that information is entered in, click on Continue and the test will either continue or stop based on the EPIC Lifting Protocol. To stop the test otherwise click on Stop and a screen will appear asking for you to select the reason for stopping the test (i.e. psychophysiological, biomechanical, etc). If the heart rate is too high the software will prompt you and two minutes will be allowed for the heart rate return to the protocol specific value. If during testing you decide it is not appropriate to test all the tests you may click on Start and then on the left hand side of the screen click on the sub-test you dont want to test. Another screen will appear asking if you do not wish to use that sub-test. Click Yes to be taken to the next sub-test. The following is how a completed sub-test will look. Click on EPIC FOCUS Summary to see the information on the clients effort during testing. 253 Based on the EPIC protocol select whether the client did or did not provide a maximal acceptable effort during testing. 254 The Universal Task Master The Universal Task Master (UTM) system allows the evaluator to measure both hands simultaneously while replicating the clients required task. The UTM allows for independent hand spread, supination/pronation positioning, and force measurement. The UTM also rotates in the saggital and coronal planes, allowing for extended versatility. The UTM is a powerful tool and the evaluators imagination and ability to apply the numerous adjustments to replicate the task will be the only limitation in its use. Identification of parts associated with the UTM Please take the time to familiarize yourself with the name and appearance of each component before continuing through this manual or using the UTM. UTM Serial Cable Load Cells (2) Force Scale Position Lock 6 UTM Handles Two Single Handles Two Palmar Handles Two Box Lift Handles 255 UTM Handle Position Lock UTM Center Housing, Bar, and F.O.C.U.S Arm Insert Bar Center Housing F.O.C.U.S Arm Insert Bar Position Locking Pin UTM Bar Position Locking System Bar Position Locking Handle In order to rotate the bar, the locking handle will need to be loosened first (half turn counterclockwise). In order to lock the bar into position, tighten the locking handle (turn clockwise until tight). Inserting the UTM into the F.O.C.U.S. Arm Place the F.O.C.U.S arm insert of the UTM (seen above) into the arm of the ER Stand that is being used for the test (top or bottom arm). 256 Connecting the UTM to the Data Acquisition Box First connect the gray UTM integration cable from the UTM to the TM port on the Data Acquisition Box. Then connect the black coil cable from the left force scale to the center of the UTM and the black coil cable from the right force scale to the center of the UTM. Integration cable port Right force scale cable port Left force scale cable port The black force scale cables should not cross at the center of the UTM. Using the Universal Task Master The software comes with two UTM tests already programmed:
UTM Standard Cart Pull Test UTM Standard Cart Push Test The parameters for these two tests have been set as follows:
257 Designing a Custom Universal Task Master Test The software allows for great flexibility in customizing strength and work simulation tests using the UTM tool. A new custom integrated UTM test may be created in either the Strength Test or the Work Sim Test functions of ODES. Enter either the Work Sim Test menu or the Strength Test menu, whichever applies to the test to be created, from the ODES main menu. On the next page, click New Test. On the next page, click Universal Task Master to customize a new test using the UTM. 258 The next page allows you to input information required to customize a test. Important things to note:
The starting threshold limit is the force required on at least one side to start the test.
When choosing between average or maximum force per trial, please note that the average will disregard the first and last half-second of the trial and average out the samples in between; the maximum force will simply be the peak force applied during the trial. Be sure that, when performing a customized test, the UTM is inserted into the arm of the ER Platform that was chosen when creating the test (top or bottom arm). For heights of less than 46 inches, the bottom arm is required. For heights greater than 60 inches, the top arm is required. 259 Suggestions on Designing / Performing Custom UTM Tests The most important rule in designing / performing a test, whether using the UTM system or other components of ER Platform, is to try to replicate the position of the task as closely as possible. Replicating the job requirements will ensure an appropriate comparison of ability to demand, and will more accurately determine whether or not the individual can Once all of the information has been entered, click Close to return to the previous page. The newly created test will now appear in the left column of the Strength Test or Work Sim Test page. To perform this test, click on the test name to highlight it then click Add to Client in the middle of the page. This will add the test to the Tests Assigned to Client column. Now click on the test name in the Tests Assigned to Client column to highlight it again and click Perform Test at the bottom of the column. This will open up the test screen and allow the newly created test to be performed. 260 On the first page of the new test, click Settings . If a red X is displayed next to an item, there is a problem reading that device or position. See the troubleshooting section of this manual. Set up the UTM based on the settings selected when the test was created. Once the UTM settings are correct, click OK to go to the test screen. After clicking Start a window will pop up reminding you to make sure the client is not touching the UTM, so the device can zero itself. Click OK and the test will begin. During testing, you have the option of collecting real time heart rate information by clicking Start HR or by clicking Capture HR to add the data to the Heart Rate Report. Once the test is completed the page will look like this:
261 Once testing is complete click on the R button to the right of a trial if you need to redo that trial. Click on Comments to add specific comments regarding the clients performance on the test. To start a new test click New or to delete the current test data click Delete. To close this page, click Close or to go to a new test in sequence click Next Protocol. 262 Functional Range of Motion The Functional Range of Motion (FROM) pegboard allows an evaluator to determine the positional tolerances of a client. The FROM system utilizes Methods Time Measurement (MTM), allowing the evaluator to extrapolate for occasional, frequent or constant demands. What is Methods Time Measurement?
Methods Time Measurement (MTM) is the industrial engineering-based method for determining time-motion performance in conjunction with work-related activities. The MTM standard offers the means to determine an exact percentage score of performance against the most widely recognized criteria for the assessment of time-motion activities. The assessment of time-motion is a vital concept to many manufacturing companies throughout the world. Without the means to assess time-motion on a standardized basis, it would be very difficult for assembly lines to run effectively. It would also make it likely that the frequency of repetitive stress injuries would increase significantly, as a specific means to determine whether or not a worker was being required to perform at a level exceeding their reasonable production would be unavailable, and guesswork would be the only substitute. The MTM standard score allows an industrial engineer to effectively design production processes to most effectively complete job demands, while taking into consideration and minimizing ergonomic risk factors. MTM employs the usage of time-motion units to calculate the required performance of functional activities. The breakdown of MTM units is as follows:
1 hour 1 minute 1 second
=
=
=
100,000 tmus (time-motion units) 1,667 tmus 27.8 tmus Is MTM applicable to Functional Testing and the evaluation of individuals with disabilities?
Time-motion activities have been used in association with the evaluation of individuals with disabilities. The MTM standard score has been the most commonly used time-motion standard to date as it provides the most accurate and reliable means of evaluating performance. Other functional evaluation systems that have employed the MTM standard include WEST, VALPAR, ERGOS and Lifestyle Enhancement Systems. With respect to the evaluation of individuals with disabilities, several papers have been published throughout the world by international associations of industrial/time-motion engineers. A copy of some of these papers has been included with this manual. How is MTM used in Functional Testing?
In functional capacity evaluations, the MTM standard score allows the evaluator to determine the extent of a test subjects capacity for positional tolerances, and determine a specific productivity equivalency for the positional tolerance. Conventional positional tolerance protocols employed without a time-motion equivalency fail to take into consideration the fact that individuals must demonstrate functionality within the prescribed posture. For example, a test that asks the individual to reach overhead without the performance of a work-related activity will not be able to discern whether or not the individual is capable of performing gross manual or fine finger dexterity activities, elements crucial to overhead work. The question is not whether the individual can reach overhead, but rather if the individual is capable of performing functional activities in an overhead position. MTM also employs time-motion units to produce a standardized and reproducible method for performance of the function making the precise repetition of the functions performance and instructions very important. Variations in the performance of the function can have an impact upon the test subjects results. In tests employing the MTM standard score, a deviation in performance will usually lower the competitive level score of the test subject. The level of 263 employability of the test subject may also be classified using the results of the MTM-based tests . The classifications and the associated ranges for the tests are as follows:
Exceeding Above Competitive Above Competitive Competitive Entry Level Below Competitive Above 140%
101-140%
80-100%
70-79%
0-69%
Does MTM replace the Functional Capacities Evaluator?
The use of MTM standard scores is not intended to replace the functional capacities evaluator. It creates a standardized yet flexible basis for the administration of positional tolerance tests and the performance of time-motion activities, as well as providing a scoring basis that is objective and ensures the reproducibility of the test results. However, the observations of a skilled evaluator are still the most essential part of positional tolerance functional tests. In some situations the individual may demonstrate the ability to assume and maintain a specific posture (e.g., kneeling, crouching, etc.), but the ability to perform at a pace commensurate with industry time-motion standards may be limited. In functional capacity evaluations such limitations must be addressed to ensure the reliability and validity of the test process. Even if the test subject did not require a modification in the required posture, the skilled evaluator will still note that while the position was assumed and maintained, the performance was limited by other physiological and/or psychological factors. Those performance limitations may include, but are not restricted to the following: pain resulting in decreased functionality; inability to perform at a satisfactory level within the full functional range of the physical demand; limitations in other bodily functional areas (e.g., slowed performance in the kneeling posture due to physical limitations in handling/fingering); severely limited cognitive processing capabilities, etc. The keen eye of the skilled evaluator is critical in recording observed deviations from the norm and providing an interpretation for variations in performance. How does the MTM standard apply to the BTE Functional Range of Motion System?
The Functional Range of Motion (FROM) System has sixteen protocols for the evaluation of positional tolerances during the performance of functional activities. Eight of the positional tolerance protocols are designed for measurements in the occasional work category, while the other eight are designed for measurements in the frequent category. The number of cycles necessary to complete the occasional work demand protocols is set to most closely approximate a 5 minute timed tolerance test period. The number of cycles necessary to complete the frequent work demand protocols is set to most closely approximate a 20 minute timed tolerance test period. Separate protocols are employed in each positional tolerance for the occasional and frequent work demand categories as the common practice of extrapolating a limited time period performance to the frequent work demand capacity has been shown to be flawed. Tests that only require an individual to assume a position for a period not exceeding five minutes cannot accurately measure a workers capacity for endurance. A test subject that achieves a score in the competitive range (80-100) in the frequent demand protocol for a specific positional tolerance has demonstrated the capacity for acceptable performance over the course of an eight hour day. It will also hold true that the test subject has successfully demonstrated the capacity for acceptable performance with regard to the occasional work demand. A test subject achieving a score above 100 has demonstrated the capacity for acceptable performance at or exceeding an eight hour day equivalency. How are the MTM test results applied to the evaluation of the patient/workers abilities?
264 Many large manufacturing concerns employ industrial engineers that have derived time-motion standards for the employers work site. If an accurate analysis of the work determines that the employee must perform kneeling activities on an occasional basis, but the work flow is at a rate equivalent to a 95 MTM standard, then the evaluator has the means to determine if the worker is capable of returning to the job and the specific demands of the workplace. Although 80 to 100 MTM is considered to be in the competitive range, an employer with a specific MTM standard will want the worker at or above that standard a 95 MTM score in the example given. For employers not using time-motion standards, the ability to quantify a workers capabilities within internationally recognized time-motion standards provides a firmer basis for assessing performance than a test where the subject is asked merely to assume a given position. Is the method by which the test subject performs the process really that important?
The method by which the test subject performs a process is very important to the analysis of the demonstrated ability of that individual. Time-motion standards are set assuming the specific tasks and task elements will be performed in the most practical and efficient manner possible. For example, the upper level reach protocol of the FROM system requires the worker to remove a peg from the unit with one hand, transfer it to the opposite hand, and then place the peg into the corresponding hole in the next panel. The process allows the worker to initiate removal of the next peg while the prior one is still being placed in its proper location. However, if the test subject were to use only one hand to transfer the first peg from one panel to the other, the MTM score would reflect a significant negative influence. Specifically, the test subject would lose the advantage of having both hands work in concert. Conversely, if the test subject were to use both hands to pull two pegs out simultaneously and then move them into the appropriate holes on the corresponding panel, the test result would likely produce a higher MTM score. When should the process be modified, and how should this be reported?
Some individuals, due to impairment, may require modifications to the testing process. In such cases, use the comments section of the specific test to record any variance required to accommodate the workers ability to perform the test. Any decrement from the norm in the test score should also be explained. For example, an individual with residual effects from a closed head injury may have difficulties specifically related to one-sided weaknesses/deficits. Although the individual may be able to kneel without difficulty during the course of the test, the transfer of the peg from one hand to the other, as well as the placement of the peg into the hole using the impacted extremity, may be problematic. In a situation such as this one, it would be important to record the observation of the deficit, but also to indicate the test subject demonstrated the ability to kneel without limitations to the lower extremities. The deficit should also be explained as being a possible performance limitation that could affect the ability to perform activities in the position if manual dexterity activities are required. Should I be observing and reporting anything other than the positional tolerances in the time-motion test process?
Although the primary positional tolerance is the specific focus of a time-motion test using the FROM system, there are several secondary observations that can have a significant bearing upon a functional capacity evaluation. For instance, observations related to the upper level reach activity include, but are not limited to, the following:
the ability to work with the cervical spine in extension the ability to work with both upper extremities through a range (chest level to full extension reach) of motion the ability to perform simple repetitive activities without unnecessary breaks the ability to coordinate right and left side activities into one process 265 the possibility of tremor associated with overhead work affecting proprioception activities Obviously, some of the most unique observations will be in the area of work conducive and non-
conducive behaviors. Pain related behaviors and the consistency of the report to the impairment are critical to an appropriate evaluation of the test subject. Distraction plays an important role in the FROM systems test protocols, in order to facilitate the clients performance of the activity without focusing on the pain. Many individuals, when asked to perform a task, will focus on the completion of that task. However, if an individual is not given a specific task to perform in the associated positional tolerance, they will focus on their physical state instead, and the subjective pain report will tend to be exaggerated. This corresponds with anecdotal reports of individuals who feel much better after returning to work, after being in a self-limiting and restrictive environment such as the couch during an extended course of recovery. Some individuals are also quite competitive, and once put to a task will perform at a level that would exceed an evaluators opinion of the functional capacity of the test subject absent a time-motion/task test. Contraindications to Testing If the test subject's initial heart rate exceeds 70% of the age-predictive maximum heart rate (220 minus Test Subject's Age). If the test subject has a reported history of prior lower extremity or heart/cardiovascular problems, it may be necessary to obtain a release for this type of testing. Reason for Conclusion 1. The test subject concludes the test and reports an inability to proceed due to discomfort that makes continuation of the test impractical. 2. The test subject's heart rate exceeds 85% of the age-predictive maximum heart rate. 3. The evaluator concludes the test as the test subject appears to be unable to continue the test due to physical limitations. 4. The test is successfully completed Accessing the FROM Tests In order to access the FROM tests, a client must first be selected, or entered. Once a client has been selected, click Work Sim Test on the ODES main page. The following FROM Protocols are available in ODES:
266 F.R.O.M. Stooping with 36'' Displacement Occ PREREQUISITES The test requires the placement of the 28" high work surface table in front of the BTE Functional Range of Motion System. The test subject is allowed the opportunity to lean against the table while placing the pins in the proper holes. The test subject is also advised that he/she may return to an erect posture subsequent to the completion of a test cycle. PROCESS The test subject is instructed to move the five rows of pegs from Panel 2 - Zone B to the corresponding row of holes in Panel 3 - Zone B. The transfer process requires the test subject to take the peg out of the hole with the left hand, transfer it to the right hand while the peg is out of the hole, and then place the peg into the corresponding hole with the right hand. The test subject commences with the highest level row and then proceeds in order to the lowest level row. Once the fifteen pegs have been moved, the process is completed in reverse order until all fifteen pegs are restored to their original position. This constitutes the completion of one cycle. The test is concluded when a total of five cycles are completed. F.R.O.M. Stooping with 36'' Displacement Freq PREREQUISITES The test requires the placement of the 28" high work surface table in front of the BTE Functional Range of Motion System. The test subject is allowed the opportunity to lean against the table while placing the pins in the proper holes. The test subject is also advised that he/she may return to an erect posture subsequent to the completion of a test cycle. The test subject is also advised that a ten second rest period is provided after the completion of each five cycles until the test is completed. PROCESS The test subject is instructed to move the five rows of pegs from Panel 2 - Zone B to the corresponding row of holes in Panel 3 - Zone B. The transfer process requires the test subject to take the peg out of the hole with the left hand, transfer it to the right hand while the peg is out of the hole, and then place the peg into the corresponding hole with the right hand. The test subject commences with the highest level row and then proceeds in order to the lowest level row. Once the fifteen pegs have been moved, the process is completed in reverse order until all fifteen pegs are restored to their original position. This constitutes the completion of one cycle. The test is concluded when a total of twenty cycles are completed. 267 F.R.O.M. Stooping Occ PREREQUISITES The test subject is advised that he/she may return to an erect posture subsequent to the completion of a test cycle. PROCESS The test subject is instructed to move the five rows of pegs from Panel 2 - Row 2 - Zone C through Panel 2 - Row 1 - Zone B to the corresponding row of holes in Panel 3. The transfer process requires the test subject to take the peg out of the hole with the left hand, transfer it to the right hand while the peg is out of the hole, and then place the peg into the corresponding hole with the right hand. The test subject commences with the highest level row and then proceeds in order to the lowest level row. Once the fifteen pegs have been moved, the process is completed in reverse order until all fifteen pegs are restored to their original position. This constitutes the completion of one cycle. The test is concluded when a total of five cycles are completed. F.R.O.M. Stooping Freq PREREQUISITES The test subject is advised that he/she may return to an erect posture subsequent to the completion of a test cycle. The test subject is also advised that a ten second rest period is provided after the completion of each five cycles until the test is completed. PROCESS The test subject is instructed to move the five rows of pegs from Panel 2 - Row 2 - Zone C through Panel 2 - Row 1 - Zone B to the corresponding row of holes in Panel 3. The transfer process requires the test subject to take the peg out of the hole with the left hand, transfer it to the right hand while the peg is out of the hole, and then place the peg into the corresponding hole with the right hand. The test subject commences with the highest level row and then proceeds in order to the lowest level row. Once the fifteen pegs have been moved, the process is completed in reverse order until all fifteen pegs are restored to their original position. This constitutes the completion of one cycle. The test is concluded when a total of twenty cycles are completed. 268 F.R.O.M. Upper Level Reach Occ PREREQUISITES The test subject is asked to stand next to the side panel of the BTE Functional Range of Motion System and raise his/her right arm with fingers extended to the highest level of the test apparatus while remaining with both feet flat on the floor. The highest row reached with the distal tip of the middle finger exceeding the top of the peg hole will be the highest row used during the evaluation. If the fingertip does not exceed the top of the peg hole, the next highest row is used. The height of the top row used must be recorded in the comments section. PROCESS The test subject is instructed to move five rows of pegs from Panel 1 to the corresponding row of holes in Panel 2. The transfer process requires the test subject to take the peg out of the hole with the left hand, transfer it to the right hand while the peg is out of the hole, and then place the peg into the corresponding hole with the right hand. The test subject commences with the highest level row and then proceeds in order to the lowest level row. Once the fifteen pegs have been moved, the process is completed in reverse order until all fifteen pegs are restored to their original position. This constitutes the completion of one cycle. The test is concluded when a total of five cycles are completed. F.R.O.M. Upper Level Reach Freq PREREQUISITES The test subject is asked to stand next to the side panel of the BTE Functional Range of Motion System and raise his/her right arm with fingers extended to the highest level of the test apparatus while remaining with both feet flat on the floor. The highest row reached with the distal tip of the middle finger exceeding the top of the peg hole will be the highest row used during the evaluation. If the fingertip does not exceed the top of the peg hole, the next highest row is used. The height of the top row used must be recorded in the comments section. PROCESS The test subject is instructed to move five rows of pegs from Panel 1 to the corresponding row of holes in Panel 2. The transfer process requires the test subject to take the peg out of the hole with the left hand, transfer it to the right hand while the peg is out of the hole, and then place the peg into the corresponding hole with the right hand. The test subject commences with the highest level row and then proceeds in order to the lowest level row. Once the fifteen pegs have been moved, the process is completed in reverse order until all fifteen pegs are restored to their original position. This constitutes the completion of one cycle. The test is concluded when a total of twenty cycles are completed. A rest period of ten seconds is allowed between each set of five cycles. 269 F.R.O.M. Crouching Reach Occ PREREQUISITES The test subject is advised that he/she must remain in the crouching/squatting position and may touch only one knee down to the ground after the completion of a cycle. The knee must return to the crouch/squat position prior to the transfer of any pegs for the next cycle. PROCESS The test subject is instructed to move the five rows of pegs from Panel 1 - Zone C to the corresponding row of holes in Panel 2 - Zone C. The transfer process requires the test subject to take the peg out of the hole with the left hand, transfer it to the right hand while the peg is out of the hole, and then place the peg into the corresponding hole with the right hand. The test subject commences with the highest level row and then proceeds in order to the lowest level row. Once the fifteen pegs have been moved, the process is completed in reverse order until all fifteen pegs are restored to their original position. This constitutes the completion of one cycle. The test is concluded when a total of five cycles are completed. F.R.O.M. Crouching Reach Freq PREREQUISITES The test subject is advised that he/she must remain in the crouching/squatting position and may touch only one knee down to the ground after the completion of a cycle. The knee must return to the crouch/squat position prior to the transfer of any pegs for the next cycle. The test subject is also advised that a ten second rest period is provided after the completion of each five cycles. PROCESS The test subject is instructed to move the five rows of pegs from Panel 1 - Zone C to the corresponding row of holes in Panel 2 - Zone C. The transfer process requires the test subject to take the peg out of the hole with the left hand, transfer it to the right hand while the peg is out of the hole, and then place the peg into the corresponding hole with the right hand. The test subject commences with the highest level row and then proceeds in order to the lowest level row. Once the fifteen pegs have been moved, the process is completed in reverse order until all fifteen pegs are restored to their original position. This constitutes the completion of one cycle. The test is concluded when a total of twenty cycles are completed. 270 F.R.O.M. Axial Rotation Occ PROCESS The test subject is instructed to move five rows of pegs from Panel 1 - Zone B to Panel 6 - Zone B. The transfer process requires the test subject to take the peg out of the hole with the left hand, transfer it to the right hand while the peg is out of the hole, and then place the peg into the corresponding hole with the right hand. The test subject commences with the highest level row and then proceeds in order to the lowest level row. Once the fifteen pegs have been moved, the process is completed in reverse order until all fifteen pegs are restored to their original position. This constitutes the completion of one cycle. The test is concluded when a total of five cycles are completed. F.R.O.M. Axial Rotation Freq PROCESS The test subject is instructed to move five rows of pegs from Panel 1 - Zone B to Panel 6 - Zone B. The transfer process requires the test subject to take the peg out of the hole with the left hand, transfer it to the right hand while the peg is out of the hole, and then place the peg into the corresponding hole with the right hand. The test subject commences with the highest-level row and then proceeds in order to the lowest level row. Once the fifteen pegs have been moved, the process is completed in reverse order until all fifteen pegs are restored to their original position. This constitutes the completion of one cycle. The test is concluded when a total of twenty cycles are completed. After each five cycles the test subject is allowed a ten-second rest period. 271 F.R.O.M. Kneeling Occ PREREQUISITES The test subject is allowed the opportunity to wear knee pads if desired. The test subject is also advised that he/she must remain in the kneeling position during the course of the test until it is completed. PROCESS The test subject is instructed to move the five rows of pegs from Panel 1 - Zone C to the corresponding row of holes in Panel 2 - Zone C. The transfer process requires the test subject to take the peg out of the hole with the left hand, transfer it to the right hand while the peg is out of the hole, and then place the peg into the corresponding hole with the right hand. The test subject commences with the highest level row and then proceeds in order to the lowest level row. Once the fifteen pegs have been moved, the process is completed in reverse order until all fifteen pegs are restored to their original position. This constitutes the completion of one cycle. The test is concluded when a total of five cycles are completed. F.R.O.M. Kneeling Freq PREREQUISITES The test subject is allowed the opportunity to wear kneepads if desired. The test subject is also advised that he/she must remain in the kneeling position during the course of the test for the completion of five cycles before a ten-second rest is allowed out of the kneeling position. The rest period is allowed out of the kneeling position after every five cycles until the test is completed. PROCESS The test subject is instructed to move the five rows of pegs from Panel 1 - Zone C to the corresponding row of holes in Panel 2 - Zone C. The transfer process requires the test subject to take the peg out of the hole with the left hand, transfer it to the right hand while the peg is out of the hole, and then place the peg into the corresponding hole with the right hand. The test subject commences with the highest level row and then proceeds in order to the lowest level row. Once the fifteen pegs have been moved, the process is completed in reverse order until all fifteen pegs are restored to their original position. This constitutes the completion of one cycle. The test is concluded when a total of twenty cycles are completed. 272 F.R.O.M. Kneeling to Standing and Back Occ PREREQUISITES The test subject is allowed the opportunity to wear kneepads if desired. PROCESS The evaluator sets up one row of pegs in each of the lowest rows (yellow) in Panel 2 - Zone B and Panel 2 - Zone C. The test subject is instructed to move a row of pegs from Panel 2 - Zone C at the lowest row to the next highest row directly above the row from which the activity started. The pegs will be moved to the corresponding hole directly above. Two of the pegs must be moved with one hand and the third peg must be moved with the opposite hand. The test subject must perform all activity in Zone C in a kneeling posture while all activity performed in Zone B must be done in a standing posture. Once the pegs have reached the top row in Zone B a test cycle has been completed. The test subject then proceeds to move the pegs downward, one row at a time employing the same process. Upon reaching the lowest row of holes in Zone C another cycle has been completed. The test is concluded when a total of seven cycles are completed. This means the person will complete the test in a standing posture. F.R.O.M. Kneeling to Standing and Back Freq PREREQUISITES The test subject is allowed the opportunity to wear kneepads if desired. PROCESS The evaluator sets up one row of pegs in each of the lowest rows (yellow) in Panel 2 - Zone B and Panel 2 - Zone C. The test subject is instructed to move a row of pegs from Panel 2 - Zone C at the lowest row to the next highest row directly above the row from which the activity started. The pegs will be moved to the corresponding hole directly above. Two of the pegs must be moved with one hand and the third peg must be moved with the opposite hand. The test subject must perform all activity in Zone C in a kneeling posture while all activity performed in Zone B must be done in a standing posture. Once the pegs have reached the top row in Zone B a test cycle has been completed. The test subject then proceeds to move 273 the pegs downward, one row at a time employing the same process. Upon reaching the lowest row of holes in Zone C another cycle has been completed. The test is concluded when a total of twenty eight cycles are completed. A ten second rest period is provided after the completion of each seven cycles until the test is completed. F.R.O.M. Standing Position Occ PROCESS The test subject is instructed to move five rows of pegs from Panel 1 - Zone B to Panel 4 Zone B. The transfer process requires the test subject to take the peg out of the hole with the left hand, transfer it to the right hand while the peg is out of the hole, and then place the peg into the corresponding hole with the right hand. The test subject commences with the highest level row and then proceeds in order to the lowest level row. Once the fifteen pegs have been moved, the process is completed in reverse order until all fifteen pegs are restored to their original position. This constitutes the completion of one cycle. The test is concluded when a total of four cycles are completed. F.R.O.M. Standing Position Freq PROCESS The test subject is instructed to move five rows of pegs from Panel 1 - Zone B to Panel 4 - Zone B. The transfer process requires the test subject to take the peg out of the hole with the left hand, transfer it to the right hand while the peg is out of the hole, and then place the peg into the corresponding hole with the right hand. The test subject commences with the highest level row and then proceeds in order to the lowest level row. Once the fifteen pegs have been moved, the process is completed in reverse order until all fifteen pegs are restored to their original position. This constitutes the completion of one cycle. The test is concluded when a total of sixteen cycles are completed. The test subject is advised that a ten second rest period is provided after the completion of each four cycles. 274 F.R.O.M. Multi-Level Axial Rotation Reach - Occ PROCESS The test subject is instructed to move five rows of pegs from Panel 6 Zone A (Height Adjusted) to Panel 5 Zone B. The five rows of pegs in Panel 5 Zone B are then transferred directly across to Panel 6 Zone B. Then, the five rows of pegs in Panel 6 Zone B are transferred to the five rows in Panel 5 Zone A (Height Adjusted). Finally, the five rows of pegs in Panel 5 Zone A are transferred to the same rows in Panel 6 Zone A. This completes one cycle. A total of two cycles are completed for this test. The transfer process requires the test subject, when going from left to right, to take the peg out of the hole with the left hand, transfer it to the right hand while the peg is out of the hole, and then place the peg into the corresponding hole with the right hand. When going from right to left, the transfer process is reversed. The test subject commences with the lowest level row and then proceeds in order to the highest-level row. F.R.O.M. Multi-Level Axial Rotation Reach - Freq PROCESS The test subject is instructed to move five rows of pegs from Panel 6 Zone A (Height Adjusted) to Panel 5 Zone B. The five rows of pegs in Panel 5 Zone B are then transferred directly across to Panel 6 Zone B. Then, the five rows of pegs in Panel 6 Zone B are transferred to the five rows in Panel 5 Zone A (Height Adjusted). Finally, the five rows of pegs in Panel 5 Zone A are transferred to the same rows in Panel 6 Zone A. This completes one cycle. A total of two cycles are completed for this test. The transfer process requires the test subject, when going from left to right, to take the peg out of the hole with the left hand, transfer it to the right hand while the peg is out of the hole, and then place the peg into the corresponding hole with the right hand. When going from right to left, the transfer process is reversed. The test subject commences with the lowest level row and then proceeds in order to the highest-level row. The test subject is advised that a ten second-rest period is provided after the completion of each two cycles. Once a test has been added to a client, and Perform test has been selected in the bottom right hand corner of the page (you can also double click the test name), your test page will appear. Below is an example of what the typical test page should look like. 275 The client should be instructed in the proper technique prior to starting the test. The instructions need to emphasize that the client is required to work as quickly as possible. It is recommended that two rows of the protocol be completed, prior to starting the actual test, to make sure that the instructions were understood. Click Examiner Instructions to switch to Patient Instructions. Click on the speaker button to have the instructions read aloud by the computer. Click Start Test to start the test. Click Start Real Time Heart Rate to start recording the heart rate. Click Capture to record the heart rate in the heart rate report. Click Close to return to the Work Sim menu The FROM protocol, once started, will provide the evaluator with a counter to track the number of cycles the client has completed. The counter can be activated by either clicking on the numbered radio button
(as shown below) or by right clicking the mouse anywhere on the page. Click Pause if the client did not then Resume to continue with the understand the instructions and test when ready. 276 The test will end once you indicate (using the counter) that the final cycle is complete, or if you click End Test or Unable to Continue. If the client is unable to continue the time will still be displayed but an MTM rating will not be calculated, as the task was not completed. 277 BTE Digital Radio Frequency Heart Rate Monitor The BTE Digital Radio Frequency Heart Rate Monitor is fully integrated with the Data Acquisition Box. The use of the Heart Rate Monitor provides the ability to monitor a clients heart rate. Unlike other heart rate monitors, the BTE Heart Rate Monitor allows for constant monitoring during the work simulation tests while remaining fully integrated with the computer. The range of the BTE Heart Rate Monitor has been tested to be accurate for up to 30-50 feet. This equipment contains an RF module, which has been previously tested and found to comply with the limits for a Class B digital device, pursuant to Part 15 of the FCC Rules. These limits are designed to provide reasonable protection against harmful interference in a residential installation. This equipment generates, uses and can radiate radio frequency energy and if not installed and used in accordance with the instructions, may cause harmful interference to radio communications. However there is no guarantee that interference will not occur in a particular installation. If this equipment does cause harmful interference to radio or television reception, which can be determined by turning the equipment off and on, the user is encouraged to try to correct the interference by one or more of the following measures:
Reorient or relocate the receiving antenna. Increase the separation between the equipment and receiver. Connect the equipment to an outlet on a circuit different from that to which the receiver is connected. Consult the dealer or an experienced radio/TV technician for help. This equipment has been certified to comply with the limits for a Class B computing device, pursuant to FCC Rules. In order to maintain compliance with FCC regulations, shielded cables must be used with this equipment. Operation with non-approved equipment or unshielded cables is likely to result in interference to radio and TV reception. The user is cautioned that changes and modifications made to the equipment without the approval of manufacturer could void the users authority to operate this equipment. ATTENTION The Hanoun Digital Radio Frequency Heart Rate Monitor is a fitness-monitoring device solely intended to monitor a clients heart rate during physical testing. It is not a medical device and should not be used in any way to diagnose a clients health or to prescribe treatment. Radio frequency allows for non-interruption of signal, therefore:
Clothing does not interfere Radio signal does not require line-of-sight Movement in front of the receiver does not block the signal 278 Components BTE Digital Radio Frequency Transmitter BTE Digital Radio Frequency Receiver Polar Belt and Two Straps Two extra 9 Volt batteries and a battery charger Connecting the Heart Rate Receiver to the Data Acquisition Box The BTE Heart Rate Monitor is designed to be readily attached to the Data Acquisition Box. Please follow the instructions below:
Step 1: Attach the cable of the Receiver to Port 12. Step 2: Place the Receiver in the Heart Rate Monitor holder on the BTE Computer Station. Placement for the BTE Digital Radio Frequency Heart Rate Monitor Step 1: Place the black strap underneath your clients chest and directly against their skin. See diagram as depicted below. 279 For optimal signal, the use of electrode conductor gel or water on the heart rate monitor chest strap is recommended. For alternative placements, please see the troubleshooting section of this manual. Please note that the Hanoun Heart Rate Monitor does not operate like a Polar Heart Rate Monitor. The transmitter does not store the values, so the readings are more accurate and updated constantly. As a result, if the heart rate is fluctuating too much, the heart rate monitor may not be able to pick up a constant value and a
? will appear The heart rate must be steady in order for the device Many physiological characteristics also play a role in obtaining a heart rate and can differ from individual to individual; for example, obesity, skin conductivity and body hair composition. Body Positioning:
Back of the Client:
Place the transmitter on the back of the client, at beltline level. This is the optimal position, as it prevents the transmitter getting in the clients way during the testing procedures. First, attach the transmitter to the belt strap that is supplied with the system. Next, place the strap around the clients waist so that the transmitter is positioned on their lower back. 280 Operation of Monitor When attaching the battery to your transmitter and depressing the on/off switch, the red light on the front surface of the transmitter should light up indicating that the battery is good. The rechargeable batteries need to be charged for a minimum of 12 hours before use. The batteries are not charged when you first receive your system. After charging them they will be good for up to 4 hours of testing in the Heart Rate Monitor. If you are having difficulties capturing the clients heart rate, try to use a regular 9-volt battery. It is recommended you replace your rechargeable batteries every year. Please note that if either of the two wires which run from the battery to the Heart Rate Transmitter break, you will be responsible for their repair, as this is not covered by the warranty. If it is hard to detach the battery, use a flat object
(such as a dull knife) to act like a wedge between the metal battery terminal and the large metal battery connector. On/Off Switch Located on the top of the Transmitter is the on/off switch. Prior to monitoring the clients heart rate, depress the switch to the on position. The light will flash in time with the clients heart rate. When finished with the device, turn the on/off switch to the off position in order to preserve the life of the battery. 281 Heart Rate Receiver Testing The Receiving unit performs a self-diagnostic on a continuous basis, indicated by the red light on the back of the unit. 1 When the unit is attached to the Data Acquisition Box the red light will be illuminated to indicate that it is receiving power. 282 Recommended Care and Maintenance Schedule The following outlines the recommended maintenance schedule for your Hanoun System. A maintenance log should be kept for the equipment. It is recommended that if your computer is going to be used for other applications than ODES or if the computer is connected to a network or the Internet, anti-virus software be installed. After each Client
Clean handles with an antibacterial wipe or rubbing alcohol (70% Alcohol) for sanitary reasons. Daily
Verify the equipment to be used to ensure it is measuring accurately. If verification fails, re-
calibrate the equipment.
Make sure Handgrip is stored on the computer management stand with the end with the cord in the top hook.
Store all equipment so that the weight of the tool is not on the cord.
Turn off the data acquisition box and computer at the end of the day.
Back up your database (have a backup disk for each day of the week) Weekly
Calibrate and verify all tools.
Back up your database (have a back up disk for each week of the month) Monthly
Clean the ER Column with a mild glass (15-20% Alcohol) or degreasing cleaner with a lint free cloth.
Re-lube the column with lightweight general lubrication oil using a lint free cloth.
Check all wires to ensure they are secure and in good condition.
Compact and Repair the ODES database. Refer to ODES section of manual.
Clear hard drive of unnecessary files by going to Start Programs Accessories System Tools Disk Cleanup. Select the C Drive and select the files you wish to delete.
Run the defragmenter program to ensure optimum computer performance. To do this go to Start
Programs Accessories System Tools Disk Defragmenter. Quarterly
Remove all handles from the ER arms, FOCUS load cell and UTM and apply a white grease to them.
Check all the bolts on the EPIC crate and lifting shelves to make sure they are secure Yearly
Make sure the ER Platform is still level and make adjustments as appropriate. 283 Upon request circuit diagrams, parts lists, descriptions and other information required to repair parts may be provided to a qualified technical person. 284 Transporting the Equipment The following is required for shipping/transporting the BTE Evaluation and Rehabilitation System or components to ensure its safe arrival at its final destination:
1) Package the computer monitor, CPU, printer, and speakers in the original packaging you received them in. If you no longer have the original packaging material, it is recommended you take the equipment to a postal center to have it packaged properly. 2) All the electrical tools (hand grip, pinch grip, algometer, inclinometer, goniometer, heart rate monitor, data acquisition box, and FOCUS load cell) need to be packaged well in bubble wrap. 3) The Computer Management Stand must have the brakes on the wheels locked. If parts of the equipment (i.e. the computer and electrical tools) are being placed on the computer management stand during shipping, the stand must be bolted to a skid. Shrink-wrap can be used to prevent the load from shifting during transportation. 4) The arms must be taken off the ER Platform and packaged in bubble wrap or the original packaging they came in. 5) The handles for the FOCUS and UTM can be packaged in bubble wrap. 6) The Universal Task Master (UTM) needs to be packaged in bubble wrap. The white cable that attaches the UTM to the data acquisition box. 7) The shelves must be lowered as far as they can so as to prevent the counter weight from moving during shipping and the cable from breaking. Remove all the cables from the arms. 8) The post will need to be removed from the base of the platform. There are four screws that can be removed using an Allen key. The post needs to be in a horizontal position for shipping. 9) The base of the platform can be shipped either flat or on its side. It is recommended when packaging the base and the platform that a couple of strong people are available due to the weight of the machine. 285 BTE MEDICAL INC. SOFTWARE - End User License Agreement IMPORTANTREAD CAREFULLY: This BTE Medical Inc. End-User License Agreement (EULA) is a legal agreement between you (either an individual or a single entity) and BTE Medical Inc. for the ODES software product. The ODES software product includes computer software and may include associated media, printed materials, and online or electronic documentation
(SOFTWARE PRODUCT). By installing, copying, or otherwise using the SOFTWARE PRODUCT, you agree to be bound by the terms of this EULA. If you do not agree to the terms of this EULA, do not install or use the SOFTWARE PRODUCT; you may, however, return it to your place of purchase for a full refund. SOFTWARE PRODUCT LICENSE Copyright laws and international copyright treaties, as well as other intellectual property laws and treaties protect the SOFTWARE PRODUCT. The SOFTWARE PRODUCT is licensed, not sold. 1 GRANT OF LICENSE. This EULA grants you the following rights:
Applications Software. You may install and use one copy of the SOFTWARE PRODUCT, or any prior version for the same operating system, on a single computer.
Storage/Network Use. You may also store or install a copy of the SOFTWARE PRODUCT on a storage device, such as a network server, used only to install or run the SOFTWARE PRODUCT on your other computers over an internal network; however, you must acquire and dedicate a license for each separate computer on which the SOFTWARE PRODUCT is installed or run from the storage device. A license for the SOFTWARE PRODUCT may not be shared or used concurrently on different computers. 2 DESCRIPTION OF OTHER RIGHTS AND LIMITATIONS.
Limitations on Reverse Engineering, Decompilation, and Disassembly. You may not reverse engineer, decompile, or disassemble the SOFTWARE PRODUCT, except and only to the extent that BTE Medical Inc. expressly permits such activity in writing and where permitted by law.
Separation of Components. The SOFTWARE PRODUCT is licensed as a single product. Its component parts may not be separated for use on more than one computer.
Rental. You may not rent, lease, or lend the SOFTWARE PRODUCT.
Support Services. BTE Medical Inc. may provide you with support services related to the SOFTWARE PRODUCT (Support Services). Use of Support Services is governed by the BTE Medical Inc. policies and programs described in the user manual, in online documentation, and/or in other BTE Medical Inc.-provided materials. Any supplemental software code provided to you as part of the Support Services shall be considered part of the SOFTWARE PRODUCT and subject to the terms and conditions of this EULA. With respect to technical information you provide to BTE Medical Inc. as part of the Support Services, BTE Medical Inc. may use such information for its business purposes, including for product support and development. BTE Medical Inc. will not utilize such technical information in a form that personally identifies you. 286
Software Transfer. You may NOT transfer the SOFTWARE PRODUCT, either in whole or in part, at any time. If you transfer the SOFTWARE PRODUCT, either in whole or in part, you may be forced to pay for each additional copy or part thereof.
Termination. Without prejudice to any other rights, BTE Medical Inc. may terminate this EULA if you fail to comply with the terms and conditions of this EULA. In such event, you must destroy all copies of the SOFTWARE PRODUCT and all of its component parts. 1 UPGRADES. If the SOFTWARE PRODUCT is labeled as an upgrade, you must be properly licensed to use a product identified by BTE Medical Inc. as being eligible for the upgrade in order to use the SOFTWARE PRODUCT. A SOFTWARE PRODUCT labeled as an upgrade replaces and/or supplements the product that formed the basis for your eligibility for the upgrade. You may use the resulting upgraded product only in accordance with the terms of this EULA. If the SOFTWARE PRODUCT is an upgrade of a component of a package of software programs that you licensed as a single product, the SOFTWARE PRODUCT may be used and transferred only as part of that single product package and may not be separated for use on more than one computer. 2 COPYRIGHT. All title and copyrights in and to the SOFTWARE PRODUCT (including but not limited to any images, photographs, animations, video, audio, music, text, and applets incorporated into the SOFTWARE PRODUCT), the accompanying printed materials, and any copies of the SOFTWARE PRODUCT are owned by BTE Medical Inc. Copyright laws and international treaty provisions protect the SOFTWARE PRODUCT. Therefore, you must treat the SOFTWARE PRODUCT like any other copyrighted material except that you may install the SOFTWARE PRODUCT on a single computer provided you keep the original solely for backup or archival purposes. You may not copy the printed materials accompanying the SOFTWARE PRODUCT. 3 DUAL-MEDIA SOFTWARE. You may receive the SOFTWARE PRODUCT in more than one medium. Regardless of the type or size of medium you receive, you may use only one medium that is appropriate for your single computer. You may not use or install the other medium on another computer. You may not loan, rent, lease, or otherwise transfer the other medium to another user, except as part of the permanent transfer (as provided above) of the SOFTWARE PRODUCT. MISCELLANEOUS If you acquired this product in the United States, the laws of the State of Washington govern this EULA. If you acquired this product in Canada, the laws of the Province of Ontario, Canada, govern this EULA. Each of the parties hereto irrevocably attorns to the jurisdiction of the courts of the Province of Ontario and further agrees to commence any litigation, which may arise hereunder in the courts located in the Judicial District of York, Province of Ontario. If this product was acquired outside the United States, then local law may apply. Should you have any questions concerning this EULA, or if you desire to contact BTE Medical Inc. for any reason, please contact the BTE Medical Inc. subsidiary serving your country, or write: BTE Medical Inc. Sales Information Center/12 Ashwarren Road/Downsview, ON Canada M3J 1Z5. LIMITED WARRANTY LIMITED WARRANTY. BTE Medical Inc. warrants that (a) the SOFTWARE PRODUCT will perform substantially in accordance with the accompanying written materials for a period of ninety (90) days from the date of receipt, and (b) any Support Services provided by BTE Medical Inc. shall be substantially as described in applicable written materials provided to you by BTE Medical Inc., and BTE Medical Inc. support engineers will make commercially reasonable efforts to solve any problem issues. Some states and jurisdictions do not allow limitations on duration of an implied warranty, so the above limitation may not apply to you. To the extent allowed by applicable law, implied warranties on the SOFTWARE PRODUCT, if any, are limited to ninety (90) days. 287 CUSTOMER REMEDIES. BTE Medical Inc.s and its suppliers entire liability and your exclusive remedy shall be, at BTE Medical Inc.s option, either (a) return of the price paid, if any, or (b) repair or replacement of the SOFTWARE PRODUCT that does not meet BTE Medical Inc.s Limited Warranty and which is returned to BTE Medical Inc. with a copy of your receipt. This Limited Warranty is void if failure of the SOFTWARE PRODUCT has resulted from accident, abuse, or misapplication. Any replacement SOFTWARE PRODUCT will be warranted for the remainder of the original warranty period or thirty (30) days, whichever is longer. Outside the United States, neither these remedies nor any product support services offered by BTE Medical Inc. are available without proof of purchase from an authorized international source. NO OTHER WARRANTIES. TO THE MAXIMUM EXTENT PERMITTED BY APPLICABLE LAW, BTE MEDICAL INC. AND ITS SUPPLIERS DISCLAIM ALL OTHER WARRANTIES AND CONDITIONS, EITHER EXPRESS OR IMPLIED, INCLUDING, BUT NOT LIMITED TO, IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, TITLE, AND NON-INFRINGEMENT, WITH REGARD TO THE SOFTWARE PRODUCT, AND THE PROVISION OF OR FAILURE TO PROVIDE SUPPORT SERVICES. THIS LIMITED WARRANTY GIVES YOU SPECIFIC LEGAL RIGHTS. YOU MAY HAVE OTHERS, WHICH VARY FROM STATE/JURISDICTION TO STATE/JURISDICTION. LIMITATION OF LIABILITY. TO THE MAXIMUM EXTENT PERMITTED BY APPLICABLE LAW, IN NO EVENT SHALL BTE MEDICAL INC. OR ITS SUPPLIERS BE LIABLE FOR ANY SPECIAL, INCIDENTAL, INDIRECT, OR CONSEQUENTIAL DAMAGES WHATSOEVER (INCLUDING, WITHOUT LIMITATION, DAMAGES FOR LOSS OF BUSINESS PROFITS, BUSINESS INTERRUPTION, LOSS OF BUSINESS INFORMATION, OR ANY OTHER PECUNIARY LOSS) ARISING OUT OF THE USE OF OR INABILITY TO USE THE SOFTWARE PRODUCT OR THE PROVISION OF OR FAILURE TO PROVIDE SUPPORT SERVICES, EVEN IF BTE MEDICAL INC. HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. IN ANY CASE, BTE MEDICAL INC.S ENTIRE LIABILITY UNDER ANY PROVISION OF THIS EULA SHALL BE LIMITED TO THE GREATER OF THE AMOUNT ACTUALLY PAID BY YOU FOR THE SOFTWARE PRODUCT OR U.S.$5.00; PROVIDED, HOWEVER, IF YOU HAVE ENTERED INTO A BTE MEDICAL INC. SUPPORT SERVICES AGREEMENT, BTE MEDICAL INC.S ENTIRE LIABILITY REGARDING SUPPORT SERVICES SHALL BE GOVERNED BY THE TERMS OF THAT AGREEMENT. BECAUSE SOME STATES AND JURISDICTIONS DO NOT ALLOW THE EXCLUSION OR LIMITATION OF APPLY. LIMITATION LIABILITY, ABOVE MAY NOT THE 288 Trouble Shooting Data Acquisition Box Error in initialization to BTE Data Acquisition Device:
Click Auto in Administration | Environment Settings Is the light on in the back of the box (red)? If so, turn box off for 30 seconds, then go to Administration |
Environment Settings, turn the box on and click Auto. If the red light still does not go off, unplug all the tools, turn off the Data Acquisition Box and turn it back on. Click on Auto and add one tool at a time and then click Auto. If a tool is plugged in a the above error is seen, this tool is shorting out the Data Acquisition Box. Call BTE Customer Service for repair. Is the light on in the front of the box? If not, make sure the box is on and connected properly. Try alternative power outlet if light still does not go on. Is the tool connected tightly into the port on the front of the Data Acquisition Box?
Is the serial cord connected tightly to COM port and to the DAC box?
Is there Palm Pilot or another Personal Device Assistant software loaded on the computer? A HotSync icon (see below) in the bottom right hand corner of the screen is usually visible. Also check for the software under Start Programs. If so, close the icon (it blocks the COM port) by right clicking your mouse over it and select Exit. Turn off the box, unplug all attachments from the front of the box, unplug the power supply from the box, get out of ODES, shut down computer for 1 min. Turn the computer back on, get into ODES, plug the power supply for the box in, turn the box on and click Auto in Administration | Environment Settings. Check you printer setting under Start Settings Printers to see which port they are printing to. If it is set to COM1 it is blocking the serial port for the Data Acquisition Box. Change the port to LPT or USB depending on where you plug the printer into the computer. Check the status of your computers COM port by going to Start Settings Control Panel System
Hardware Device Manager. Double click on Ports and then double click on the COM port. The status of the COM port will be outlined in there. If it is not working properly following the troubleshooting tips there. 289 Inclinometer and Goniometer If the interface system cannot be launched when using the BTE Dual Inclinometers, ensure that:
The cords are properly connected (into the Data Acquisition Box and between the Master and the Remote) The Range of Motion test that is selected in ODES is designed for use with either the Inclinometers or the Goniometer, or is non-integrated. Check the top left corner of the test page to determine which tool the software is looking for. If you receive this message upon entering a range of motion testing page, you may not have the Data Acquisition Box set up properly, or the device may not be attached correctly. Upon entering the testing screen, you will notice a red X beside the testing tool. This indicates a lack of communication between the tool and the Data Acquisition Box. Ensure that the tool is in the correct port. 290 Hand Grip, Pinch Grip, Algometer, and FOCUS No Testing can be done until this device has been calibrated or verified:
Has the tools been calibrated and verified? If not, calibrate and verify. Is the Calibration/Verification reminder set to must be done or reminder in Administration |
Environment Settings? If on must be done, calibration must occur prior to performing a test. If set to reminder tests can be performed without a new calibration. The voice is not beginning the count down on your screen. You cannot perform any test (no prompts). Go into Administration Environment Settings. Make sure that Voice Response is on. Try to switch the voice type to see if there are any problems with the speech software. If an error occurs you will need to re-load the SAPI51 file located on the ODES CD under the Speech folder. Cannot start the strength test that has been selected Are your voices installed properly?
291 Do you have the correct tool selected? Only one strength tool can be associated with a protocol. You have to create a duplicate test to utilize both the FOCUS and Algometer for a given protocol. To check if the correct tool is selected, highlight the test from the Strength Protocol Screen. Click Edit Test and see which tool is selected. NOTE: If you have previously done testing with this protocol, you will receive a warning prior to entering the Edit Test screen. This will alert you that any changes made to the protocol may affect data obtained previously for other clients. Edit Test Screen: If you have performed this test with a tool already, the Integrate Custom Test By section will be deactivated to prevent you from changing tools. This is why you have to create a duplicate copy of the test to utilize a different testing device. 292 If the wrong tool is selected, create a new test using the same values (just a different name) If the correct tool is selected, ensure that your DAC box is set up successfully. If you still cannot perform the test, contact our customer service department at (800) 461-6888 X2. Evaluator/CIRES Systems:
Ensure that your device settings are both set to PORT 6 in Administration Environmental Settings. This will ensure that the Algometer will work in both the strength testing screens and in the superficial tenderness testing screens. To check device settings, go to Administration Environment Settings from the ODES main menu. The device settings are listed in the upper right-hand corner of the screen. The F and P values should both say 6. If they dont (as shown above), double click on the word Device Settings. Device Settings should now be in red. 293 You are now able to modify the number located beside F to 6. To do this, click on the number 3 until it reads 6. You have now set the Algometer to read in only port 6 for both strength and fibromyalgia tests. Ensure that the Algometer is plugged into port 6. Troubleshooting the Multiplanar Accessory Housing Joint If you have problems inserting or removing the Multiplanar Accessory Housing Joint from one of the ER arms, try the following:
Locate the small round silver pin on the right side of the upper or lower accessory arm (this pin is located at the end of each arm). Try pulling the pin outward (further to the right), and then twist it slightly in any direction. This will create space in the opening of the accessory arms end. Locate the short black handle on the right side of the upper or lower accessory arm. This handle is located at the end of each accessory arm. Turn the handle in a counterclockwise direction. This will loosen the opening in the accessory arm. These steps should loosen the openings in the ends of the accessory arms, and create space for the insertion or removal of the Multiplanar Accessory Housing Joint. If you have problems securing the Multiplanar Accessory Housing Joint to one of the ER arms, try the following:
Locate the small round silver pin on the right side of the upper or lower accessory arm. This pin is located at the end of each arm. Ensure that the pin is in the locked position (tucked into the far left). If it is not, twist it slightly in any direction, until you hear a click. This will tighten the space in the opening of the accessory arms end and secure the Multiplanar Accessory Housing Joint. Troubleshooting: Accessory Attachment and Removal If an accessory cannot be inserted into the Accessory Housing Joint, try the following:
Locate the handle on the top of the Accessory Housing Joint. This handle is on the right side of the Multiplanar Accessory Housing Joint. Make sure that the handle is set to the unlocked position. In order to be in the unlocked position, the handle must be given a turn in a counter-clockwise direction, and then pulled outward. The handle can be maintained in the unlocked position by twisting it gently in either direction. Select the accessory to be attached. Be sure that the flattened end of the accessory is being inserted into the housing mechanism facing to the right. Grip the handle and twist it gently until a click is heard. If an accessory cannot be removed from the accessory housing mechanism, try the following:
Locate the top handle of the Multiplanar Accessory Housing Joint. Pull the handle and twist it gently in any direction. 294 Grip the accessory and pull it out of the Accessory Housing mechanism. You may need to gently rotate the accessory and pull it upward in order to remove it. Locate the short black handle on the right side of the upper or lower accessory arm. This handle is located at the end of each accessory arm. Turn the handle in a clockwise direction. This will tighten the opening in the accessory arm, and secure the Multiplanar Accessory Housing Joint. These steps should tighten the openings at the ends of the accessory arms, and create a tighter fit around the cylinder of the Multiplanar Accessory Housing Joint. Troubleshooting: Multiplanar Accessory Housing Joint Rotation If you cannot rotate the Multiplanar Accessory Housing Joint in the sagittal plane, try the following:
Ensure that you are using the correct handle. There are two handles on the Multiplanar Accessory Housing Joint. The handle furthest from you when you are facing the ER, on your right-hand side, is the one to adjust for sagittal rotation. Ensure that you turn the handle counterclockwise approximately rotation. Ensure that you pull the handle outward and hold it in this position while rotating the Multiplanar Accessory Housing Joint. If you cannot rotate the Multiplanar Accessory Housing Joint in the coronal plane try the following:
Ensure that the short black handle is properly unlocked by turning it counterclockwise approximately rotation. Ensure that the small round pin is properly unlocked by pulling it outward (further to the right) and twisting is gently in any direction. Grip the Multiplanar Accessory Housing Joint and gently shake it to ensure that it is not stuck in a particular position. If the load cell does not appear to be accurate after you have calibrated it, check the following:
Was the Multiplanar Accessory Housing Joint properly connected to one of the ER accessory arms?
Did you calibrate the load cell with NO ATTACHMENTS on the Multiplanar Accessory Housing Joint?
Was the Multiplanar Accessory Housing Joint properly connected to the Data Acquisition Box?
Was the computer properly connected to the Data Acquisition Box?
Was the main power supply of the Data Acquisition Box properly connected?
Was the main power switch of the Data Acquisition Box turned to the ON position?
I feel the ER shelf height readings are not correct Ensure the cable connections are correct and are tight at either end. Check that it is plugged into the correct port. Re-calibrate the shelves. Check the DAC Box troubleshooting section. If you are still having difficulty, re-route the cord from the DAC Box directly to the shelf (i.e. single cord connection rather than a two-cord connection through the junction box at the base of either shelf ruler). BE AWARE that the shelf height reading refers to the arm with the shelf / accessory attached and in the up position. If horizontal then you must subtract 7.25 inches and if down you must subtract 14.5 inches from the shelf height reading. 295 Universal Task Master When I go into a UTM test, I get a message that says Click OK to Calibrate but I just calibrated my UTM. ODES and the UTM perform a self-calibration each time you use the UTM load cells. Since you calibrate your UTM system without any accessories attached, the computer needs to first measure the accessory prior to commencing a test. This will re-zero the load cell to include the accessory. Once you click OK, you may proceed with the test. One of the UTM load cell readings is not correct. Ensure the cable connections are tight at the UTM center. Ensure the cable connections are tight at the Data Acquisition Box. Re-calibrate the load cell. Check the Data Acquisition Box troubleshooting section. The UTM handle rotation readings are not correct. Ensure the cable connection is tight at the UTM center. Ensure the cable connections are tight at the Data Acquisition Box. Re-calibrate the handle rotation. Check the Data Acquisition Box troubleshooting section. The UTM force scale distance readings are not correct. Ensure the cable connection is tight at the UTM center. Ensure the cable connections are tight at the Data Acquisition Box. Re-calibrate the force scale distances. Check the Data Acquisition Box troubleshooting section. Cannot select Start Test for one of the UTM tests. Ensure the cable connection is tight at the UTM center. Ensure the cable connections are tight at the Data Acquisition Box. Re-calibrate the UTM. Check the Data Acquisition Box troubleshooting section. Exit the screen and re-enter the test. Cannot see the Universal Task Master calibration icon in the Utilities menu. The Universal Task Master option is not installed on your computer. Call the Customer Service Department at BTE Medical. Cannot select the Universal Task Master icon when I try to create a new strength test or work simulation test. The Universal Task Master option is not installed on your computer. Call the technical support department at BTE Medical. 296 Heart Rate Monitor Why am I not getting a reading with my Transmitter?
Is the red light on the back of the Transmitter flashing?
Is the receiver plugged into PORT 12 on the DAC box?
Under HelpAbout do you see HR=117? If not call BTE to unlock your Heart Rate Monitor. Does the Transmitter battery need to be recharged?
Have you tested the Transmitter on a different subject?
Are you using a 9-volt battery? Have you tried a non-rechargeable one?
297 BTE Training Programs BTE Medical Inc provides superior training to complement its leading technology. Introductory and advanced courses are available. ER Level One This two day training course is for any individual who will be using the BTE functional testing technology. Training will cover the use of each individual tool, basic principles of functional evaluations, how to use the protocol grid and evaluations handbook, testing analysis, report writing and more. ER Level Two This one-day course covers advanced applications of the use of the BTE software and technology. The course is developed ideally for those evaluators who have completed the ER Level One course, are familiar with the system, and have completed a minimum of 20 functional tests. The course will include several cases studies to improve the evaluators evaluation, analysis, and report writing skills. E.P.I.C. Lifting Capacity The ELC is the only peer reviewed and published lift capacity protocol, which measures all three domains of function (biomechanical, physiological and psychophysiological). This one-day course is designed to prepare healthcare professionals and technicians to provide standardized, reliable, valid and defensible evaluations with the ELC evaluation. Information on course dates is provided to those who are interested. Continuing Education Courses BTE provides continuing education courses in post offer of employment testing, advanced marketing applications, report writing, National Disability Evaluators Program and many others. Information regarding these courses is posted on our website. To obtain dates of upcoming courses and to register:
On-Line www.BTETech.com Call
(800) 331-8845 and ask for course registration 298
frequency | equipment class | purpose | ||
---|---|---|---|---|
1 | 2006-02-27 | 902.7 ~ 926.05 | DTS - Digital Transmission System | Original Equipment |
app s | Applicant Information | |||||
---|---|---|---|---|---|---|
1 | Effective |
2006-02-27
|
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1 | Applicant's complete, legal business name |
BTE Technologies, Inc.
|
||||
1 | FCC Registration Number (FRN) |
0014420616
|
||||
1 | Physical Address |
7455-L New Ridge Road
|
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1 |
Hanover, Maryland 21076
|
|||||
1 |
United States
|
|||||
app s | TCB Information | |||||
1 | TCB Application Email Address |
t******@metlabs.com
|
||||
1 | TCB Scope |
A4: UNII devices & low power transmitters using spread spectrum techniques
|
||||
app s | FCC ID | |||||
1 | Grantee Code |
TV3
|
||||
1 | Equipment Product Code |
DAQRETROFIT
|
||||
app s | Person at the applicant's address to receive grant or for contact | |||||
1 | Name |
J******** P****
|
||||
1 | Title |
VP of Engineering
|
||||
1 | Telephone Number |
410-8********
|
||||
1 | Fax Number |
410-8********
|
||||
1 |
j******@btetech.com
|
|||||
app s | Technical Contact | |||||
n/a | ||||||
app s | Non Technical Contact | |||||
n/a | ||||||
app s | Confidentiality (long or short term) | |||||
1 | Does this application include a request for confidentiality for any portion(s) of the data contained in this application pursuant to 47 CFR § 0.459 of the Commission Rules?: | Yes | ||||
1 | Long-Term Confidentiality Does this application include a request for confidentiality for any portion(s) of the data contained in this application pursuant to 47 CFR § 0.459 of the Commission Rules?: | No | ||||
if no date is supplied, the release date will be set to 45 calendar days past the date of grant. | ||||||
app s | Cognitive Radio & Software Defined Radio, Class, etc | |||||
1 | Is this application for software defined/cognitive radio authorization? | No | ||||
1 | Equipment Class | DTS - Digital Transmission System | ||||
1 | Description of product as it is marketed: (NOTE: This text will appear below the equipment class on the grant) | Strength measurement equipment. | ||||
1 | Related OET KnowledgeDataBase Inquiry: Is there a KDB inquiry associated with this application? | No | ||||
1 | Modular Equipment Type | Does not apply | ||||
1 | Purpose / Application is for | Original Equipment | ||||
1 | Composite Equipment: Is the equipment in this application a composite device subject to an additional equipment authorization? | No | ||||
1 | Related Equipment: Is the equipment in this application part of a system that operates with, or is marketed with, another device that requires an equipment authorization? | No | ||||
1 | Grant Comments | Power Output Listed is peak Conducted. | ||||
1 | Is there an equipment authorization waiver associated with this application? | No | ||||
1 | If there is an equipment authorization waiver associated with this application, has the associated waiver been approved and all information uploaded? | No | ||||
app s | Test Firm Name and Contact Information | |||||
1 | Firm Name |
MET Laboratories, Inc.
|
||||
1 | Name |
J****** M****
|
||||
1 | Telephone Number |
410-3********
|
||||
1 | Fax Number |
410-3********
|
||||
1 |
j******@metlabs.com
|
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Equipment Specifications | |||||||||||||||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Line | Rule Parts | Grant Notes | Lower Frequency | Upper Frequency | Power Output | Tolerance | Emission Designator | Microprocessor Number | |||||||||||||||||||||||||||||||||
1 | 1 | 15C | 902.70000000 | 926.05000000 | 0.0180000 |
some individual PII (Personally Identifiable Information) available on the public forms may be redacted, original source may include additional details
This product uses the FCC Data API but is not endorsed or certified by the FCC