Biodex System Pro

BIODEX MULTI-JOINT SYSTEM - PRO
SETUP/OPERATION MANUAL
850-000
850-000-10
850-000-30
BIODEX
Biodex Medical Systems, Inc.
20 Ramsey Road, Shirley, New York, 11967-4704, Tel: 800-224-6339 (Int’l 631-924-9000), Fax: 631-924-9338, Email: info@biodex.com, www.biodex.com
FN: 08-262 Rev B 8/14
BIODEX SYSTEM PRO
This manual contains installation and operation procedures for the following
Biodex products:
#850-000 Biodex Multi-Joint System, PRo
#850-000-10 Biodex Multi-Joint System, JPN
#850-000-30 Biodex Multi-Joint System, w/o CMP
NOTE: All or some of the following symbols, cautions, warnings and notes may apply to your Biodex PRO
and correspond to this operation manual:
Symbol Meaning
! Attention, consult accompanying documents.

! Symbol signification: Attention, se référer à la notice.
! Warning: Injuries to health may result from incorrect or excessive training.
! Attention, incorrect ou extrême entrainement peut aboutir des lesíons au santé.
NOTE: Circuit diagrams for this product are available upon request.
— II —
TABLE OF CONTENTS
INTRODUCTION ..................................................................................................................................IV
BEFORE PROCEEDING ..........................................................................................................................V
1. CONTROLS AND ADJUSTMENTS ..............................................................................................1-1

Dynamometer....................................................................................................................................1-4
Positioning Chair ..............................................................................................................................1-7
Seat Back Brace..................................................................................................................................1-7
Controller ..........................................................................................................................................1-8
Dynamometer Attachments ............................................................................................................1-9
Using the Combination Ankle Attachment (for All Ankle Patterns and
Knee: Tibial Internal/External Rotation) ....................................................................................1-11
2. OPERATION ........................................................................................................................................2-1
Considerations for Safe Operation of Your Biodex Multi-Joint System ..................................2-1
Readying the System for Use ..........................................................................................................2-3
Modes of Operation..........................................................................................................................2-3
Additonal Considerations ..............................................................................................................2-8
Proper Testing Technique................................................................................................................2-8
3. SETUP AND POSITIONING FOR STANDARD TEST AND EXERCISE PATTERNS ......3-1
Knee Extension/Flexion ..................................................................................................................3-2
Ankle Plantar/Dorsiflexion (Seated) ............................................................................................3-6
Ankle Inversion/Eversion ............................................................................................................3-10
Hip Abduction/Adduction (Lying on Side) ..............................................................................3-13
Hip Extension/Flexion (Supine) ..................................................................................................3-16
Shoulder Extension/Flexion (Seated)..........................................................................................3-19
Shoulder Abduction/Adduction (Seated) ..................................................................................3-22
Shoulder Internal/External Rot. in Modified Neutral Position ..............................................3-25
Shoulder Internal/External Rot. in 90-Degrees of Abduction ................................................3-28
Shoulder Diagonal (Seated) ..........................................................................................................3-31
Shoulder Diagonal (Standing) ......................................................................................................3-34
Elbow Extension/Flexion ..............................................................................................................3-37
Forearm Pronation/Supination ....................................................................................................3-40
Wrist Extension/Flexion................................................................................................................3-43
Wrist Radial/Ulnar Deviation ......................................................................................................3-46
4. USING ThE OPTIONAL CLOSED ChAIN ATTAChMENT ..................................................4-1
Introduction ......................................................................................................................................4-1
Setup Procedure ................................................................................................................................4-2
Upper Extremity Exercise................................................................................................................4-4
Lower Extremity Exercise................................................................................................................4-4
Applications ......................................................................................................................................4-5
Technical Information ......................................................................................................................4-8
5. REFERENCE MATERIALS ..............................................................................................................5-1
Suggested Test Speeds ....................................................................................................................5-1
Legal Precedents ..............................................................................................................................5-2
Biodex Data Admitted as Medical Evidence in Court ................................................................5-2
Patient Progress Chart ....................................................................................................................5-3
Current Recorded Normative Goals (English Units) ..................................................................5-4
Current Recorded Normative Goals (Metric Units) ....................................................................5-5
6. APPENDICES ......................................................................................................................................6-1
EMG/Analog Signal Access Interface ..........................................................................................6-1
Maintenance ......................................................................................................................................6-4
System Specifications ......................................................................................................................6-5
Conformance to Standards..............................................................................................................6-7
Declaration of Conformity ..............................................................................................................6-8
Recommended Separation Distance ............................................................................................6-10
General Product Warranty ............................................................................................................6-11
— III — TABLE OF CONTENTS

INTRODUCTION
Congratulations, you’ve made an excellent choice!
By selecting the Biodex Multi-Joint System you have acquired the most advanced, versatile and
reliable technology ever developed for testing and rehabilitation of the human musculoskeletal
system. You’ve also joined the Biodex team of satisfied customers who benefit from unsurpassed
product education, customer service, promotional and clinical support.
With your new system, you can offer testing and rehabilitation services for the knee, ankle and
hip plus the shoulder, elbow, forearm and wrist. Modes of operation for exercise and testing
include Isokinetic, Passive, Isometric, Isotonic and Reactive Eccentric. What’s more, you’ll be able
to test and exercise over the broadest range of speeds available today. Biofeedback is provided by
the high resolution color graphics monitor to encourage patient compliance with exercise proto-
cols.
You’ll also appreciate the Windows-based Biodex Advantage Software touch screen package that
comes with your system. Our patient database prompts quick and easy retrieval of patient infor-
mation while Windows flexibility makes protocol selection and patient setups a snap. The wide
variety of output reports allows numeric and graphic information to be printed in a number of
different formats. Third party payers and referring physicians receive information that is com-
plete but not overwhelming.
The versatility of the Biodex Multi-Joint System facilitates effective treatment of a broad range of
patients and pathologies. If you add the Back, Lift and Work Simulation options, your Biodex
Multi-Joint System is transformed into a comprehensive clinic. The future certainly looks bright
for you and your patients! Thank you for allowing Biodex Medical Systems, Inc., to be a part of it.
NOTE: PRODUCT ENHANCEMENTS AND MODIFICATIONS

Due to on-going product enhancements and modifications, the Biodex Multi-Joint System you have
purchased may differ slightly from the system depicted in the photographs and illustrations used in
this manual.
INTRODUCTION — IV —
BEFORE PROCEEDINGTABLE OF CONTENTS
! Before you get started with any of the setups described in this manual, there are a few
preliminary points to consider which will help ensure safe and smooth operation of your
Biodex Multi-Joint System.
• This system should be operated only by qualified personnel.
• Ensure that all system wiring and cables are routed away from any area where they
might be stepped on or rolled over by wheeled equipment.
• For testing and exercise patterns in which the positioning chair will be used, we sug-
gest the chair be set to its minimum height before allowing a subject to mount or dis-
mount. It may also help to have a fixed location from which all subjects approach and
leave the chair.
• Be aware that use of Biodex technology requires professional expertise for discerning
appropriate treatment techniques. Each subject’s unique situation should be taken
into account before beginning any type of testing or rehabilitation program. Be sure
you fully comprehend the operating instructions, as well as the considerations, both
physical and clinical, discussed throughout the manual before attempting to set up a
subject for testing or exercise. Practice setups and positioning with a healthy subject
before attempting to set up an injured patient.
• Instructions for each of the patient setups provided later in this manual assume that the
clinician is starting with the system in its neutral position, as illustrated in Figure 1.1.
• To assist our users and stimulate interest in developing protocols, this manual con-
tains a ”Clinical Applications” section where appropriate. These comments come
from the clinical experience of our users as well as from published journals.
• The setups presented in this manual are intended to cover most patient protocols.
However, because the Biodex Multi-Joint System is so versatile and adaptable, you
may find additional setups possible. It is suggested that the clinician try the setups
presented herein before attempting any setup improvisations (especially for testing
applications). If you do use a pattern that deviates from the manual, be sure to fully
document it in your “Patient File” notes.
! CAUTION: Placing your hands or fingers between the dynamometer input shaft (or
attachment) and the mechanical ROM stops may result in serious injury.
NOTE: Service should be provided by qualified personnel only. Please do not attempt installation or repair
on your own. Call Biodex Customer Service first, they’ll be glad to help.
For additional technical advice, service or educational information, contact Biodex personnel at
the following address:
Biodex Medical Systems, 20 Ramsey Road, Shirley, New York 11967-4704.
In New York and Int’l, (631) 924-9000, 1 (800) 224-6339 (Customer Service), FAX: (631) 924-8355
—V— BEFORE PROCEEDING

AVANT TOUTE APPLICATION
! Avant d'appliquer les montages décrits dans cette notice, plusieurs consignes aideront à
obtenir une utilisation sûre et facile de votre système BIODEX.
• Utilisation de ce système doit être limité au personnel qui a les qualités requises.
• Vérifier que tous les câbles et cordons suivent un trajet qui ne traverse ni un zone de
travail ni une zone de déplacement des pièces mobiles.
• Pour les mouvements d'examen ou d'entraînement nécessitant une chaise accessoire,

régler la chaise accessorie à sa position la plus basse avant de faire monter ou descen
dre le patient. Dans certains cas un accèss fixe à la chiase peut être utile.
• La technologie BIODEX nécessite une expertise professionelle pour choisir la tech

nique thérapeutique appropriée. La situation de chaque patient doit déterminer le
programme de rééducation. S'assurer de bien comprendre la présente notice ainsi que
le contexte clinique associé avant d'applier la technologie pour l'examen ou la rééd
cation d'un patient. S'entraîner à faire des montages avec des sujets sains avant d'en
faire avec un patient.
• Le indications pour les montages spécifiques fournies dans les pages qui suivent pren-
nent comme point de départ le système dans sa position neutre montré à l'image 1.1.
• Pour aider nos clients à développer leurs protocoles, cette notice contient certains
passages sur des applications cliniques. Ces textes tiennent compte de l'expérience des
utilisateurs BIODEX et des informations publiécs mais ne puevent pas remplacer
le jugement clinique.
• Les montages présents dans la présente notice couvrent la plupart des protocoles.
Toutéfois les nombreuses possibilités du système BIODEX permettent d'autres mon
tages. On conscille d'utiliser les montages de la notice avant de réaliser des improvi
sations, surtout pour les applications d'examen. Si vous utilisez un mouvement dif
férent de ceux trait´s, notez-en les détails dans votre dossier patient.
! ATTENTION: Placer vos mains ou doigts entre le dynamometer données (ou attache-
ment) et le mécanique ROM arrêts peut résulter dans sérieux blessure.
BEFORE PROCEEDING — VI —
X
Figure 1.1. The Biodex Multi-Joint System - PRO positioning configuration.
— VII — BEFORE PROCEEDING

1. CONTROLS AND ADJUSTMENTS
2
13
14
12 10
5
1 BIODEX HOLD / RESUME
COMFORT STOP
9
11
3
6 7 8 9
4
Figure 1.2. Dynamometer positioning controls and adjustments.

1. Dynamometer Rotation Knob
2. Dynamometer Tilt Knob
3. Dynamometer Height Lever
4. Dynamometer Foot Pedals (travel)
5. Shaft Red Dot (on dynamometer shaft)
6. Rotate Counterclockwise Button
7. Rotate Clockwise Button
8. Hold/Resume Button
9. Comfort Stop
10. Dynamometer Locking Knob Storage
11. Dynamometer Position Color Code Label
12. Dynamometer Yoke
13. Dynamometer Tilt Scale
14. Dynamometer Tilt Key
DYNAMOMETER
(Refer to Figure 1.2.)
Dynamometer Rotation: To rotate the dynamometer in a horizontal plane, loosen

the Dynamometer Rotation Knob by turning it counterclockwise. You may now
rotate the dynamometer in either direction. To secure the dynamometer rotation
position, tighten the knob in a clockwise direction and ensure that the dynamome-
ter teeth are engaged. Use the Dynamometer Rotation Scale, located on the base of
the dynamometer directly beneath the yoke, to note the new position.
CONTROLS AND ADJUSTMENTS — 1-1 —

SYSTEM SPECIFICATIONS
Dynamometer Tilt: Permits rotation of the dynamometer

on a vertical plane allowing the shaft axis to tilt upward or
0
downward from the horizontal position. To tilt the
(Dynamometer Tilt Degrees)

dynamometer, support the dynamometer with one hand.
With the other hand, loosen the Dynamometer Tilt Knob 0
in a counterclockwise direction. You can now gently push
or pull the dynamometer to the desired position. Tighten the knob firmly in
a clockwise direction, and ensure that the dynamometer teeth are engaged, 50
to secure the dynamometer in place. Use the Dynamometer Tilt Scale (locat-
ed on the yoke) to note the new dynamometer tilt position. Use the 50
Dynamometer Tilt Key (located on directly beneath the Dynamometer Tilt
Scale for a quick reference during patient set-up.
5
Dynamometer height: The dynamometer can be raised or lowered over a range of

14”. Loosen the Dynamometer Height Handle by turning it counterclockwise and
simply apply hand pressure to the top or underside of the dynamometer to respec-
tively raise or lower it. Retighten the handle to lock the dynamometer in position.
Use the Dynamometer Height Scale, located on the dynamometer mounting post, to
note the new dynamometer height.
NOTE: The weight of the dynamometer is counterbalanced by a pneumatic assembly in the

mounting post. When the locking handle is loosened, the dynamometer may tend to
gently rise or fall, depending on the weight of attachments affixed to the dynamome-
ter shaft. After proper height is established, always secure the locking handle.
Dynamometer Travel: The dynamometer Foot Pedals allow the dynamometer to move along the
travel in a horizontal plane left or right of the positioning chair. To move the dynamometer, press
down on either foot pedal and slide the dynamometer to the desired location. Release the foot
pedal to lock the dynamometer in place. To ensure stability, check that the dynamometer is fully
locked in a detent (i.e., try to shake the dynamometer). Use the Dynamometer Position Scale on
the travel to note position.
! Shaft Red Dot (dynamometer shaft): The small red dot on the end of the dynamometer
shaft provides an index for proper alignment of attachments on the dynamometer setup.
When affixing any attachment to the dynamometer shaft, position the attachment so that
its dot for the side to be exercised aligns with the dynamometer shaft red dot. Failure to
properly align the dots may result in a reduced range of motion.
! Point Rouge Sur L'Axe Du Dynamometre.

Le point rouge situé sur l'axe du dynamomètre fournit une indication pour l'alignement
correct de l'accessoire pendant le montage. Positionner l'accessoire de telle sorte que le
point rouge de l'accessoire s'aligne avec le point rouge du dynamomètre. Un mauvais
alignement peut entraîner une r´duction de l'amplitude.
— 1-2 — CONTROLS AND ADJUSTMENTS

ASSEMBLY AND INSTALLATION
Rotate Clockwise/Counterclockwise: The Rotate buttons atop the dynamometer allow the
dynamometer shaft to be moved by pressing (and holding) the Rotate button corresponding to the
direction the shaft must turn. This function of the Rotate buttons has no effect on the range of
motion limits previously established in Setup Mode.
hold/Resume: Stops shaft rotation. Press this button a second time to resume the test or exercise
session. One Hold/Resume button is located atop the dynamometer next to the Comfort Stop. A
second Hold/Resume button is activated by a hand-held remote located to the right of the con-
trol panel on the Clinical Data Station (CDS) cart.
! Comfort Stops (Dynamometer, Remote): These buttons

provide the subject with the ability to instantaneously ter- COMFORT STOP
minate exercise in any mode. Depressing either the large
red button atop the dynamometer or the hand-held remote
button causes immediate cessation of dynamometer shaft rotation.
The principal purpose of this control is to guard against moving the subject into a portion of
the range of motion that, for any reason, is contraindicated. It should be noted that activating
a comfort stop after the onset of discomfort will result in a stoppage of movement while the
subject is still in the undesirable portion of the range. Should this occur in Isokinetic or Isotonic
mode, with concentric contractions selected, the operator should immediately press the Stop
button on the control panel, then press Start to free the shaft and allow rotation toward a more
comfortable point in the subject’s ROM. (With the shaft free, the operator should manually
place the subject in a position such that the limb will not move in the direction of gravity.)
! CAUTION: Extra consideration is required for resuming dynamometer shaft rotation in the Passive
or Reactive Eccentric mode as the patient may be assisted further into a painful portion of the ROM.
In this case, remove the patient immediately from the attachment by releasing the Velcro® cuff.
! ATTENTION: Redoubler de précautions pour reprendre la rotation de l’arbre du dynamomètre en

mode Passif ou Réactif Excentrique. Le patient pourrait se retrouver assisté encore plus loin dans
la partie douloureuse de l’amplitude du mouvement. En pareil cas, retirer le patient de l’accessoire
en détachant la manchette en Velcro®.
L'objectif principal des ces commutateurs est d'éviter au sujet d'entrer dans une ampli-
tude de mouvement contre-indiquée quelle qu'en soit la raison. L'utilisation de l'arrêt
d'urgence peut laisser le sujet à l'intérieur d'une amplitude inconfortable: dans ce cas, il
faut des uite passer en mode isocinétique ou isotonique; appuyer sur les boutons stop et
start dans l'ordre sur le panneau du contrôleur pour libérer l'axe de rotation et placer le
membre dans une position confortable; il faut tenir le membre pour cette manipulation
pour contrôler les effets de gravité.
! ATTENTION: Une attention particuliére doit être appliquéc avant de remettre en marche le
dynamomètre dans le mode passif ou excentrique puisque le patient peut être porté à nouveau dans
une amplitude douloureuse.
Educating the subject about the use of the Comfort Stops (prior to exercise) also serves to
improve confidence and motivation by reducing apprehension regarding the equipment.
NOTE: As a safety precaution, the system will not function in any mode if the Remote Comfort
Stop is not connected to the dynamometer.

X
Dynamometer Position Color Code

▲ ▲ ▲ ▲ ▲ ▲ ▲
1 2 3 3 4 4 5
Label: Located on the Dynamometer
Yoke Pivot Plate, the Dynamometer
Position Color Code Label helps the user
to quickly position the dynamometer
according to the pattern selected. Rotate
the dynamometer to the yellow color code positions when setting up to test or exercise the
patient’s left side. Rotate the dynamometer to the blue color code positions for right side testing
or exercise. Patterns that use the same positioning for both sides utilize the green color code areas.
POSITIONING ChAIR
(See Figure 1.3.)
Seat Rotation: The positioning chair offers 360 degrees of rotation

in the horizontal plane with detente settings at 15-degree intervals.
To rotate the seat in either direction, turn the Seat Rotation Handle
toward the rear of the seat. The Seat Rotation Handle is located
beneath the seat between the forward receiving tube and forward
buckle. While holding the Seat Rotation Handle, swivel the seat to
the desired position. Release the handle to lock the seat in place, making sure the seat sets in the
appropriate detente. Note the seat rotation position on the Seat Rotation Scale, located beneath the
seat on the seat post.
Chair Foot Pedals: The Chair Foot Pedals allow fore/aft adjustment of the positioning chair in rela-
tion to the dynamometer. To move the chair along the travel, press down on either foot pedal and
slide the chair to the desired location. Release the foot pedal to lock the chair in place. To ensure sta-
bility, check that the chair is fully locked in a detente. Use the Chair Position Scale, located on the trav-
el, to note the new position.
Seatback Tilt: This adjustment allows the user to select any of five
seatback angle settings: 85, 70, 55, 40 and 25 degrees. To adjust the
seatback tilt, pull up on one of the Seatback Tilt Handles, located
on either side of the lower seatback frame. You may now adjust the
seatback to the desired angle. Release the handle and ensure that it
locks into the selected detente. Record the new seatback tilt angle
from the Seatback Tilt Indicator, located at the bottom on either
side of the seatback frame.
Seat height: The motorized seat may be automatically raised or lowered over a range of 14 inch-
➡
➡
es. To adjust the seat height, step down on the or Seat Height Foot Switches, located at the
rear base of the chair.
NOTE: The seat may be raised or lowered with the subject seated. Ensure, however, that all wires are clear
and the patient is not strapped to any attachment before you begin to raise or lower it.

X
Seatback Fore/Aft: Crank the Seatback Fore/Aft Handle, located at the back of the seatbase, in a
counterclockwise direction to move the seatback forward on the seat. Crank the handle in a clockwise
direction to move the seatback toward the rear of the seat. Record the new fore/aft position from the
Seatback Fore/Aft Scale, located along each side of the seat frame near the back belt buckle.
Cervical Support: To reposition the Cervical Support, use one hand to hold the support so it will
not slip down. With your free hand, turn the Cervical Support Locking Knob in a counterclock-
wise direction until loose. Lift up or push down on the support until the desired position is
achieved. Turn the locking knob in a clockwise direction until tight to secure the support in place.
NOTE: Be sure to support the Cervical Support with one hand before loosening the locking knob. If you do
not support the Cervical Support, it may slide down and pinch your hand as you loosen the knob.
Stabilization Straps: The Positioning Chair is fitted with a Thigh Strap and buckle (secured
toward the front on each side of the seat frame), a Pelvic Strap and buckle (secured directly
beneath the Seatback Tilt handle on the seat back frame,) and a pair of Shoulder Straps and buck-
les (secured toward the back on each side of the seat base) To secure any strap, lift the buckle han-
dle, insert the strap into the buckle and pull until tight but not uncomfortable for the patient. Press
the buckle handle all the way down to secure.
Receiving Tubes: There are four receiving tubes located on the seat. Two are positioned at the
front of the seat, left and right of center. The remaining two tubes are located one on each side of
the seat. These tubes receive the T-Bar, Limb Support Pad and Footrest. Each receiving tube has a
locking knob. To loosen the knobs, turn them counterclockwise. To tighten the knobs, turn them
clockwise.
Stabilization handles: Located on the side receiving tubes, these handles can be used by the
patient for added support, stabilization, and consistent hand positioning during exercise and
rehabilitation sessions. They should not be used during test session. These stabilization handles
are also convenient for the clinician as a means to pull or push the chair fore or aft on the T-base.

CONTENTS
8
6
Figure 1.3. Positioning

Chair adjustments:
7
1. Seat Rotation Handle
2. Receiving Tubes 2
3. Chair Foot Pedals
1
4. Seat Height Foot Switches 4
5. Cervical Support
Adjustment Knob
6. Seatback Tilt Handle
7. Seatback Fore/Aft Handle
8. Stabilization Handles
3
Figure 1.4. Positioning Chair

attachments: 2
1. T-Bar Adapter
2. Footrest 1
3. Limb-Support Pad

CLINICAL CONSIDERATIONS
SEAT BACK BRACE

The Seat Back Brace is designed to provide added stability when the seat back is used in a low-
ered position at zero degrees seat rotation for side lying, supine and prone patterns (particularly
of the hip). The Seat Back Brace is adjustable and simple to use. Once installed, set-up takes only
seconds.
INSTALLATION
(See Figures 1.5 - 1.7.)
1. Ensure the seat back is in the up position.
Rotate the seat to 0 degrees on either side of
the seat rotation scale.
2. Line up one rod-end swivel of the Seat Back

Brace with the clevis on the seat back and
insert the clevis pin.
3. Release the seat back handle and lower the

seat back to “10” on the seat back tilt scale.
Figure 1.5. Attaching the Seat Back
4. Loosen the seat back brace locking knob. Brace to the Multi-Joint System seat back clevis.
Extend the lower part of the brace and insert
the rod-end swivel into the trolley mount
clevis. Insert the clevis pin.
5. Position the patient per protocol, then lock

the Seat Back Brace locking knob to secure.
Be sure to loosen the seat locking knob
when adjusting the height of the seat or the
position of the seat back.
6. To rotate the seat to the opposite 0 degree

position, disconnect the lower end of the
back only. Repeat steps four and five. Figure 1.6. Attaching the Seat Back Brace
to the Multi-Joint System trolley mount clevis
Figure 1.7. Seat Back Brace installed and

ready for use.

CONTENTS
ThE CONTROLLER (Located at the bottom, rear, of Computer Data Station)

(See Figure 1.8 - 1.9)
Main Power Switch

Controls main power supply to controller, computer and dynamometer. Contains a circuit break-
er to protect against extreme power surges. Breaker is reset by turning the Power Switch OFF (0)
and then ON (l).
NOTE: It is not necessary to turn the system OFF each day. Use the Dynamometer and Computer Power
Switches described below for daily shut-down. Use the Main Power Switch only if you intend to
shut the system down for an extended period of time.
Dynamometer Power Switch

This switch controls power to the dynamometer. In the ON position, power to the dynamometer
is enabled. In the OFF position, the dynamometer is on Standby.
Computer Power Switch

Controls power to the computer and peripherals (including printer and monitor). In the ON posi-
tion, power to computer, monitor and printer are ON. In the OFF position, power to the comput-
er, monitor and printer are OFF.
NOTE: Be sure to properly exit and close down the Biodex Advantage Software application and Windows
Programs before turning off the computer.
CPU ON/OFF Switch

Use this switch to turn the CPU ON/OFF.
Status/Diagnostics Panel (LEDs)

This panel provides information to assist in troubleshooting of dynamometer/control panel prob-
lems. In the event of a system malfunction, always be sure to record which LEDs light before
attempting to correct a problem or restart the system. Contact a Biodex Service Representative
whenever the status panel indicates a malfunction.
5
4
1 2
Figure 1.8. Figure 1.9.
Figures 1.8 and 1.9. The Biodex Multi-Joint System Controller front panel (left) and rear of unit (right).
1. Main Power Switch
2. Dynamometer Power Switch
3. Controller Power Switch
4. Status/Diagnostics Panel (LED’s)
5 CPU ON/OFF Switch

CONTENTS
DYNAMOMETER ATTAChMENTS
Figure 1.10. Shoulder/Elbow Adapter

Shoulder Attachment
(Insert in Shoulder/Elbow Adapter)
Patterns:
Shoulder: Ex/Flex
Ab/Ad
Diagonals Shoulder Attachment
Figure 1.11.
Shoulder/Elbow Attachment
(Insert in Shoulder/Elbow Adapter)
Patterns:
Shoulder: In/Ex Rotation
Elbow: Ex/Flex (remove cuff)
NOTE: Only one Shoulder/Elbow Adapter is supplied. Shoulder/Elbow Shoulder/Elbow
The same adapter is used with the Shoulder Adapter Attachment
Attachment and Shoulder/Elbow Attachment.
Figure 1.12.
Knee Attachments (Left and Right)
Patterns:
Knee: Tibial In/Ex Rotation Knee
Ankle: Plantar/Dorsiflexion Attachment
Inversion/Eversion
NOTE: Ensure finger guard is

! in place when using this attachment.
See Figure 1.16.
Knee Adapter
NOTA: S’assurer que le doigtier

! est bien en place lorsqu’on utilise
cet accessoire. Voir figure 1.16.
Figure 1.13. Wrist

Wrist Attachment Attachment
Patterns:
Wrist: Ex/Flex
Radial/Ulnar Deviation Wrist Adapter
Forearm: Pro/Supination

CLINICAL CONSIDERATIONS
Figure 1.14.
Hip Attachments (Left and Right)
Patterns:
Hip: Ab/Ad
Ex/Flex
! NOTE: Ensure finger guard is in place

when using this attachment. See Figure 1.16.
! NOTA: S’assurer que le doigtier est bien

en place lorsqu’on utilise cet accessoire.
Voir figure 1.16.
Figure 1.15.
Combination Ankle Attachment
Patterns:
Ankle: Plantar/Dorsi Flexion
Inversion/Eversion
NOTE: See "Using The Combination Ankle Attachment

(next section).
Figure 1.16.
Finger Guard positioned correctly on dynamometer for
Knee and Hip attachments.
Patterns:
Knee: Ex/Flex
CAUTION: Placing your hands or fingers between the dynamometer input shaft (or
! attachment) and the mechanical ROM stops may result in serious injury.
ATTENTION: Placer vos mains ou doigts entre le dynamometer données (ou attache-
! ment) et le mécanique ROM arrêts peut résulter dans sérieux blessure.

COMPUTER PRELIMINARIES
USING ThE COMBINATION ANKLE ATTAChMENT

(See Figure 1.17.)
D
A h
E C
A. Footplate Rotation Lever

B. Footplate Tilt Lever
C. Heelcup Release Buttons
D. Footplate
E. Adapter Locking Knob
F. Ankle Attachment Adapter
G. Toe Strap
H. Ankle Strap
Figure 1.17 The Combination Ankle Attachment adjustment mechanisms.
The Combination Ankle Attachment (#830-331) is color-coded to facilitate set ups for all ankle
patterns. To prepare the attachment for use, simply line up the appropriate color coded position
tags for footplate tilt and rotation with the red dots on the attachment shaft and Footplate
Rotation Lever.
The footplate color codes are as follows:
White “P” to Red Dot: Plantar/Dorsiflexion

Green “I” to Red Dot: Inversion/Eversion

X
Adjusting The Footplate
Footplate Rotation: The Footplate Rotation Lever is located on the underside of the footplate at
the toe end. Pull the lever and hold it back while you rotate the footplate until the desired color-
coded position tag aligns with the lever. Release the lever and ensure that the appropriate foot-
plate peg is secured in the lever’s notch.
Footplate Tilt: The Footplate Tilt Lever is located on the underside of the footplate just above
the color-coded position tags. Loosen the lever and tilt the footplate to align the color-coded tags
per test or exercise protocol by aligning the white “P” with the red dot for plantar\dorsiflexion
or the green “I” to the red dot for Inversion\Eversion. Tighten the lever to secure the footplate
in place.
heel Cup Position: To facilitate alignment of the subject’s axis of rotation with the dynamome-
ter shaft, it may be necessary to raise or lower the patient’s foot on the footplate by adjusting the
heel cup position. The Heel Cup Release Buttons are located on the top side of the footplate at
the heel end. Squeeze the Heel Cup Release Buttons together and slide the support cup to the
desired position. Release the buttons to lock the heel cup in place.
Toe and Ankle Straps: Once all adjustments to the footplate have been completed, secure the
patient’s foot using both the foot and ankle straps. To secure the toe and ankle straps, thread
each strap through its respective buckle. Pull up on the narrow end of each buckle to ratchet the
strap tight. Pull up on the wide end of each buckle to loosen the strap.

2. OPERATIONAPPLICATIONS
! CONSIDERATIONS FOR SAFE OPERATION OF YOUR

BIODEX MULTI-JOINT SYSTEM
1. The clinician should always be present during testing or exercise sessions. Do not allow sub-
jects to test or exercise by themselves.
2. Range limits should always be set after the subject is positioned according to protocol and
before switching to a test or exercise mode. Limits should never be set at points that are
beyond the safe maximum allowable range of motion for the individual subject.
Always assume that previously set limits are inappropriate for successive subjects, or for suc-
cessive joints on the same subject. Limits should be canceled by pressing Set-up, Start and Set-
up again at the completion of each test or exercise session.
3. Range of motion limits should be set so that the mechanical stop on the attachment or fixture
will not contact the mechanical stop on the dynamometer. Metal-to-metal contact of these
parts during operation will override the system’s normal deceleration function (cushion),
causing harsh impacts at ends of ROM.
4. Always educate subject as to function and use of the Comfort Stop buttons. Always place the
hand-held remote Comfort Stop (on black coiled cord) in the subject’s free hand before the
start of any test, exercise or biofeedback session.
5. During setup, check subject positioning and ability to complete range of motion (slowly) prior
to securing stabilization straps. Ensure that both the positioning chair and dynamometer are
securely locked in detentes before allowing subject to move through ROM.
6. Before beginning any test or exercise session, always inform the subject that the input arm will
now be able to move.
7. Always keep the surrounding area free of equipment and other personnel, especially when
the passive mode is to be used. Check for clear, unobstructed path of movement pattern
(through complete ROM).
8. Do not operate equipment that has malfunctioned until it has been serviced by a qualified
technician or use has been approved by a Biodex Service Representative.
9. Use equipment only with recommended power supplies, grounding, and surge suppression.
(Refer to Biodex site survey or contact Biodex Service Department for specifications).
— 2-1 — OPERATION
APPLICATIONS
! POINTS à RETENIR POUR UN FONCTIONNEMENT SéCURITAIRE DE VOTRE

SYSTèME BIODEX
1. Le clinicien doit toujours être présent durant les séances de test ou d’exercice. Ne pas per-
mettre aux sujets de se tester ou de s’exercer seuls.
2. Les limites d’amplitude doivent toujours être fixées après avoir positionné le sujet suivant le
protocole et avant de passer à un mode de test ou d’exercice. On ne doit jamais régler les
limites à des points qui dépassent l’amplitude du mouvement maximale permissible pour la
sécurité du sujet dont il s’agit.
Toujours partir du principe que les limites fixées précédemment sont inappropriées pour les
sujets qui suivront ou pour une succession d’articulations chez le même sujet. Il faut annuler
les limites en appuyant sur Réglage, Départ, puis Réglage à nouveau, à la fin de chaque
séance de test ou d’exercice.
3. On doit fixer les limites de l’amplitude du mouvement de telle sorte que l’arrêt mécanique de
l’accessoire ou de la fixation n’entre pas en contact avec l’arrêt mécanique du dynamomètre.
Tout contact métal sur métal de ces pièces en cours de fonctionnement désactive la fonction nor-
male de décélération (coussin), entraînant des impacts durs en fin de course.
4. Toujours veiller à bien informer le sujet de la fonction et de l’utilisation des touches Arrêt
confort. Toujours placer la télécommande Arrêt confort (avec cordon extensible noir) dans la
main libre du sujet avant le départ de toute séance de test, d’exercice, ou de biofeedback.
5. Durant le réglage, vérifier le positionnement du patient et sa capacité de se mouvoir (lentement)
dans toute l’amplitude du mouvement, avant de fixer les sangles de stabilisation. S’assurer que
le siège de positionnement et le dynamomètre sont tous deux bien verrouillés dans leurs crans
d’arrêt avant de permettre au sujet d’évoluer dans l’amplitude du mouvement.
6. Avant d’appuyer sur la touche Départ, toujours informer le sujet que le bras de saisie peut
maintenant se déplacer.
7. Garder en tout temps la zone environnante libre de tout équipement et d’autres personnes,
surtout lorsqu’on utilise le mode passif. S’assurer d’une trajectoire libre de tout obstacle
pour les évolutions dans toute l’amplitude du mouvement.
8. Ne pas faire fonctionner un équipement qui a subi une panne avant qu’il n’ait fait l’objet
d’un entretien par un technicien qualifié, ou que son utilisation n’ait été autorisée par un
agent du service après-vente de Biodex.
9. N’utiliser l’équipement qu’avec les alimentations électriques, la mise à la terre et la protec-
tion contre les surtensions préconisées. (Se reporter au sondage sur les installations de
Biodex ou communiquer avec le service après-vente de Biodex pour le cahier des charges.)
OPERATION — 2-2 —
READYING ThE SYSTEM FOR USE

1. Turn the main power switch on the back of the controller to the ON (1) position.
2. Ensure that the dynamometer and computer power switches are set to the ON (I) position.
3. Upon power up, a message will be displayed on the monitor that the system needs to be ini-
tialized. Initialization consists of a self-test during which the firmware checks to ensure that
the dynamometer and associated hardware are working properly. Initialization must be per-
formed any time the system is turned ON following system shut-down or an interruption in
power supply.
4. Remove any attachments from the dynamometer input shaft and select <OK> to proceed
with initialization. The dynamometer input shaft will turn fully clockwise and then counter-
clockwise. If any problems are encountered, the system will display an error message. If all
circuits and phases of the Biodex Multi-Joint System dynamometer and hardware are work-
ing properly, no error message will be presented and the display advances to the
Dynamometer Operation screen. The message “Set ROM Limits” should now be displayed
in the System Status window at the top of the screen. The system is now ready for use.
NOTE: Should a coded initialization error message be displayed, contact Biodex Customer Service.
Shutting Down the System at the End of the Day

At the end of your day, switch the computer and dynamometer power switches, located on the
back of the controller, to the OFF position. If the Biodex Multi-Joint System will not be used for an
extended period of time, you may also want to switch the controller OFF via the Main Power
switch on its rear panel.
NOTE: You must exit both the Biodex Advantage Software and the Windows program prior to shutting
down the system. Failure to do so may result in lost or damaged files. To quit Windows and shut
down your computer:
1. Close the Biodex Advantage Software application by selecting the <X> in the top right corner of the
screen.
2. Select the <Start> button at the lower left side of the screen to access the Start menu.
3. Select the <Shut Down> to bring up the Shut Down window.
4. Select <Yes> to shut down the computer. A screen message will be displayed when it is safe to turn
the computer OFF.
Following is a general guideline for use of the Biodex in each of its operating modes. These guide-
lines are of a mechanical nature and do not reflect use of the computer software. They are pre-
sented only as an example to help familiarize you with the mechanical aspects of equipment setup
and each of the various modes of operation.
MODES OF OPERATION
The Biodex Pro offers several modes of operation. These are selected via the Advantage
Software package. A brief review of each mode follows.
Biofeedback Operation
Biofeedback Operation incorporates all the functions that, in earlier versions of Biodex Multi-
Joint Systems, were controlled by the front panel. In this mode, clinicians can set up and begin
patient exercise without entering patient-specific data such as name, address, weight, etc. When
Biofeedback Mode is selected, all settings default to match the last biofeedback session. Patient
exercise data is displayed on the graph in real-time but cannot be printed or saved.
Isokinetic Mode
In this mode, the dynamometer acts to control velocity, allowing the subject to accelerate up to,
but no higher than, the maximum speed value selected for each direction of shaft rotation (accom-
modating resistance). The subject may freely decelerate or change direction of movement at any
point within the range of motion.
The following general procedure is provided to help clarify use of Isokinetic mode.
Isokinetic Mode Clinical Applications

1. The Isokinetic mode may be used at higher speeds in order to simulate functional or sports
activities. It can also be used early on in the rehabilitation process to prevent compression and
translation in the knee joint.
2. The Isokinetic mode may be used with differing bi-directional velocities to simulate func-
tional activities or place the focus of the activity on one specific muscle group.
3. There is a 15-degree physiologic overflow in strength on each side of the end ROM (30º total
carry-over) with a limited range of motion strengthening program performed isokinetically
(Halbach, 1985).
4. Choose con/ecc or ecc/con to isolate one muscle group.
5. Exercising at a specific speed has shown strength gains which overflow to both faster and
slower speeds. However, there is enough research to demonstrate that by exercising at every
30 degrees/second, physiological overflow will occur with regards to specific strengthening
at each speed exercised (Davies, G.J., 1987.)
6. In the Isokinetic mode, the Force-Velocity relationship of muscle dictates that as speed of con-
traction increases concentrically, the muscular tension (and therefore torque) decreases.
(Davies, G.J., 1987.)
7. A velocity spectrum is recommended which will start the subject at either a high or low speed,
depending on the pathology and status of the subject, and progress to other speeds. Varying
the number of repetitions (i.e., less reps at slow speeds, more reps at high speeds), will help
keep the work performed consistent over the range of the velocity spectrum.
8. Exercising at higher speeds has shown excellent benefits for endurance gains. This will limit
compression on joints, tension developed in the muscles and tendons, and generally allows
the subject to do larger numbers of sets or repetitions, which transfers to daily activities.
9. Keep in mind the stretch shortening cycle. It has been found that an eccentric contraction per-
formed before a concentric contraction results in a more forceful concentric contraction than
a concentric contraction performed alone (Duncan, P., et. al., 1989). High speed contractions
followed by slow speed contractions will simulate an isolated plyometric activity.
2. OPERATION
The Passive Mode

The Biodex Passive mode allows the dynamometer to provide continuous motion at constant
velocity, with direction changes occurring only when range of motion limits are reached.
In Passive mode, the dynamometer initiates motion when the Start button is pressed, requiring no
active participation by the subject.
Passive Mode Clinical Applications

1. The Passive mode is frequently used post-operatively for the benefits of continuous passive
motion, which assist with nourishment of the joint.
2. The Passive mode may be used isokinetically in the agonistic direction and then passively in
the antagonistic direction or vice versa.
3. The Passive mode may be used to exercise or test isokinetically. Subjects that cannot meet the
speed, will be passively moved through this portion of the range.
4. The Passive mode may be used for passive stretching. When this is performed, the torque lim-
its in each direction should be set low. If the subject feels uncomfortable, they may resist the
motion and the unit will stop, e.g., if the clinician is trying to increase knee flexion the subject
will be passively flexed. If at any time the subject is uncomfortable, they may resist the flex-
ion movement and isometrically exceed the Toward torque limit. This will stop the unit. The
Pause buttons can also be used to hold the patient at the end ROM corresponding to the direc-
tion the pause is set.
5. For knee, shoulder flex/ex, ab/ad, and lumbar movements, ensure torque limits are set to
overcome limb weight.
6. Passive motion may be used to warm-up and cool-down a subject, stretching ROM, and to
perform contract/relax protocols . Used during rest periods, passive motion can help prevent
muscles from “tightening up” before the next set of repetitions.
7. By instructing the subject to move the limb at a speed that will keep the Away and Toward
Applied Torque Indicator ON and the middle Applied Torque Indicator OFF, the Passive
mode can be used to provide biofeedback and stimulate joint and muscle mechanoreceptors
to improve proprioception.
8. In the case of poor muscle strength, passive mode allows for active assistive motion which
will initiate or continue motion of the subject.
9. Contract/Relax may be performed in the Passive mode. Range of motion limits are selected
to include the entire range the subject should be able to achieve that day. It is recommended
that the Limit Set buttons are set no more then five degrees outside of the beginning range.
Percent Range dials are then decreased to an appropriate level so that the entire range is com-
fortable. The subject is placed on the unit with the comfort stop in hand. As the subject is pas-
sively moved in one direction, they exert force in the opposite direction. The torque limit in
the opposing direction must be set low enough so that the subject exceeds the limit and per-
forms an isometric contraction. At this time, the clinician slightly increases the range of
motion using the Percent Range dial in the appropriate direction. The procedure is repeated
for as many cycles as desired.
XXX
10. Immediately post exercise, some subjects exhibit joint effusion. Application of ice while mov-
ing passively at 20 degrees per second has been reported to reduce post exercise swelling and
discomfort. This may also be done in conjunction with electric stimulation to further assist
edema control.
Isometric Mode
In this mode, the dynamometer maintains zero velocity at any selected point in the range of
motion. Significant change in joint angle and overall muscle length does not occur.
Isometric Mode Clinical Applications

1. The Isometric mode may be used pre- or post-surgery with discretion.
2. The Isometric mode may be used near a painful range for strength carryover into the painful
range. Overflow has been found to be plus or minus as much as 10 degrees.
3. Isometric holds can be checked for quality of contraction. Monitoring these can help set goals
and monitor progress.
4. The Isometric mode can be used very effectively to initiate contractions submaximally. Make
sure to stabilize other body parts to prevent compensation. Relaxation can be assisted by the
application of heat, cold, or biofeedback.
Isotonic Mode
In this mode, the dynamometer requires the patient to meet a minimum selected torque limit in
order to move the input arm. Thus, speed is variable but torque is constant.
Isotonic Mode Clinical Considerations

1. The Isotonic Mode may be used concentrically or eccentrically to train a selected muscle group.
2. Torque limits may be set independently (in each direction) for agonist/antagonist muscle
groups in order to focus the activity on one specific muscle group or compensate for domi-
nance in strength of either the agonist or antagonist muscle group.
3. In this mode it is possible to set a “pre-load” for the patient to overcome prior to movement.
This ensures that the patient is performing the contraction with a minimal amount of force.
4. Concentric/concentric isotonics can be completed before concentric/eccentric movements.

This improves safety for the patient as the limb will not be forceably moved into any portion
of the range of motion should the patient not have ample neuromuscular control.
TESTING A PATIENT
The Reactive Eccentric Mode

In this mode the dynamometer responds to torque exerted by the patient by moving in the oppo-
site direction of the applied torque.
In Reactive Eccentric or mode, the Torque buttons on the Control Panel are used to specify a win-
dow of desired human force output. To initiate shaft motion, the subject is required to meet a min-
imum torque threshold corresponding to 10% of the Torque button setting. If the subject exceeds
the torque limit value selected for either direction of motion, the shaft stops rotating until the sub-
ject’s force output is reduced to within the desired range. The subject is therefore required to
exceed a specified torque value to achieve motion, and to keep torque output at the specified level
to continue movement.
Low torque limits require greater neuromuscular control. Setting a torque limit of 20 ft-lb will
require 2 ft-lb of force to initiate motion and 20 ft-lb to stop, resulting in a window of 18 ft-lb
Setting the window at 100 ft-lb results in a window of 90 ft-lb.
Reactive Eccentric mode allows for direction changes at any point in the range of motion.
Reactive Eccentric Mode Clinical Applications

1. The Reactive Eccentric mode may be used to perform submaximal or maximal eccentrics.
2. The Reactive Eccentric mode may be used to work on proprioception. When torque limits are
set, the subject must exert at least one-tenth of the torque limit to keep the shaft moving. If the
subject exceeds the limits, the unit will stop.
Low torque limits require greater neuromuscular control. Setting a torque limit of 20 ft-lb will
require 2 ft-lb of force to initiate motion and 20 ft-lb to stop, resulting in a window of 18 ft-lb.
Setting the window at 100 ft-lb results in a window of 90 ft-lb.
3. At higher velocities the stretch reflex is more active than at lower velocities.
4. It is possible to generate 30-40% more force eccentrically than concentrically. (Set the torque
limits appropriately.) In that the stimulus for strength gain is contraction intensity, it is sug-
gested by some research that eccentric contractions will result in significant strength gains.
(Knuttgen, H.G., et. al., 1971; Komi, P.V., 1972).
5. There is patient specific eccentric speed above which muscular force will not increase.
(Knuttgen, H.G., et. al., 1972).
6. Eccentric contraction involves a “training” of the non-contractual elements of muscle so that

the muscle “learns” to function in a higher force environment. (Komi, P.V.,1972).
7. In eccentric exercise, the force increases as the velocity of contraction increases (up to a cer-
tain point) which is in contrast to concentric exercise in which the force decreases as the speed
of contraction increases. (Davies, G.J., 1987.)
8. It has been suggested that eccentric exercise produces the greatest force in the least amount of
time (Komi & Cavanaugh, 1977).
XX
9. Eccentric contractions enhance muscle force production and are less costly metabolically than
concentric contractions (Bosco & Komi, 1979, Asmussen, 1953).
10. Eccentric rehabilitation is usually performed no more than two times a week secondary to
delayed onset muscle soreness.
ADDITIONAL CONSIDERATIONS
1. Very often clinicians use the following progression during the rehabilitation process: Passive
mode, isometrics, multi-angle isometrics, sub-maximal eccentrics, concentric isokinetics.
2. Electrical stimulation may be used in conjunction with any of the tests or exercise modes on
the Biodex.
3. Consider ending a rehabilitation set by work or time, especially if the goal is to improve endurance.
4. Giving a subject copies of their rehabilitation reports can help with motivation.
5. Submaximal exercise prevents neural dissociation, promotes articular cartilage nourishment

and proprioception, and retards muscular atrophy.
6. Delayed Onset Muscle Soreness (DOMS) is not usually apparent until one to two days after
treatment. Work submaximally to minimize and develop protocols accordingly.
7. The Biodex Multi-Joint System is a versatile piece of equipment, making it difficult to docu-
ment every possible setup position. If a non-documented position is used, document it. If it
becomes a position that is used often, send the information to Biodex.
PROPER TESTING TEChNIQUE

1. Verify calibration at least twice a month. If you are going to use your data in court or for
research, calibrate and verify before a test is performed.
2. Be consistent in warm-up procedures, commands, setups and instructions, (i.e., Four total rep-
etitions, first one at 25% effort, next at 50% effort, then 75% effort and, finally, 100% max effort.)
3. Each patient should perform trial repetitions before each speed to become familiar with what
to expect.
4. Be sure to familiarize the subject with the equipment before testing to eliminate a learning
curve. It is recommended that the patient peform two or three exercise sessions on the system
prior to testing.
5. Use proper stabilization techniques, making every attempt to restrict motion only to the area
of interest. Body parts on either side of the joint(s) being rehabilitated or tested should be
firmly secured. Studies have reported significant differences in data generated with and with-
out stabilization. Uncontrolled movement leads to testing errors. If you add or remove stabi-
lization devices, document it.
6. Axis alignment of the dynamometer shaft with the subject’s anatomical axis of rotation is cru-
XX
cial to ensure that during testing and rehabilitation the pattern performed is consistent with
the proper biomechanics of the joint. Correct alignment also helps eliminate stressful loading
of the joint and recruitment of other muscle groups.
7. Use standardized setups. If you use an unconventional setup, document it.
8. Make sure to set the correct anatomical reference angle. The internal goniometer of the soft-
ware is based on this reference angle, and is important for later data interpertation.
9. Verbal and visual encouragement should be consistent.
NOTE: Allowing a patient to view the monitor during a test may cause the patient to change force
output based on perception. For testing consistency, it is recommended that the patient not be
allowed to view the monitor.
3. SETUP AND POSITIONING
The following section details the Biodex Multi-Joint System setup and positioning for each of the
standard test and exercise patterns. Included is information on both mechanical and anatomical
aspects.
It is suggested that clinicians who are not familiar with the Biodex Multi-Joint System read the
preceding chapters and practice each setup with a healthy subject before attempting to position
any person for actual testing or exercise. Instruction can also be gained through the use of the
AVIs is in the Advantage Software Program.
While the following setups are standard, it should be noted that other positioning setups are pos-
sible. The Biodex Multi-Joint System is extremely versatile and can accommodate to many test and
rehabilitation needs. If you find a new setup to be especially useful in your practice, be sure to
document it and pass the information along so it can be included in our database.
NOTE: All attachments have “R” (right) and “L” (left) designations. In the case of the ankle and wrist
attachment, R&L are together (R L). Proper range of motion is ensured by aligning the dynamome-
ter shaft red dot with the appropriate designation for the side to be exercised or tested.
NOTE: Check the dynamometer, gimbal and seat for proper positioning before each testing, exercise or
biofeedback session.
NOTE: When performing bilateral testing, make sure the length of the attachment is equal on both sides to
assure validity and reliability of results.
— 3-1 — SETUP AND POSITIONING

SERVICE PROCEDURES
KNEE: EXTENSION/FLEXION
Figure 3.2.
Figure 3.1
0
Away
135
Toward
. Figure 3.3.
Quick Reference
Dynamometer Orientation: 90˚
Dynamometer Tilt: 0˚
Seat Orientation: 90˚
Seatback Tilt: 70 - 85˚
Axis of Rotation: Axis is through the lateral femoral condyle on a sagittal plane.
Ready Position: Full Flexion
Parts Needed
Dynamometer: Knee Attachment (left or right)
Positioning Chair: No additional parts required.
SETUP AND POSITIONING — 3-2 —

X
KNEE EXTENSION/FLEXION
Because of multiple factors such as stability through mostly ligamentous and muscular support,
the bearing of high forces, and the fact that it is located between the body’s two longest lever arms,
the knee is one of the most commonly injured joints in the body. The knee is also the most com-
monly tested and rehabilitated joint on the Biodex Multi-Joint System.
! NOTE: Ensure finger guards are securely in place.
! NOTA: S’assurer que le doigtier est bien en place lorsqu’on utilise cet accessoire.
Setup and Positioning

(Starting Movement: Away/Extension)
1. Seat patient on chair.
2. Rotate chair to 90 degrees.
3. Rotate dynamometer to 90 degrees. Slide dynamometer along travel to position outside leg to
be tested or exercised.
4. Attach knee attachment to dynamometer. Align dynamometer shaft red dot with red dot on
attachment.
5. Move patient into position.
6. Align patient knee axis of rotation with dynamometer shaft. Raise/lower seat or move patient
toward/away from dynamometer to fine adjust.
7. Adjust knee attachment so that it is proximal to medial malleoli. Secure with strap.
NOTE: Moving the pad proximally has been demonstrated to decrease anterior tibular translation.
8. Stabilize patient with shoulder, waist and thigh straps.

9. Set ROM stops.
Opposite Side
1. Unstrap patient’s knee from attachment and thigh strap.
2. With patient remaining in chair, slide chair back away from dynamometer.
3. Press Hold button to retain dynamometer shaft position. Remove attachment. Get knee
attachment for opposite side.
4. Rotate dynamometer to 90 degrees on opposite side. Slide dynamometer to opposite side of
patient.
5. Attach knee attachment to dynamometer. Align dynamometer shaft red dot with red dot on
attachment.
7. Align patient knee axis of rotation with dynamometer shaft. Raise/lower seat or move patient
toward/away from dynamometer to fine adjust.
8. Adjust knee attachment so that it is proximal to medial malleoli. Secure with strap.
10. Reset ROM stops.

X
Clinical Applications of Biodex Operating Modes
Isokinetic Mode
1. The isokinetic mode may be used at high speeds to simulate functional or athletic activities.
2. The isokinetic mode may be used for bi-directional velocities (i.e., during early ACL recon-
struction rehabilitation, the hamstrings may be worked at low speeds and the quadriceps at
high speeds. At end stage rehab, the quads may be worked at low speeds and the hamstrings
at high speeds).
Passive Mode
1. The passive mode is frequently used post-operatively, especially with anterior cruciate liga-
ment repairs, abrasion arthroplasties, and total knee replacements, for the benefits of contin-
uous passive motion.
2. The passive mode may be used to move the limb in one direction and concentrically assist or
eccentrically resist in the other direction (i.e., in early rehab for ACL reconstructions, the limb
may be moved passively through partial range extension. The subject may then assist or resist
flexion with voluntary effort.
3. The passive mode may be used for active-assisted exercise (i.e., a subject status post medial
meniscectomy may be moved passively through a range where voluntary effort cannot be
exerted and may assist in the parts of the range where able).
4. The passive mode may be used to do eccentric/concentric contractions. After an ACL recon-
struction, the hamstrings may be worked eccentrically and concentrically through limited
range and then through the full range. At end stage rehab, the quadriceps may be worked at
the end of the range, both concentrically and eccentrically, to decrease an extensor lag.
Isometric Mode
1. The isometric mode may be used with pre- or post-operative subjects or when pain is a fac-
tor.
Isotonic Mode
1. Prior to performing traditional isotonics on weight equipment, a patient can perform various
contractions isotonically to ensure proper muscular function.
2. Since a pre-load is required, gravity and momentum play a minimal role in exercise. This
ensures patient compliance.

X
Reactive Eccentric Mode

1. The Reactive Eccentric mode may be used maximally or submaximally to replicate function-
al activities. The role of submaximal eccentrics has been greatly overlooked. With ACL recon-
structions, the hamstrings may be worked through full range of motion eccentrically with
submaximal effort.
2. Specific areas of weakness in a range of motion such as quadriceps extensor lag may be
worked eccentrically at the last 30˚ of extension with submaximal effort.
3. Submaximal eccentrics may be used to protect injured or grafted structures (i.e., post-opera-
tively, subjects may exercise in the eccentric mode with the torque limits set very low. If the
subject were to exceed the set torque limit, the input shaft would stop).
Additional Comments
1. The pause may be used for passive stretching or to perform contract/relax for the facilitation
of motion. This is especially important after a total knee replacement when early motion is
crucial. The pause may also be used when working in the passive mode to do eccentric or non-
reciprocal contractions.
2. All modes may be used in combination with electrical stimulation.
3. With anterior cruciate ligament rehabilitation, pay close attention to tibial pad placement.
Research has shown that while working the quadriceps, less stress is placed on the ACL when
the pad is placed in the proximal position. For hamstring work, place the pad in a more dis-
tal position.
4. Subjects may be worked through only a partial range using the percent setting in Biofeedback.
This is important to assist with focusing on range of motion specific weakness.
5. When treating the knee, total leg strength should be considered, especially the strength of hip
abductors and adductors.
6. It has been found that most ACL injuries occur during deceleration, therefore, eccentric exer-
cise is an important part of the rehabilitation process.
7. Because a subject is proximally stabilized, very little substitution will occur. Proximal stabi-
lization lends itself to joint isolation.
8. The seatback of the positioning chair may be adjusted to accommodate any hip angle the clin-
ician finds appropriate. Typically, a 70º incline will place the hamstring and quadraceps in an
optimal length-tension relationship allowing for improved muscle output.
9. Increasing speeds (180˚-300˚/sec.) decreases anterior tibial translation, and joint compressive forces.
Important applications for rehabilitating anterior cruciate injuries and patellofemoral dysfunction.

X
ANKLE: PLANTAR/DORSIFLEXION (SEATED)
Figure 3.5.
PlantarFlexion/DorsiFlexion
30
Figure 3.4.
50
Figure 3.6.
Quick Reference
Dynamometer Orientation: 90°
Dynamometer Tilt: 0°
Seat Orientation: 90°
Seatback Tilt: 70 - 85°
Footplate Tilt: 0°
Footplate Code: Red dot to P/D
Knee Flexion: 20 - 30°
Axis of Rotation: In neutral position, axis passes through the body of talus,
fibular malleolus, and through or just below the tibial malleolus.
Ready Position: Full Plantarflexion
Parts Needed
Dynamometer: Ankle Attachment
Positioning Chair: Limb-Support Pad, T-Bar, Footrest (optional)

X
ANKLE: PLANTAR/DORSIFLEXION (SEATED)

The ankle joint or talocrural joint is really three joints (tibiotalar, fibulotalar, and tibiofibular)
formed by the superior portion of the body of the talus fitting within the cavity created by the
combined distal ends of the tibia and fibula. The subtalar joint is the articulation between the
talus and calcaneus.
Motions of the ankle are rarely true single plane motions. This holds for dorsiflexion/plan-
tarflexion, which usually occurs in conjunction with other movements.

(Starting Movement: Toward/Dorsiflexion)
NOTE: For both ankles, the limb support pad is positioned in the positioning chair front right
receiving tube.

3. Set seat back tilt to 70 - 85 degrees.
4. Install Limb Support Pad (with T-Bar) in the positioning chair front right receiving tube.
Angle support toward chair. Place pad under distal femur and secure with strap.
NOTE: Because the origin of insertion of the gastrocnemius is above the knee, the extent of ankle
dorsiflexion will generally increase with increased knee flexion and decrease with knee extension.
Positioning should be recorded for valid comparisons and reproducibility.
NOTE: For exercise, the footrest may be inserted in the left chair front receiving tube if desired. Use
of the footrest provides a stable base for the patient to push off and may cause the system to record
artificial peak torques.
5. Rotate dynamometer to 90 degrees.

6. Set dynamometer tilt to 0 degrees.
7. Attach Ankle Attachment dynamometer.
• Place Ankle Attachment input tube on dynamometer so that P/D engraving faces
outward then rotate footplate so that P/D aligns with the dynamometer shaft red dot.
• With attachment tube horizontal, press Hold.
8. Raise dynamometer to align axis of rotation.
9. Move patient into position and align patient ankle axis of rotation with dynamometer shaft.
10. Strap foot to footplate.
11. Stabilize patient with appropriate straps.
12. Set ROM stops
Opposite Side
1. Press Hold to retain dynamometer shaft position.
2. Unstrap patient’s ankle and leg.
3. With patient remaining in chair, slide chair away from dynamometer.
4. Place limb support in the opposite receiving tube .
Angle limb support toward patient (switch with footrest if needed).
5. Place limb support pad under distal femur and secure with strap.
6. Slide dynamometer in front of ankle to be tested.
7. Move patient forward and secure leg in limb support with foot on footplate.
8. Align patient ankle axis of rotation with dynamometer shaft.
9. Strap foot to footplate.
10. Stabilize patient with appropriate straps.
11. Reset ROM Stops as needed.

X

Isokinetic Mode
1. The isokinetic mode may be used at bi-directional velocities. This is especially important at
the ankle complex where the muscular strength is unbalanced. Many clinicians work the
plantarflexors at slower speeds and the dorsiflexors at higher speeds.
Passive Mode
1. The passive mode may be used after a period of immobilization for the benefits of
continuous passive motion.
2. The passive mode may be used to perform non-reciprocal contractions (e.g., many times the
plantarflexors are considered to be the more essential muscle group to be rehabilitated after
injury. The plantar flexors may be worked both concentrically and eccentrically in the
passive mode.
Isometric Mode
1. Multi-angle isometrics may be used pre- and post-operatively or after periods of immobilization.
Isotonic Mode
1. In later phases of rehab, perform various concentric contractions to isolate one muscle
group only.
2. Set torque limit higher for plantarflexors and lower for dorsiflexors to ensure fatigue time
remains constant.

1. The eccentric mode may be used to strengthen the musculotendinous junction. Many times
injuries occur at the ankle secondary to eccentric loading to failure. It may be especially
important to rehab athletes in the eccentric mode.

Additional Comments
1. The ankle is known to be unstable in the plantarflexed position, an important fact to keep
in mind when dealing with athletes.
2. It has been stated that peroneal and dorsiflexor strengthening may help in resisting an
inversion/plantarflexion injury.
3. The gait cycle may be simulated by using the passive mode in this sequence:
• Subject works eccentric dorsiflexion (heelstrike).
• Subject works eccentric plantarflexion (midstance).
• Subject works concentric plantarflexion (toe off).
• Subject works concentric dorsiflexion motion (swing phase).
4. When rehabilitating the ankle, it is important to consider total leg strength.
5. If swelling is a consideration, the dynamometer may be raised. If cramping of the lower leg
musculature is a problem, the dynamometer may be lowered to bring the ankle into a more
dependent position to allow enhanced blood flow.
6. Optionally, the seatback can be placed in the horizontal position to allow testing or exercise
in the supine position.

X
ANKLE: EVERSION/INVERSION
Figure 3.8.
Eversion/Inversion
Figure 3.7.
55
40
Away
Toward
Figure 3.9.
Quick Reference
Dynamometer Tilt: 60 - 70° (shaft up)
Seatback Tilt: 70°
Footplate Color Code: Red dot to I/E
Knee Flexion: 30 - 45°
Axis of Rotation: Passes through the fibula malleolus and the body of the talus at
an angle of 35°.
Ready Position: Full Inversion
Parts Needed
Dynamometer: Ankle Attachment
Positioning Chair: Limb-Support, T-bar, Footrest (optional)

GENERAL MAINTENANCE
ANKLE: INVERSION/EVERSION (SEATED)

The ankle is vulnerable to inversion injuries making injuries to the anterior talofibular complex
a common occurrence that may be difficult to rehabilitate.
Recurrent injuries to the lateral ligamentous complex have been shown to decrease propriocep-
tion of the ankle and athletic performance.

(Starting Movement: Away/Eversion)

2. Install Limb Support Pad (with T-Bar) in chair front receiving tube for side to be exercised
or tested. Angle Limb Support toward chair. Place pad under tibia and secure
with strap.
3. Attach input tube to dynamometer.
• I/E engraving faces outward.
• Right Ankle and Left Ankle are oriented with input shaft straight up. Align shaft red dot
with R L.
• With attachment vertical, press Hold.
4. Install footplate. Red dot to I/E.
5. Adjust the footplate angle to align red dot with “I” marker.
6. Rotate dynamometer to 0 degrees and position in line with limb support.
7. Lower dynamometer all the way down in pedestal.
9. Set dynamometer tilt to 60-70 degrees (see label on dynamometer face).
10. Set seat back tilt to 70 degrees.
11. Move patient into position and align ankle axis of rotation with dynamometer shaft.
12. Raise chair as needed to fine adjust axis of rotation.
13. Strap foot to footplate and stabilize patient with appropriated straps.
14. Set ROM Stops.
15. Ensure the subject’s lower leg is parallel to the floor.
Opposite Ankle
1. Press Hold to retain dynamometer shaft position.
2. Unstrap patient’s ankle and leg.
3. With patient remaining in chair, slide chair away from dynamometer.
4. Place limb support in the opposite receiving tube. Angle limb support toward chair.
5. Slide dynamometer to opposite position.
6. Move patient forward into position and secure leg in limb support with foot on footplate.
Align ankle axis of rotation with dynamometer shaft.
7. Strap foot to footplate and stabilize patient with appropriate straps.
8. Reset ROM Stops.

SERVICE PROCEDURES
Isokinetic Mode
1. The isokinetic mode may be set bi-directionally. In the case of a lateral sprain, evertors may
be set at relatively low speeds and invertors at higher speeds. Range of motion should be
limited as warranted.
2. The concentric/eccentric setting may be used in the later stages of rehab for muscle strengthening.
Passive Mode
1. The passive mode may be used after immobilization for the benefits of continuous passive
motion. The passive mode may also be used to assist with neurologic retraining in the first
few weeks after injury or surgery.
2. The passive mode may be used in combination with electric stimulation, ice and elevation
for acute ankle sprains to help reduce swelling.
3. The passive mode may be used after a lateral ligamentous sprain to evert submaximally and
passively invert. Inversion may be limited by ROM settings or using the percent range
settings during Biofeedback operation if warranted.
4. The passive mode may be used after lateral ligamentous sprain to work the evertors both
concentrically and eccentrically. Range of motion may be limited as stated above.
Isometric Mode
1. Multi-angle isometrics may be performed in the isometric mode. Strength carry-over has
been found to be plus or minus ten degrees of the ankle exercise performed. Isometrics may
be used to stress either the agonist or antagonist.
Isotonic
1. Set torque limits accordingly to ensure adequate force production throughout the ROM.

1. The eccentric mode may be used to perform maximal or submaximal activities, develop
preprioception, and to simulate function or sports activities.
Additional Comments
1. Ankle inversion injury has been noted to be caused by eccentric peroneal activity to failure.
2. Athletes who have poor static balance have been found to have weak evertors. Evertor
strengthening may be helpful.
3. Consider the importance of total leg strength in the process of rehabilitating the ankle.
4. The ankle may be rehabilitated in an elevated position if edema is present.
5. If cramping is a problem, the dynamometer may be lowered to bring the ankle into a more
dependent position, allowing enhanced blood flow.
6. The seat tilt may be placed in the horizontal plane to allow testing in the supine position.
This may require a slight adjustment of the dynamometer.

REPLACEMENT PARTS
hIP: hIP ABDUCTION/ADDUCTION (LYING ON SIDE)
Figure 3.11
Figure 3.10
45
30
Figure 3.12
Quick Reference
Seatback Tilt: Fully Reclined
Axis of Rotation: Superior and medial to greater trochanter.
Ready Position: Full Adduction
Parts Needed
Dynamometer: Hip Attachment
Positioning Chair: Seat Back Brace

X
hIP: ABDUCTION/ADDUCTION (LYING ON SIDE)
The abductors of the hip are very important in maintaining a level pelvis. When standing on
one leg, the opposite pelvis is supported by the gluteus medius, minimus and tensor fascialata.
Should there be a weakness, the pelvis may exhibit a drop.
NOTE: Make sure finger guards are securely in place.

(Starting Movement: Away/Abduction)
1. Affix appropriate left or right Hip attachment to dynamometer shaft so that attachment and
shaft red dots align. Secure with locking knob.
2. Install Seat Back Brace on positioning chair.
3. Instruct patient to lie on side on positioning chair with hip to be tested on top. Subject
should face away from dynamometer with hip axis of rotation aligned with dynamometer
input shaft. If desired, opposite limb can be flexed at the knee so that foot can rest on
positioning chair.
4. Align dynamometer shaft with axis of rotation for the upper hip. Adjust attachment length
so that pad is positioned just superior to the popliteal fossa. Secure attachment strap.
5. Place Remote Comfort Stop in subject’s hand. Explain the purpose of the Comfort Stop.
6. Set range of motion limits. Move subject through desired range to check for proper
positioning and comfort. Reset range of motion limits, if necessary.
7. Select mode and proceed as required by test/therapy protocol.
Opposite Side
1. Unstrap patient from attachment.
2. Remove Hip attachment from dynamometer and replace with opposite side attachment.
Rotate positioning chair 180°.
3. Instruct patient to lie on positioning chair so that hip to be tested is on top. Subject should
face away from dynamometer with hip axis of rotation aligned with dynamometer input
shaft. If desired, opposite limb can be flexed at the knee so that foot can rest on positioning
chair.
4. Align dynamometer shaft with axis of rotation for the upper hip. Adjust attachment length
so that pad is positioned just superior to the popliteal fossa. Secure attachment strap.
6. Set range of motion limits. Move subject through desired range to check for proper
positioning and comfort. Reset range or motion limits, if necessary.

SCHEMATICS
Clinical Applications
1. The passive mode may be used for the benefits of continuous passive motion after a total
hip replacement.
! NOTE: Progress hip range of motion only under the direct supervision of a physician.
! NOTA: Avancer en flexion seulement sous la surveillance d’un médecin.
2. Many times in cases of degenerative joint disease (DJD) the cartilage in the area does not
undergo the absorption and squeezing out of synovial fluid necessary for adequate
nutrition. The passive mode may be used to assist this process, especially for older persons
who use their joints less frequently and through smaller ranges of motion. The passive
mode may also be used as a preventative measure to reduce capsular tightening at the hip.

CONTENTS
hIP: EXTENSION/FLEXION (SUPINE)
Figure 3.14.
Figure 3.13.
Away
120
Figure 3.15.
Quick Reference
Seatback Tilt: Fully Reclined
Axis of Rotation: Superior and anterior to greater trochanter when limb is in
neutral position.
Ready Position: Neutral Extension
Parts Needed
Dynamometer: Hip Attachment
Positioning Chair: Footrest (optional)
Seat Back Brace

TROUBLESHOOTING
hIP: EXTENSION/FLEXION (SUPINE)

The hip is a multiaxial ball and socket joint which consists of the articulation between the head
of the femur and acetabulum of the os coxae.
There are a number of bursae at the hip. The iliopectineal bursa covers the anterior aspect of the
hip joint and inflammation may cause anterior hip pain.
! CAUTION: Placing your hands or fingers between the dynamometer input shaft (or
attachment) and the mechanical ROM stops may result in serious injury.
! NOTE: Ensure finger guards are securely in place.

(Starting Movement: Away/Flexion)
1. Affix appropriate left or right Hip attachment to dynamometer shaft so that attachment and
shaft red dots align. Secure with locking knob.
2. Install Seat Back Brace on positioning chair.
3. Instruct patient to lie supine on positioning chair with hip to be tested closest to the
dynamometer. Adjust chair and dynamometer so that shaft aligns with the axis of rotation
of the hip. The axis of rotation of the hip in this pattern is slightly superior and anterior to
the greater trochanter.
4. Adjust Hip Attachment length so that thigh support is just superior to the popliteal fossa.
Position pad anteriorly on the thigh and secure by wrapping the padded strap snuggly
around the thigh.
6. Set range of motion limits. Move patient through range of motion to check for proper
alignment and subject comfort. Make sure straps do not impede range of motion. Readjust
ROM limits, if necessary.
7. Select mode and proceed as required by test/therapy protocol.
Opposite Side
1. Unstrap patient from attachment.
2. Remove attachment from dynamometer and replace with opposite side attachment.
3. Rotate positioning chair 180°.
4. Instruct patient to reposition and lie supine on chair. Hip to be tested should be closest to
the dynamometer. Adjust chair and dynamometer so that shaft aligns with the axis of
rotation of the hip. The axis of rotation of the hip in this pattern is slightly superior and
anterior to the greater trochanter.

CONTENTS
5. Adjust Hip attachment length so that thigh support is just superior to the popliteal fossa.
Secure Hip attachment strap.
7. Reset range of motion limits. Move patient through range of motion to check for proper
alignment and subject comfort. Make sure straps do not impede range of motion. Readjust
ROM limits, if necessary.

Passive Mode
1. The passive mode may be used for the benefits of continuous passive motion after a total
hip replacement.
NOTE: Progress flexion only under the direct supervision of a physician.
NOTA: Advancer en flexion seulement sous la surveillance d’un médecin.
2. Many times in cases of degenerative joint disease (DJD) the cartilage in the area does not
undergo the absorption and squeezing out of synovial fluid necessary for adequate
nutrition. The passive mode may be used for this problem, especially for older persons who
use their joints less frequently and through smaller ranges of motion. The passive mode
may also be used as a preventative measure to reduce capsular tightening at the hip.

CONTENTS
ShOULDER: FLEXION/EXTENSION (SEATED)
Shoulder/Elbow Adapter
Shoulder Attachment
Figure 3.17.
180
Away
Figure 3.16.
60
Toward
Figure 3.18.
Quick Reference
Axis of Rotation: Compromise axis is acromial process in the sagittal plane.
Ready Position: Full Extension
Parts Needed
Dynamometer: Shoulder/Elbow Adapter (remove cuff), Shoulder Attachment

REPLACEMENT PARTS
ShOULDER: EXTENSION/FLEXION (SEATED)

Shoulder extension/flexion is a motion that is usually initiated early in the rehabilitation process,
however, clinicians must be careful not to cause impingement. An impingement sign is produced
when the shoulder is fully flexed and there is jamming of the greater tuberosity against the antero
inferior surface of the acromion. For this reason, the clinician may want to limit flexion range of
motion in the early stages of the rehabilitation process.

NOTE: This pattern may be accomplished with the positioning chair seatback reclined to any position
which provides for both subject comfort and proper alignment of the anatomical axis.

2. Attach Shoulder/Elbow Adapter to dynamometer (remove cuff). Insert Shoulder Attachment
into Adapter.
3. Align Shaft red dot with R or L and move attachment to almost full extension. Press Hold.
4. Slide dynamometer along travel to position outside of shoulder to be tested.
6. Tilt dynamometer to 0 degrees
8. Move patient into position. Align patient axis of rotation. Raising dynamometer or tilting seat-
back can accommodate various size patients.
9. Check for proper ROM. Keep handgrip loose during motion to allow for the compromising
positions of the glenoid humeral joint as it goes through the motions.
11. Set ROM stops.
Opposite Side
1. Press Hold.
2. With patient remaining in chair, slide chair back along travel.
3. Remove attachment and rotate it 180 degrees. Align Shaft red dot with R or L.
4. Move attachment to almost full extension.
5. Move dynamometer to opposite position. Dynamometer rotation remains at 0 degrees.
6. Rotate chair to opposite 0 degrees.
7. Move patient into position. Align patient axis of rotation. Raising dynamometer or tilting seat-
back can accommodate various size patients.

REPLACEMENT PARTS
Isokinetic Mode
1. The isokinetic mode may be used bi-directionally to focus on one specific muscle group
(i.e., in an impingement syndrome the flexors may be worked at a fast speed through a
limited range and the extensors at a lower speed).
Passive Mode
1. The passive mode may be used initially for the benefits of continuous passive motion. It has
been suggested that early re-establishment of neural pathways without stressing an inflamed
capsule is essential.
2. It has been suggested to increase anterior shoulder flexibility in the acute phase of a rotator
cuff strain without offering resistance. The passive mode may be used to carry the limb into
the flexed position. The subject may be instructed to assist the extensors as the arm is moved
in the away direction.
3. It has been suggested by some clinicians that submaximal eccentrics that can be performed in
the passive mode may be used to treat subjects with bicipital tendinitis.
4. With adhesive capsulitis, the subject may be placed in the passive mode with a four second
pause at end range.
Isometric Mode
1. Isometrics may be used immediately pre- and post-operatively. Multi-angle isometrics are
recommended to achieve physiological overflow into that portion of the range which has not
been exercised.
Isotonic
Additional Comments
1. With impingement syndrome and anterior subluxation, it has been recommended to initially
limit motion to under 90 degrees and progress slowly past this point.
2. It is important to consider that glenohumeral motion requires a coordinated effort between

the deltoid and the rotator cuff musculature. Working the anterior deltoid non-reciprocally
will strengthen this muscle concentrically and eccentrically.

REPLACEMENT PARTS
ShOULDER: ABDUCTION/ADDUCTION (SEATED)
Shoulder Attachment
Figure 3.20.
180
Away
Figure 3.19.
75
0
Toward
Figure 3.21.
Quick Reference
Axis of Rotation: Axis of rotation for this pattern approximates the axis of the acromio
clavicular joint, which connects the distal end of the clavicle to the
anterior medial portion of the acromial process.
Ready Position: Full adduction
Parts Needed

REPLACEMENT PARTS
ShOULDER: ABDUCTION/ADDUCTION (SEATED)

The shoulder complex is made up of multiple linkages. These include the glenohumeral joint,
acromioclavicular joint, sternoclavicular joint, and scapulothoracic articulation. The glenohumer-
al joint is the most mobile joint in the body with global freedom. Because of this, stability is sacri-
ficed. Only a little more than 1/3 of the head of the humerus makes contact with the glenoidfos-
sa at any one time.
Abduction/adduction is usually one of the last motions exercised in rehabilitation of the shoul-
der. The clinician must exercise great care in order to avoid impingement.

(Starting Movement: Away/Abduction)
NOTE: This pattern may be accomplished with the seatback reclined to any position which provides for
both patient comfort and proper alignment of the anatomical axis. The seatback and dynamometer
tilt must, however, be set to the same angle.

into Adapter.
3. Align Shaft red dot with R or L and move attachment to almost full abduction. Press Hold.
6. Raise dynamometer.
7. Tilt dynamometer to 10 degrees.
8. Move patient into position (patient is facing away from dynamometer). Slide dynamometer
along travel to align axis of rotation.
10. Stabilize patient with shoulder and waist straps.
11. Set ROM stops.
Opposite Side
2. Remove attachment and rotate it 180 degrees opposite. Align Shaft red dot with R or L.
3. Move attachment to almost full abduction. Press Hold.
5. Move dynamometer to opposite position. Dynamometer orientation remains at 0 degrees.
6. Move patient into position (patient is facing away from dynamometer). Slide dynamometer
along travel to align axis of rotation.
9. Reset ROM stops.

SCHEMATICS
Isokinetic Mode
1. The isokinetic mode may be used at bi-directional velocities to stress either the abductors or
adductors (i.e., in early rotator cuff rehabilitation, the focus may be placed on the adductors).
The adductors may be worked at low speeds concentrically and the abductors at higher
speeds concentrically. Set limits as appropriate.
Passive Mode
1. The passive mode may be used initially for the benefits of continuous passive motion. This is
especially important post-surgically. It has been suggested that early re-establishment of
neural pathways without over-stressing an inflamed capsule is essential.
2. The passive mode may be used to work the adductors early in the rehabilitation, both con-
centrically and eccentrically. Conversely, the abductors may be stressed in the same way later
in rehabilitation.
Isometric Mode
1. Multi-angle isometrics may be performed (i.e., with adhesive capsulitis, subjects who perform
an isometric contraction at the end of the range, will develop strength gains in a greater range
due to the overflow principle.
Isotonic

1. The eccentric mode may be used to perform submaximal eccentrics especially in cases of ten-
dinitis.
Additional Comments
1. The pause may be used at end range simply to focus on that portion of the range.
2. The limit set buttons and/or percent range dials, may be used in subjects with impingement
syndrome to limit the range of motion to 90 degrees or less.
3. It has been recommended in some cases that a strong supraspinatus contraction be present in
the first 30 degrees of motion before other strengthening may begin.
4. It has been suggested that strengthening the abductors is very important in the rehabilitation
of acromioclavicular separations.
5. It has been suggested that the force of the abducting musculature is very important in estab-
lishing equilibrium at the glenohumeral joint and that the supraspinatus helps prevent down-
ward dislocation of the humerus.
6. It has been stated that the long head of the biceps may act as an accessory shoulder abductor
if the glenohumeral joint is externally rotated.
7. For alternate positioning, the seat and dynamometer can be positioned at any 15˚ of rotation.

CONTENTS
ShOULDER: EXTERNAL/INTERNAL ROTATION IN ThE

MODIFIED NEUTRAL POSITION (SEATED)
Figure 3.23.
Figure 3.22.
Away
50
Toward
90
Figure 3.24.
Quick Reference
Axis of Rotation: Axis alignment is longitudinal through the head of the shaft of the
humerus in a horizontal plane.
Ready Position: Full Internal Rotation
Parts Needed
Dynamometer: Elbow/Shoulder Attachment with Cuff

CONTENTS
ShOULDER: EXTERNAL/INTERNAL ROTATION IN ThE

MODIFIED NEUTRAL POSITION (SEATED)
The rotator cuff is one of the most important structures in maintaining the integrity of the shoul-
der complex. The stability of the glenohumeral joint depends largely on an intact and functioning
rotator cuff. A strong rotator cuff is especially important for a balanced and smooth movement of
the upper extremity.
There are several different positions available to set up a subject for testing or rehabilitation of the
internal/external rotation movement. Two are presented in this manual: the modified neutral
position and shoulder internal/external rotation in 90˚ of abduction.

(Starting Movement: Away/External Rotation)
NOTE: Attachment must be reversed for Right to Left. Align shaft dot with R or L.

5. Attach Elbow/Shoulder attachment. Align shaft dot with R or L. Secure with locking knob.
6. Move patient into position
7. Raise dynamometer to align patient axis of rotation. If needed, raise chair or adjust seat back
tilt to accommodate various patient sizes.
9. Set ROM stops.
Opposite side.
2. Rotate chair to 0 degrees on opposite side.
3. Rotate dynamometer to 20 degrees on opposite side.
4. Remove attachment and rotate it 180 degrees opposite.
5. Reattach Shoulder/Elbow attachment to dynamometer and align shaft dot with R or L. Secure
with locking knob.
6. Move chair and patient into position.
7. Adjust dynamometer to align patient axis of rotation. If needed raise chair or adjust seat back
tilt to accommodate various patient sizes.
9. Reset ROM stops.

CONTENTS
Isokinetic Mode
1. The isokinetic mode may be used at bi-directional velocities to stress either the internal rota-
tors or the external rotators. This mode may also be used to replicate function (i.e., the athlete
may work the external rotators at lower speeds and the internal rotators at higher speeds to
replicate the throwing motion.)
Passive Mode
especially important post-surgically. Many clinicians are using this early on post arthroscop-
ic surgery.
2. The passive mode may be used to work one muscle group both concentrically and eccentri-
cally, (i.e., after an anterior shoulder dislocation, the internal rotators may be worked both
concentrically and eccentrically through a limited range. With a tear in the posterior rotator
cuff, the internal rotators may also be stressed initially in this way).
Isometric Mode
1. Multi-angle isometrics may be performed early in the rehabilitation process or to work near
painful points in the ROM. In this way, strength gains will be made through a portion of the
unworked range.
Isotonic
1. Set torque accordingly (internal rotation high, external rotation low).
2. To increase speed of movement, set torque limits lower.

1. The eccentric mode may be used to perform submaximal eccentrics for the diagnosis of ten-
dinitis (i.e., this technique may be used in cases of supraspinatus tendinitis).
Additional Comments
1. Subjects with impingement syndrome may best be worked in the modified neutral position
and not 90 degrees of abduction.
2. A subject may be started in the modified neutral position and be worked into increasing
degrees of abduction as tolerated.
3. Athletes, especially pitchers, may be worked at the 90 degree abduction position and full
external rotation since this is a functional position for this group.
4. It has been found that the posterior cuff muscles act to decelerate the arm motion eccentrical-
ly during the follow-through phase of throwing. This eccentric motion may be simulated on
the Biodex.
5. Some clinicians have thought of impingement syndrome as an ineffective action of the rota-
tor cuff musculature. Use the eccentric mode to work on control.
6. As the glenohumeral joint is externally rotated, the anterior capsule undergoes a wringing
which may cause an inflammatory response in the capsule. External rotation may initially be
limited with ROM stop buttons or percent dials to prevent this.

CONTENTS
ShOULDER: EXTERNAL/INTERNAL ROTATION IN 90˚ OF ABDUCTION
Figure 3.26.
Figure 3.25.
40-45 55
Away Toward
Figure 3.27.
Quick Reference
Axis of Rotation: Axis alignment is longitudinal through the head of the shaft of the
humerus in a horizontal plane.
Ready Position: Full Internal Rotation
Parts Needed
Dynamometer: Elbow/Shoulder Attachment

CONTENTS
ShOULDER: EXTERNAL/INTERNAL ROTATION IN 90˚ OF ABDUCTION
The rotator cuff is one of the most important structures in maintaining the integrity of the shoul-
der complex. The stability of the glenohumeral joint depends largely on an intact and functioning
rotator cuff. A strong rotator cuff is especially important for a balanced and smooth movement of
the upper extremity.
There are several different positions available to set up a subject for testing or rehabilitation of the
internal/external rotation movement. The setup for this pattern in 90˚ of abduction is as follows.

(Starting Movement: Away/External Rotation)
NOTE: Attachment must be reversed for Right to Left. Align shaft dot with R or L.

2. Attach Elbow/Shoulder attachment. Align shaft dot with R or L. Secure with locking knob.
6. Move dynamometer along travel to align axis.
7. Tilt seat back to 55 - 85 degrees. If needed, lower seat or adjust seat back tilt to accommodate
various patient sizes.
8. Move patient into position and raise dynamometer to align patient axis of rotation.
9. Stabilize patient with shoulder and thigh straps.
10. Set ROM stops.
Opposite Side
1. Press Hold.
2. With patient remaining in chair, move seat away from dynamometer.
3. Remove attachment and align shaft dot with R or L. Shaft will have to rotate 180 degrees.
4. Place attachment back onto shaft, secure with locking knob.
5. Slide dynamometer to opposite side.
6. Rotate chair to 0 degrees opposite position.
7. Move patient into position. Raise dynamometer to align patient axis of rotation.
8. Tilt seat back to 55 - 85 degrees. If needed, lower seat or adjust seat back tilt to accommodate
various patient sizes.
9. Stabilize patient with shoulder and thigh straps.

CONTENTS
Isokinetic Mode
1. The isokinetic mode may be used at bi-directional velocities to stress either the internal rota-
tors or the external rotators. This mode may also be used to replicate function (i.e., the athlete
may work the external rotators at lower speeds and the internal rotators at higher speeds to
replicate the throwing motion.)
Passive Mode
especially important post-surgically. Many clinicians are using this mode one day post-op
after arthroscopic surgery.
2. The passive mode may be used to work one muscle group both concentrically and eccentri-
cally, (i.e., after an anterior shoulder dislocation, the internal rotators may be worked both
concentrically and eccentrically through a limited range. With a tear in the posterior rotator
cuff, the internal rotators may also be stressed initially in this way).
Isometric Mode
unworked range.
Isotonic
1. To increase speed of movement, set torque limits lower.
2. Set torque accordingly (internal rotation high, external rotation low).

1. The eccentric mode may be used to perform submaximal eccentrics for the diagnosis of ten-
dinitis (i.e., this technique may be used in cases of supraspinatus tendinitis).
Additional Comments
1. Subjects with impingement syndrome may best be worked in the modified neutral position
and not 90 degrees of abduction.
2. A subject may be started in the modified neutral position and be worked into increasing
degrees of abduction as tolerated.
3. Athletes, especially pitchers, may be worked at the 90 degree abduction position and full
external rotation since this is a functional position for this group.
4. It has been found that the posterior cuff muscles act to decelerate the arm motion eccentrical-
ly during the follow-through phase of throwing. This eccentric motion may be simulated on
the Biodex.
5. Some clinicians have thought of impingement syndrome as an ineffective action of the rota-
tor cuff musculature. Use the eccentric mode to work on control.
6. As the glenohumeral joint is externally rotated, the anterior capsule undergoes a wringing
which may cause an inflammatory response in the capsule. External rotation may initially be
limited with ROM stop buttons or percent dials to prevent this.

CONTENTS
ShOULDER: DIAGONAL (SEATED)
Shoulder Attachment
Figure 3.29
180
Away
Figure 3.28.
0
Toward
Figure 3.30.
Quick Reference
Dynamometer Tilt: 10 - 35˚
Seatback Tilt: 85˚
Axis of Rotation: Off axis through the glenohumeral joint.
Parts Needed

CONTENTS
ShOULDER: DIAGONAL (SEATED)

1. Seat patient on chair

into Adapter.
3. Align Shaft red dot with R or L. Move attachment to an upright position. Press Hold.
6. Tilt dynamometer 10 - 35 degrees. Increase or decrease the amount of horizontal abduction by
varying the dynamometer height and tilt. A lower dynamometer requires more tilt, which
increases abduction.
7. Move patient into position. Slide dynamometer along travel to align patient axis of rotation.
Seat back can be tilted to accommodate various size patients.
10. Set ROM stops.
Opposite Side
2. Remove attachment and rotate 180 degrees opposite. Align Shaft red dot with R or L and reat-
tach Shoulder attachment.
3. Move attachment to an upright position. Press Hold.
4. Rotate dynamometer to opposite 30 degrees.
5. Tilt to 10-35 degrees. Increase or decrease the amount of horizontal abduction by varying the
dynamometer height and tilt. A lower dynamometer requires more tilt, which increases
abduction.
7. Move patient into position. Slide dynamometer along travel to align patient axis of rotation.
Seat back can be tilted to accommodate various size patients.

CONTENTS
Isokinetic Mode
1. Seat patient to isolate the muscular surrounding the shoulder responsible for Glenohumeral
stabilization.
2. Stand patient to become more functional in the throwing pattern.
3. To isolate the D2 flexors, set select ecc/con. Vary speeds accordingly.
Passive Mode
1. Have patient work with the system in active assist fashion.
2. Have patient light the Force Away indicator at all times to work the D2 flexors.
Isometric
unworked range.
Isotonic
1. The Isotonic mode can be utilized to ensure a proper force limit is achieved.
Reactive Eccentric
1. For neuromuscular re-education, vary torque limits and have patient apply the “correct” force
to ensure proper attachment movement (to challenge the patient, make various changes to
torque limits without patient knowledge - but ensure that correct movement occurs.)

CONTENTS
ShOULDER: DIAGONAL (STANDING)
Shoulder Attachment
Figure 3.32.
180
Away
Figure 3.31
0
Toward
. Figure 3.33.
Quick Reference
Dynamometer Tilt: 10 - 35˚
Axis of Rotation: Off axis through the glenohumeral joint.
Parts Needed

CONTENTS
ShOULDER: DIAGONAL (STANDING)


into Adapter.
2. Tilt dynamometer to 10 - 35 degrees. Increase or decrease the amount of horizontal abduction
by varying the dynamometer height and tilt. A lower dynamometer requires more tilt, which
increases abduction.
4. Have patient stand perpendicular to dynamometer.
5. Align Shaft red dot with R or L. Move attachment to an upright position. Press Hold.
6. Align axis of rotation.
8. Set ROM stops.
Opposite Side
1. Remove attachment and rotate it 180 degrees opposite. Align Shaft red dot with R or L and
reattach.
2. Move attachment to an upright position. Press Hold
3. Have patient face opposite way and grasp handgrip.
4. Align axis of rotation (glenohumeral joint).
positions of the glenohumeral joint as it goes through the motions.
6. Reset ROM stops.

CONTENTS
Isokinetic Mode
1. Seat patient to isolate the muscular surrounding the shoulder responsible for Glenohumeral
stabilization.
2. Stand patient to become more functional in the throwing pattern.
3. To isolate the D2 flexors, set select ecc/con. Vary speeds accordingly.
Passive Mode
1. Have patient work with the system in active assist fashion.
2. Have patient light the Force Away indicator at all times to work the D2 flexors.
Isometric
unworked range.
Isotonic
1. The Isotonic mode can be utilized to ensure a proper force limit is achieved.
Reactive Eccentric
1. For neuromuscular re-education, vary torque limits and have patient apply the “correct” force
to ensure proper attachment movement (to challenge the patient, make various changes to
torque limits without patient knowledge - but ensure that correct movement occurs.

CONTENTS
ELBOW: EXTENSION/FLEXION (SEATED)
Figure 3.35.
Figure 3.34
Toward
160
0 Away
. Figure 3.36.
Quick Reference
Positioning Chair Orientation: 0˚
Seatback Tilt: 85˚
Axis of Rotation: Passes through the center of the trochlea and the capitulum,
bisecting the longitudinal axis of the shaft of the humerus.
Parts Needed
Dynamometer: Elbow/Shoulder Attachment
Positioning Chair: Limb-Support Pad, Footrest (optional)

CONTENTS
ELBOW: EXTENSION/FLEXION
The elbow joint consists of the articulation between the trochlea of the humerus and the trochlear
notch of the ulna, the capitulum of the humerus and the facet on the head of the radius and the
circumference of the head of the radius and the radial notch of the ulna. Any bony malalignment
(such as a fracture) interferes with the critical angles of these articulations making normal move-
ment impossible.
Of special note at the elbow are the tendinous origins of the wrist musculature. The flexor/prona-
tor muscles of the wrist originate at the medial epicondyle of the humerus and wrist extensor
group at the lateral epicondyle. These are areas that frequently become inflamed with overuse.

1. Seat patient on chair

2. Place Elbow/Shoulder attachment onto shaft (remove cuff). Align shaft dot with either R or
L. Bring attachment to vertical. Press Hold.
3. Install limb support (angled toward patient) in chair side receiving tube for side to be tested
or exercised.
4. Rest elbow on limb support. Limb support pad should be angled back with pad angled slight-
ly downward, allowing full extension. Securing strap may not be necessary.
8. Move patient into position. Slide dynamometer along travel and raise to align axis of rotation.
10. Allow handgrip to rotate as patient goes through motion.
11. Set ROM Stops.
Opposite Side
1. Press Hold.
2. Unstrap patient from support pad. With patient remaining in chair, slide chair back away
from dynamometer.
3. Place limb support in opposite side chair receiving tube.
4. Remove attachment and rotate it 180 degrees opposite. Align shaft dot with R or L. Place
attachment back onto shaft and secure with locking knob.
5. Rotate dynamometer to 30 degrees on opposite side.
6. Rotate chair to 0 degrees on opposite side.
7. Move patient into position. Slide dynamometer along travel to align axis of rotation.
8. Allow handgrip to rotate as patient goes through motion.
10. Reset ROM stops

CONTENTS
Isokinetic Mode
1. The isokinetic mode may be used to work the elbow bi-directionally. In this way job specific
tasks, functional tasks, or sports activities may be simulated.
Passive Mode
1. The passive mode may be used to treat inflammatory conditions of the elbow. Many times when
rest is recommended it does not mean total immobilization but the elimination of activities that
cause pain. The passive mode may be used for the effects of continuous passive motion.
2. The passive mode may be used to perform non-reciprocal contractions, e.g., working the
extensors at the end range of motion both concentrically and eccentrically, as it is not uncom-
mon for elbow extension to be compromised after injury or fracture.
Isometric Mode
1. Isometrics may be used when pain or inflammation is a concern. Multi-angle isometrics
are recommended.
Isotonic Mode
1. To simulate a functional activity, set the isotonic force accordingly to a patient task.
2. Perform eccentric/concentric movements to do biceps-only exercise.

1. The eccentric mode may be used to simulate job specific tasks, e.g., the eccentric mode may
be used to work the elbow flexors, eccentrically as if the worker were lowering a heavy box.
Additional Comments
1. It has been recommended by some clinicians that the dominant arm should be 5% stronger
than the non-dominant arm in recreational athletes and 10% stronger in competitive athletes.
2. Ice may be applied to the site of the lesion while the patient is in the passive mode for approx-
imately fifteen minutes.
3. For cases of capsular tightness. Place the patient in the passive mode. Red range of motion
limit set buttons may be set to encompass a slightly greater range of motion than the patient
currently is capable of moving. The percent range settings should be reduced to 55% and the
patient should be placed on the unit. Slowly and with caution, the percent ROM dials should
be turned up. NEVER EXCEED A COMFORTABLE OR PHYSIOLOGICAL RANGE OF
MOTION. ALWAYS HAVE THE COMFORT STOP AVAILABLE. The pause may also be used
for a passive stretch at end range.
4. The elbow is frequently injured by the repeated application of stresses. Throwing injuries
commonly occur secondary to throwing too frequently and throwing repeatedly at maximum
force. These injuries may be treated by working either passively, isokinetically, or eccentri-
cally at submaximal levels.
5. Position the handgrip to concentrate on specific muscle groups. If desired, keep the handgrip
loose to obtain active supination or pronation.

CONTENTS
FOREARM: SUPINATION/PRONATION
Figure 3.38.
Away 80
80
Figure 3.37. Figure 3.39.
Quick Reference
Dynamometer Tilt: 5˚ (shaft down)
Seatback Tilt: 85˚
Elbow Flexion: 90˚
Axis of Rotation: Axis of rotation for this pattern is the longitudinal line through the
center of the head of the radius proximally, and through the center of
the head of the ulna distally.
Ready Position: Full Pronation
Parts Needed
Dynamometer: Wrist Attachment

CONTENTS
FOREARM: SUPINATION/PRONATION
Pronation and supination occur when the forearm rotates around a longitudinal axis passing
through the head of the radius and center of the distal ulna. During pronation/supination, the
radial head articulates with the capitellum of the humerus and the radial notch of the ulna.
Distally the radius and articular disc of the distal radioulnar joint articulates with the scaphoid,
lunate and triquetrum. The radius carries the wrist about the ulna during pronation and supina-
tion. Pronation/supination may be a particularly difficult motion to fully achieve after injury sec-
ondary to the complex nature of the movement.

(Starting Movement: Away/Supination)
NOTE: Right and Left use same dot orientation for this pattern.

2. Install limb support (angled away from patient) in chair side receiving tube for side to be test-
ed or exercised.
3. Attach Wrist attachment to dynamometer. Align shaft red dot with R L. Handgrip orientation
should be up.
4. Rotate Chair to 90 degrees.
5. Slide dynamometer along travel to align patient with axis of rotation. Raise dynamometer, if
necessary.
8. Tilt dynamometer to 5 degrees (shaft down).
10. Set ROM stops.
Opposite Side
2. Move limb support to opposite side chair receiving tube.
3. Rotate attachment (do not remove) to horizontal. Rotate handgrip to angle up. Press Hold.
5. Move patient into position and align axis of rotation.
7. Reset ROM stops.

CONTENTS
Clinical Applications of Biodex Operating Modes:
Isokinetic Mode
1. The isokinetic mode may be used at bi-directional velocities in order to simulate functional or
sports activities.
Passive Mode
1. The passive mode is important for the effects of continuous passive motion. The passive mode
may be used to initiate treatment of reflex sympathetic dystrophy.
2. The passive mode may be used to work a specific muscle group both concentrically and
eccentrically, e.g., after a colles fracture, supination may be limited secondary to immobiliza-
tion. The supinators may be worked both concentrically and eccentrically to gain motion and
increase strength.
Isometric Mode
1. The isometric mode may be used to strengthen musculature when pain, instability or surgery
is a factor.
Isotonic Mode

1. The eccentric mode may be used to strengthen the musculotendinous junction. This may be
important since the wrist is frequently used eccentrically during functional activities.
Additional Comments
1. At certain times, full range of motion may never be achieved, e.g., if in a colles fracture the
distal radial fragment moves toward supination, there may be a permanent loss of pronation.
2. With involvement of the wrist, be careful of shoulder-hand syndrome. Be sure to mobilize the
entire upper extremity.
3. If edema is a concern, the dynamometer and multi-support fixture may be raised dur-
ing rehabilitation.

CONTENTS
WRIST: EXTENSION/FLEXION
Figure 3.41.
Away
70
Figure 3.40.
0
80
Toward
Figure 3.42.
Quick Reference
Seatback Tilt: 85˚
Elbow Flexion: 90˚
Axis of Rotation: Axis of rotation for this pattern lies between the proximal row of the
carpals, at the capitate bone, and the radius at the radiocarpal joint.
Parts Needed

CONTENTS
WRIST: EXTENSION/FLEXION
The wrist joint consists of the distal end of the radius and the articular disc of the distal radioul-
nar joint articulate with the proximal row of carpal bones (scaphoid, lunate, and triquetrum.) The
carpal bones form a much larger surface than do the radius and the articular cartilage. This allows
for adduction/abduction, flexion/extension and circumduction to occur. Movement also occurs
between the proximal and distal row of carpal bones. The midcarpal joint adds considerably to
flexion and extension of the wrist.

NOTE: Right and left side use same dot orientation for this pattern.

2. Install limb support (angled away from patient) in chair side receiving tube.
3. Attach Wrist attachment to dynamometer. Align shaft red dot with R L. Handgrip orientation
is horizontal to floor.
7. Move patient into position. Slide dynamometer in front of patient’s wrist to be exercised or
tested.
8. Align patient’s axis of rotation.
10. Set ROM Stops.
Opposite Side
2. Move limb support to opposite chair side receiving tube.
3. Rotate Wrist attachment to horizontal (do not remove). Press Hold.
4. Rotate chair to opposite 0 degrees setting.
9. Reset ROM Stops.

CONTENTS
Isokinetic Mode
1. The isokinetic mode may be used bi-directionally to emphasize one particular muscle group,
e.g., in cases of golfer’s elbow where there is involvement of the flexor tendon at the elbow,
the wrist flexors may be worked at low speeds and the extensors at high speeds.
Passive Mode
1. The passive mode may be used for continuous passive motion effects. It may also be used to
maintain/increase range of motion, e.g., this is especially important in a colles fracture when
regaining range of motion is most difficult.
2. The passive mode may be used in cases of reflex sympathetic dystrophy which frequently
develops in conjunction with a colles fracture. These patients may receive sympathetic blocks
followed by mobilization and range of motion. The patient may move passively at first and,
as tolerated, begin to assist the motion in each direction.
3. The passive mode may be used to work non-reciprocally. In this way the wrist, both muscle
groups or one muscle group may be exercised concentrically/eccentrically or vice versa, e.g.,
in cases of tennis elbow with involvement of the common extensor tendon at the elbow, the
wrist extensors may be worked concentrically/eccentrically by having the patient assist wrist
extension and resist wrist flexion.
Isometric Mode
1. Isometrics may be used after periods of immobilization or surgery. Isometrics may be used to
strengthen musculature after very delicate surgical procedures, e.g., isometrics may be the
first step in treating a scapholunate advanced collapse wrist.
Isotonic Mode

1. The eccentric mode may be used to simulate functional activities. Sub-maximal eccentrics
have been used successfully to treat tendinitis.
Additional Comments
1. Whenever there is wrist involvement, it is important to examine shoulder and elbow move-
ments. If there is immobility in these areas, the passive mode may be used to improve ROM.
2. Wrist flexion and extension exercises are frequently performed with the forearm pronated because
tests have demonstrated that a greater mean torque can be produced than when in supination.
3. Use of the work tools may be an important adjunct in returning a patient to work.

CONTENTS
WRIST: RADIAL/ULNAR DEVIATION
Figure 3.44.
Away
Figure 3.43. 25
35
Toward
Figure 3.45.
Quick Reference
Seatback Tilt: 85˚
Elbow Flexion: 90˚
Axis of Rotation: Axis of rotation for this pattern is at approximate center of capitate
bone if viewed from the palmar surface of the hand.
Ready Position: Full Ulnar Deviation
Parts Needed

CONTENTS
Wrist: Radial/Ulnar
Radial/Ulnar deviation involves radiocarpal and midcarpal movement. Ulnar deviation occurs
over a greater ROM than radial deviation. Radial deviation is limited by bony contact of the
scaphoid tubercle against the radial styloid.

(Starting Movement: Away/Radial Deviation)
NOTE: Right and left side use same dot orientation for this pattern.

2. Install limb support (angled away from patient) in chair side receiving tube.
3. Attach Wrist attachment to dynamometer. Align shaft dot with R L. Handgrip orientation is
up.
7. Move patient into position. Slide dynamometer in front of patient’s wrist to be exercised or test-
ed.
8. Slide dynamometer along travel to align axis of rotation. Raise dynamometer, if necessary.
10. Set ROM Stops.
Opposite Side
2. Move limb support to opposite side of chair.
3. Rotate Wrist attachment so handgrip faces up (do not remove). Press Hold.
5. Rotate chair to opposite 0 degrees setting.
10. Reset ROM Stops.

Isokinetic Mode
1. The isokinetic mode may be used at bi-directional velocities to simulate function or to empha-
size one particular muscle group.
Passive Mode
1. The passive mode may be used post-surgically in order to gain range of motion. e.g. After
surgery to correct a scapholunate advanced collapse, place the patient in the passive mode at
the range available and gradually increase as warranted.
2. The passive mode may be used to perform concentric/concentric, concentric/eccentric, eccen-

tric/concentric, and eccentric/eccentric contraction types. It is important to perform multiple
contraction types when rehabilitating the wrist since the hand performs such a wide variety
of functional tasks.
Isometric Mode
1. Isometrics may be used after delicate surgical procedures or when instability is a concern. The
physician and therapist’s expertise and the type of surgery that has been performed must be
taken into account when beginning any form of exercise.
Isotonic Mode

1. The eccentric mode may be used to perform submaximal eccentrics or to simulate function-
al activities.
Additional Comments
1. Swelling may be a concern when exercising the wrist and hand. If so, the multi-support fix-
ture and dynamometer may be raised to keep the hand above the level of the heart.
2. At times, there may be situations where full range of motion cannot be achieved. In a colles
fracture, secondary to malalignment during healing, there may be a permanent loss in ulnar
deviation. In this case, it is important to work on motions that may have been limited during
immobilization such as ulnar deviation.
3. Whenever the wrist is involved, it is important to evaluate the entire upper extremity for lack
of mobility and then treat accordingly.

4. USING THE OPTIONAL
CLOSED CHAIN ATTACHMENT
PARTS AND COMPONENTS
(See Figure 4.1.)
3
1
2
6 4
8 9
7
Figure 4.1. Closed Chain Attachment with Footplate and Handgrip.
1. Attachment Receiving Tube

2. Attachment Locking Knob
3. Closed Chain Locking Knob (blue dot/white dot are located
opposite locking knob)
4. Footplate
5. Heel Strap
6. Padded Foot Strap
7. Footplate Rotation Pull Pin
8. Footplate Rotation Scale
9. Handgrip with Neutral Handle
INTRODUCTION
The Optional Closed Chain Attachment (#830-520) has been designed to provide early, safe,
progressive rehabilitation for both the upper and lower extremity.
Essentially, this device converts rotational motion at the dynamometer into linear motion,
allowing closed kinematic chain exercises to be performed on the ankle, knee, hip, shoulder,
elbow, wrist and back without eliciting the increased shear forces inherent in open chain exer-
cise. Interchangeable upper and lower extremity attachments afford a wide range of exercise
possibilities. As with all Biodex attachments, speed, torque and ROM settings are addressed
through the system controller.
— 4-1 — USING THE CLOSED CHAIN ATTACHMENT

CONTENTS
The Closed Chain Attachment is designed for use in acute care and early intervention, in restor-
ing ROM, and for limiting shear forces during sub-maximal torque production (especially when
exercising the lower extremity).
WARNING: Do not exceed:

• 75 ft. lbs. of torque
! • ~200 lbs. of force
• 890 Newtons (~100 Nm)
ATTENTION: Ne pas dépasser:

• 75 ft. lbs. de torque
! • ~200 lbs. de force
• 890 Newtons (~100 Nm)
NOTE: For additional information on use and care of the Closed Chain Attachment, refer to the Closed
Chain Attachment Operations Manual which was supplied with this unit.
SETUP PROCEDURE
(See Figures 4.2-4.6.)
The Closed Chain Attachment can be used with both Biodex System 3 Pro as explained in the
following procedure.
4. Attach Closed Chain attachment to dynamometer. Align dynamometer shaft red dot with
Closed Chain Attachment dots as follows:
• Closed Chain white dot to dynamometer shaft red dot for horizontal
out and vertical down positioning.
• Closed Chain blue dot to dynamometer shaft red dot for horizontal
in and vertical up positioning.
NOTE: For first time installation only, set the attachment adjustment screws so that they are flush
against the appropriate indents in the face of the dynamometer. These four screws are located on the
side of the Closed Chain attachment that faces the dynamometer. They are used to provide additional
stabilization to the attachment. Use a 1/2-inch open-end wrench to adjust the screws as required.
5. Insert handgrip or footplate in attachment receiving tube. Secure attachment locking knob.
6. Position chair and/or dynamometer to align patient axis of rotation.
7. Set ROM stops.
NOTE: Dynamometer/Chair positions and height can be varied to match specific exercise patterns.
USING THE CLOSED CHAIN ATTACHMENT — 4-2 —

CONTENTS
Figure 4.2. The Closed Chain Attachment in horizontal position. Chair and dynamometer are both set
to 0 degrees rotation.
Away
Away
36”
Toward
Toward
Figure 4.3. Direction of movement Figure 4.4. Direction of movement

for upper body exercise. for lower body exercise.
Figures 4.5 and 4.6. In addition to horizontal left and right positions, the Closed-Chain Attachment can
be used in the vertical up and vertical down positions.

CONTENTS
UPPER EXTREMITY EXERCISE

(See Figure 4.7.)
1. For upper extremity exercise, insert handgrip into attachment receiving tube with neutral
handle facing up or down, based on the pattern to be performed. Tighten the attachment
locking knob to secure the handgrip in place.
2. The degree of elbow and shoulder flexion is easily adjusted by raising or lowering the
dynamometer or adjusting seatback or dynamometer positioning fore/aft.
3. Dynamometer tilt can be adjusted if necessary to fine tune axis alignment. Be sure to note
the height, position and tilt settings of the dynamometer and chair to ensure reproducibility
in future exercise sessions.
Figure 4.7. The handgrip can be inserted with the neutral handle facing up or down based on patient protocol.
Dynamometer rotation = 0 degrees, Chair rotation = 0 degrees.
LOWER EXTREMITY EXERCISE

(See Figure 4.8.)
NOTE: The round plate, directly adjacent to the footplate rotation scale, is marked with a “L” for left side and
a “R” for right side patient setups. The appropriate letter faces up when the footplate is correctly positioned.
2. Insert footplate into attachment receiving tube. Tighten the attachment locking knob to
secure the footplate in place.
3. The footplate can be used in either of two ways: free to rotate or fixed at specific 15 degree
increments of plantar/dorsiflexion from 0 degrees to 60 degrees as indicated by the footplate
tilt scale.
4. To adjust the degree of fixed ankle flexion, pull out on the footplate rotation pin and rotate
the footplate in accordance with patient protocol. Ensure the pin locks into the fixed
position hole at the desired setting.

CONTENTS
5. To allow the footplate to rotate freely throughout the ROM, pull up on the footplate rotation
pin and rotate the plate one half turn so that the pin will not retract into any of the fixed
position holes.
6. To stabilize the patient’s foot, the padded Velcro® brand hook and loop fastener foot strap is
threaded through the middle strap guides and secured over the forefoot. The heel strap is then
threaded through the appropriate heel strap slots and secured tightly against the patient’s heel.
7. Knee and hip flexion is easily adjusted by raising or lowering the dynamometer or positioning
chair or by moving the dynamometer along the T-base so that it is closer or further from the patient.
8. Be sure to note the height, position and tilt settings of the dynamometer and chair to ensure
reproducibility in future exercise sessions.
Figure 4.8. The footplate can be set at specific 15-degree increments of plantar/dorsiflexion, or free to rotate.
APPLICATIONS
(See Figures 4.9 - 4.14.)
The Biodex Closed Chain Attachment is quite versatile and can be used for both upper and
lower extremity exercise. Chair/dynamometer positions and height can be adjusted to allow for
a variety of patterns. Some commonly used exercise patterns are shown in Figure 4-9.
Knee
Early anterior and posterior cruciate ligament reconstructions, meniscus repairs, patellofemoral
pathologies, and total knee replacements benefit from:
• Ability to perform passive ROM with leg in elevated position.

• Increased protection due to co-contraction of hamstrings and quadriceps during closed chain.
• Sub-maximal active or passive range of motion and exercise in a safe, protected position that
utilizes co-contraction.
• Minimizing the introduction of increased anterior and posterior translation forces to the
reconstructed or unstable joint.
• Functional concentric/eccentric mini squat in a controlled sub-maximal application.

CONTENTS
Ankle
• Allows leg musculature to be exercised while maintaining the ankle in a safe, neutral, non-weight
bearing position for early plantarflexion and dorsiflexion, ankle sprains and ankle fractures.
• Safe range of motion in strengthening exercises across functional positions, or where ankle
instability requires co-contraction for protection.
• Footplate rotates freely or locks into position to protect the healing structures.
hip
• Provides general lower extremity (hamstring, quadriceps, gleutels and calf) strengthening
for total hip replacement.
Back
• Back patients can strengthen entire lower extremity in functional positions through safe
comfortable range of motion.
• Dynamic lumbar strengthening can be obtained in standing functional position to perform
pelvic stabilization exercises.
Shoulder
• Allows safe exercise of shoulder girdle, pectorals, triceps and serratus in functional posi-
tions, utilizing safe, short arc ranges to avoid excessive joint strain.
• Scapular stabilization exercise performed concentric or eccentric.
• Serratus anterior exercised using concentric or eccentric protraction.
• Chest press in limited arc, safe from excessive joint strain.
• Safe, progressive exercise for anterior/posterior dislocations.
Elbow
• Safely load triceps and biceps for treatment of dislocations and ulnar collateral ligament sprains.
• Range of Motion and strengthening exercise with shoulder and wrist in functional positions.
Wrist
• Functional wrist exercise utilizing co-contraction to preserve joint integrity.
Figure 4.9. Knee Extension/Flexion.


CONTENTS
Figure 4.10. Chest Press/Lat Row.

Figure 4.11. Elbow Extension/Flexion.


CONTENTS
Figure 4.13. Scapula Protraction/Retraction, scapular plane.

Figure 4.14. Overhead Elevation/Depression

TEChNICAL INFORMATION
Specifications
Speed: 0-36” per second (0-90 cm/sec) @ 4500/sec

Force: Up to ~200 lbs. (890 Newtons)
Stroke: 18” (46 cm) accommodates pediatric to 6’4” (195 cm) patients
Force Conversion: Force (lbs.) = 2.6181 x torque (ft. lbs.)
Distance Conversion: Distance (in) = .08 x degrees of rotation
Velocity Conversion: Vel (in/sec) = .08 x angular velocity (deg/sec)
U.S. Patent #4,907,797

5. REFERENCE MATERIALSCONTENTS
SUGGESTED TEST SPEEDS
Joint Pattern Orthopedic Athlete

Patient
Knee Extension/Flexion (60), 180, 300 180, 300, 450
Knee Tibial External/Internal (60), 60, 120 120, 180, 240

Rotation
Shoulder Abduction/Adduction (60), 180, 300 180, 300, 450
Shoulder Flexion/Extension (60), 180, 300 180, 300, 450
Shoulder External/Internal Rotation (60), 180, 300 180, 300, 450
Shoulder D1, D2 (60), 180, 300 180, 300, 450
Shoulder Horizontal Abduction/ (60), 180, 300 180, 300, 450

Adduction
Elbow Flexion/Extension (60), 180, 300 180, 300
Wrist Extension/Flexion 60, 120 120, 180
Wrist Radial/Ulnar Deviation 60, 120 120, 180
Forearm Supination/Pronation 60, 120 120, 180, 240
Ankle Plantarflexion/ 60, 120 (60), 120, 180

Dorsiflexion
Ankle Eversion/Inversion 60, 120 (60), 120, 180
Hip Flexion/Extension (120), 180, 300 180, 300, 450
Hip Abduction/Adduction (120), 180, 300 180, 300, 450
Hip Internal/External Rotation 60, 120 120, 180
NOTE: Test speeds in parenthesis may be approximate depending on pathology.
— 5-1 — REFERENCE MATERIALS

LEGAL PRECEDENT FOR BIODEX EVIDENCE
In a Florida court decision, the Biodex System was accepted into evidence as a measure of dynam-
ic human function. This decision establishes a precedent with important medical/legal implica-
tions for all rehabilitation professionals. In the future, the testifying therapist need only cite the
precedent case number for Biodex evidence to be accepted as valid.
Sue Chestnut, P.T., of Plantation Physical Therapy, testified as a witness for the plaintiff during
the trial Larry Beard vs. State Paving Co. The trial convened the week of May 21, 1986 in Broward
County Circuit Court, Fort Lauderdale, Florida. Case #81-12431 CH.
The plaintiff had sustained injuries in an automobile accident and was recommended to
Chestnut’s offices in Plantation, Florida for rehabilitation. Shortly before trial, a work-up on the
patient was done on the Biodex System. Evidence introduced indicated that the individual had a
functional deficit on his affected side of 50%.
“Biodex evidence was integral to the case,” says Chestnut. “The evidence was the only factual
measure of his functional ability introduced during the trial.”
Chestnut was able to explain to the jury exactly how the Biodex functioned and what it was used
for. This included explaining the difference between the Biodex and one of the original Isokinetic
devices. The attorney for the defense was familiar with the older system, but the Biodex was new
to him.
After Chestnut had outlined the differences to the attorney, neither the presiding judge,
Honorable Robert Andrews, nor the attorney had any further question or objection. The evidence
was then legally admitted in a United States court of law for the first time.
Evidently, the judge and attorneys were not the only ones impressed with Chestnut’s testimony.
The jury retired to consider its verdict and returned with a ruling in favor of Chestnut’s client.
BIODEX DATA ADMITTED AS MEDICAL EVIDENCE IN COURT
1. Larry Beard vs. State Paving Co.

Broward County Circuit Court
Ft. Lauderdale, FL
Docket No. 81-12431 CH
Judge: Hon. Robert Andrews
2. Gilbert Green vs. Delta Airlines

Federal Court
Ft. Lauderdale, FL
Docket No. 85-6656 CIVJAG
Attorney: David Kratlin, Esq.
3. Grace Monico vs. G.E. Credit Corp.

Broward County Court
Plantation, FL
Docket No. 87-000 75CA
Attorney: Jeffrey Fenster, Esq.
REFERENCE MATERIALS — 5-2 —

CONTENTS
PATIENT PROGRESS ChART
BIODEX

CONTENTS
CURRENT RECORDED NORMATIVE GOALS (ENGLISh UNITS)
JOINT MOVEMENT SPEED PEAK TORQUE/BW RANGE FLEX/EXT RATIO EXT ROT/INT ROT RATIO ABD/ADD RATIO DORSI/PLANTAR RATIO EVER/INVER RATIO
AND POSITION DEGREES/SECONDS MALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE
Lumbar Flexion 60 114 121 * *

Semi Standing 90 * * * *
120 * * * *
Lumbar Extension 60 150 162 * * 49 49

Semi Standing 90 133 139 * * 59 59
120 145 150 * * 51 51
Shoulder External Rot. 60 13 17 10 13

Mod. Neutral 180 11 15 8 12
Shoulder Internal Rot. 60 19 26 14 18 64 71

Mod. Neutral 180 17 23 13 17 66 71
Shoulder Flexion 60 25 34 23 30
Seated 180 22 29 20 26
300 9 12 21 27
Shoulder Extension 60 28 37 24 31 90 79
Seated 180 22 30 18 23 83 83
300 28 37 17 23 69 81
Shoulder Abduction 60 20 27 16 20
Seated 180 18 24 14 18
Shoulder Adduction 60 32 43 27 35 66 64
Seated 180 27 36 25 33 53 78
Ankle Plantarflexion 30 49 65 43 55
Seated 60 36 48 36 46
120 23 31 20 26
Ankle Dorsiflexion 30 13 17 16 21 26 39
Seated 60 11 15 15 20 31 43
120 9 12 11 14 39 54
Ankle Eversion 30 13 17 12 16
Seated 60 9 12 9 12
Ankle Inversion 30 12 16 14 19 87 81
Seated 60 11 14 12 15 90 80
Knee Flexion * * * * *
Seated * * * * *
Knee Extension 60 86 115 80 95 61 62

Seated 180 58 75 50 65 72 76
300 40 55 30 45 78 79
Hip Flexion 45 40 52 38 50
Supine 300 10 13 7 9
Hip Extension 45 63 82 57 77 64 66
Supine 300 34 44 28 37 29 25
Elbow Flexion 60 21 28 20 26
Seated 120 21 28 34 45
Elbow Extension 60 21 28 23 30 97 88
Seated 120 23 30 18 24 93 98
Wrist Flexion 60 4 7 4 7
Seated 120 2 4 2 4
Wrist Extension 60 2 4 2 4 57 57
Seated 120 2 4 2 4 97 97
* The Biodex normative database is a compilation of published information to be used as unilateral goals.
Peak Torque to body weight is expressed in a range which enables these goals to be recommended for var-
ious groups (Prepubescent patients do not apply)
REFERENCE MATERIALS — 5-4 —

CONTENTS
CURRENT RECORDED NORMATIVE GOALS- (METRIC UNITS)
JOINT MOVEMENT SPEED PEAK TORQUE/BW RANGE FLEX/EXT RATIO EXT ROT/INT ROT RATIO ABD/ADD RATIO DORSI/PLANTAR RATIO EVER/INVER RATIO
AND POSITION DEGREES/SECONDS MALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE
Lumbar Flexion 60 38.1 40.4 * *

Semi Standing 90 * * * *
120 * * * *
Lumbar Extension 60 50.1 54.1 * * 49 49

Semi Standing 90 44.4 46.4 * * 59 59
120 48.4 50.1 * * 51 51
Shoulder External Rot. 60 4.3 5.7 3.3 4.3

Mod. Neutral 180 3.7 5.0 2.7 4.0
Shoulder Internal Rot. 60 6.3 8.7 4.7 6.0 64 71

Mod. Neutral 180 5.7 7.7 4.3 5.7 66 71
Shoulder Flexion 60 8.4 11.4 7.7 10.0

Seated 180 7.4 9.7 6.7 8.7
300 3.0 4.0 7.0 9.0
Shoulder Extension 60 9.4 12.4 8.0 10.4 90 79

Seated 180 7.3 10.0 6.0 7.7 83 83
300 9.4 12.4 5.7 7.7 69 81
Shoulder Abduction 60 6.7 9.0 5.3 6.7

Seated 180 6.0 8.0 4.7 6.0
Shoulder Adduction 60 10.7 14.3 9.0 11.7 66 64

Seated 180 9.0 12.0 8.4 11.0 53 78
Ankle Plantarflexion 30 16.4 21.7 14.4 18.4

Seated 60 12.0 16.0 12.0 15.4
120 7.7 10.4 6.7 8.7
Ankle Dorsiflexion 30 4.3 5.7 5.3 7.0 26 39

Seated 60 3.7 5.0 5.0 6.7 31 43
120 3.0 4.0 3.7 4.7 39 54
Ankle Eversion 30 4.3 5.7 4.0 5.3
Seated 60 3.0 4.0 3.0 4.0
Ankle Inversion 30 4.0 5.3 4.7 6.3 87 81

Seated 60 3.7 4.7 4.0 5.0 90 80
Knee Flexion * * * * *
Seated * * * * *
Knee Extension 60 28.7 38.4 2.7 31.7 61 62

Seated 180 19.4 25.1 16.7 21.7 72 76
300 13.4 18.4 10.0 15.0 78 79
Hip Flexion 45 13.4 17.4 12.7 16.7

Supine 300 3.3 4.3 2.3 3.0
Hip Extension 45 21.0 27.4 19.0 25.7 64 66

Supine 300 11.4 14.7 9.4 12.4 29 25
Elbow Flexion 60 7.0 9.4 6.7 8.7

Seated 120 7.0 9.4 11.4 15.0
Elbow Extension 60 7.0 9.4 7.7 10.0 97 88

Seated 120 7.7 10.0 6.0 8.0 93 98
Wrist Flexion 60 1.3 2.3 1.3 2.3

Seated 120 .7 1.3 .7 1.3
Wrist Extension 60 .7 1.3 .7 1.3 57 57

Seated 120 .7 1.3 .7 1.3 97 97

6. APPENDICESENTS
EMG/ANALOG SIGNAL ACCESS INTERFACE*
The EMG/Analog Signal Access Configuration Utility (ASA Config) is part of the EMG/Analog
Signal Access Interface option to the Advantage Software Program. The utility configures the
scale factors and operating modes of the analog signal outputs for velocity, torque and position.
With the configuration capability, the analog signals can be custom tailored to provide the best
and most appropriate analog data for a wide variety of usages.
Installation and Usage

The ASA Config utility must be installed on the computer, which runs the Advantage Software
program. Insert the provided ASA Config utility CD into the CD drive, and it will automatically
start the setup installation. If all the defaults are chosen during setup, a shortcut will be created
on your desktop called: System -- ASA Config.
The utility cannot be run simultaneously with the Advantage Software application. Typically you
must exit the application, run the ASA Config utility to setup the scaling and modes, then run the
Advantage Software application to perform your tests and data capture.
All settings performed in the ASA Config utility will be permanently set in the Biodex Multi-Joint
System, even if the unit is completely shut down and re-started. The current settings can always
be verified by running the utility – it will show the current active settings. Status information on
the Biodex Multi-Joint System is shown on the top of the screen for your reference. As long as the
status shows ONLINE, the current displayed Analog Signal settings are accurate.
The Analog Signal Access port is an output of analog signals of velocity, torque and position data
in real-time directly from the motor control Digital Signal Processor (DSP). In addition to the real-
time data, a synchronization pulse is issued whenever the real-time data is updated. The syn-
chronization pulse can be used by the monitoring equipment to know when the real-time data
output has changed.
NOTE: For the pin-out definition of the port, please refer to the diagram at the back of this document enti-
tled: EMG/Analog Signal Port Pin Configuration
Analog Signal Resolution Effected By Scale Factor

The analog signals range from –5 volts to +5 volts, resulting in a total range of 10 volts. The System
defaults to full scale. Full scale for torque as an example is –512 ft-lbs to +512 ft-lbs, for a total
range of 1024 ft-lbs. This results in an output resolution scale factor as follows:
1024 ft-lbs = 10 volts,
1 ft-lb = 9.8 milli-volts
*Consult with Biodex Customer Service before ordering.
S — 6-1 — APPENDICE
CONTENTS
9.8 milli-volts is well below the signal noise rated for this port, therefore it’s not possible to see 1
ft-lb increments on this analog signal. This program provides scaling options separately for all
three analog signals, so if typical usage is well below the maximum levels, 1 ft-lb increments can
be seen on typical analog monitoring equipment. For example, applying a range of +/- 0 to 64 ft-
lbs, the output resolution scale factor would look as follows:
128 ft-lbs = 10 volts,
1 ft-lb = 78.1 milli-volts
78.1 milli-volts is well above the worse case of signal noise (15 – 35 mV), so increments as low as
1/4 to 1/2 ft-lbs can be seen reliably.
Operating Modes
The Output Frequency, or update rate, controls how frequently the system will change the analog
outputs. The best it can do is 2,000 times per second, which is the default. If this high frequency is not
needed or may even be causing problems with the monitoring equipment, the update rate can be
lowered. Every time the analog signals are output, the synchronization signal is pulsed also.
Therefore the update rate controls how frequent the synchronization signal (i.e.: “syncout”) is pulsed.
NOTE: Syncout is a Digital TTL pulse which is Active High and has a continuous pulse width of 29
micro-seconds.
The Output Mode selects in what state the analog signal outputs are updated. The options are
as follows:
On Always - always output regardless of current operational state
On Timed - turns on analog outputs only for the next fixed period of time (in seconds)
Off (disabled) - totally shuts down the analog signal outputs
Auto, when active - is automatically on only when the system is in an active state, meaning not
STOP’ed and not in HOLD
On Go command - synchronizes the analog signal output with the Advantage Software applica-
tion’s GO command, so the output is performed only during the trials exercised
NOTE: Use the <Refresh> button to display the current Remote Access Port setting in effect.
APPENDICES — 6-2 —
CONTENTS
Table Of Scale Range and Factors

Following is the break down of ranges and the resulting scale factors for all three signals:
Scaling Option Range Scale Factor
Velocity:
0 – 512 deg/sec -512 to +512 deg/sec 9.8 mV per deg/sec
Torque:
0 – 512 ft-lbs -512 to +512 ft-lbs 9.8 mV per ft-lb
Position:
Full scale (~ 348.6 deg) 12 to 320 degrees 28.7 mV per degree
ROM Only (varies) Ex: 45 degrees Ex: 222.2 mV per degree
EMG/ANALOG SIGNAL PORT PIN CONFIGURATION
Pin # Designation Description

1 Common Signal ground
2 Torque Analog torque signal
3 Velocity Analog velocity signal
4 Position Analog position signal
5 Syncout TTL pulse
6-9 reserved Do not connect!
10 Common Signal ground [same as pin 1]
11-15 not connected
— 6-3 — APPENDICES
MAINTENANCE
MAINTENANCE
Cleaning Instructions
With the system turned OFF, wipe down all surfaces with a damp cloth. Mild soap and water can
be used to remove stains and scuff marks. Pay particular attention to the upholstery, which can
be damaged by exposure to perspiration and other body fluids.
NOTE: DO NOT use cleaning solutions containing ammonia or alcohol to clean upholstery. Mild soap and
water should be sufficient. Allow the system to dry thoroughly before resuming testing, rehab or exercise sessions.
A leather cleaner/conditioner can be used monthly on all upholstery.
hardware
As needed, inspect all locking and adjustment mechanisms for signs of wear or damage.
If you have any questions or need further assistance, contact the Biodex Customer Service Department.
CONTENTS
SYSTEM SPECIFICATIONS
Features:
17” Flat Panel LCD Touch Screen Monitor
Multi-Mode operation; Isokinetic, Isometric, Isotonic, Reactive Eccentric and Passive
Concentric speed up to 500 deg/sec
Eccentric speed up to 300 deg/sec
Concentric torque up to 500 ft-lb (680 Nm)
Eccentric torque up to 400 ft-lb (444 Nm)
Passive speed as low as .25 deg/sec
- Passive torque as low as .5 ft-lb
- Isotonic torque as low as .5 ft-lb
Clinical Data Station:

Windows™ based PC (current model)
Windows™ Operating System
Biodex Advantage Software
LCD Flat Panel Touch-Screen Color Monitor with integrated Speakers
Color Printer
Attachments for Ankle, Knee, Shoulder, Elbow, Wrist and hip
Attachment Cart
Calibration Kit
Manuals and Wall Chart
Operating space: 64 square feet (6 square meters)
220 VAC
Certification:
ETL and cETL listed to UL 60601-1,CAN/CSA C22.2 No.: 601-1-M90 and EN60601-1.
CE conformity to M.D.D. 93/42/EEC
CONTENTS
Electrical Requirements
208/230VAC, 50-60Hz, 8 amps
Requires 20A isolated dedicated service
Hospital Grade Plug must be rated for 230VAC, 15 amps minimum

North American Units supplied with NEMA 6-20P
Equipment should have means to isolate its circuits electrically from the supply mains on all
poles, simultaneously.
Mechanical Specifications
Total Weight (Pro Configuration): 1350 pounds
Physical Dimensions:CDS Cart: 27 inches wide, 24 inches deep, 66 inches high

T-Base & Chair: 52 inches wide, 65 inches deep, 60 inches high
Attachment Cart: 50 inches wide, 26 inches deep, 50 inches high
Dynamometer Performance Specifications

Torque accuracy is +/- 1% of full scale (500 ft-lbs)
Torque is factory calibrated
Position range is 330 degrees

Position accuracy is +/- 1 degree of rotation
Torque verification fixture is 50 ft-lbs +/- 0.5 ft-lbs
Authorized European Community Representative:
EC REP
Emergo Europe
Molenstraat 15
2513 BH, The Hague
The Netherlands
0413
CONTENTS
CONFORMANCE TO STANDARDS
This equipment conforms to the following safety standards:
Standard Edition and/or date

IEC60601-1-2 First edition, 2007
Table 1.1 Safety standards
Accompanying EMC Documents

This medical electrical equipment needs special precautions regarding EMC and needs to be
installed and put into service according to the EMC information provided in this manual.
• Portable and mobile RF communications equipment can affect medical electrical equipment.
• Use of accessories, transducers and cables other than those specified, with the exception of
accessories, transducers and cables sold by the manufacturer of this equipment, as replace-
ment parts for internal and external components, may result in increased emissions or
decreased immunity of the equipment.
• The System 4 Multi Joint Device should not be used adjacent to or stacked with other equip-
ment. If the System 4 Multi Joint Device is used while positioned adjacent to other equipment,
it should be observed to verify normal operation in the configuration in which it will be used.
List of Cable Accessories

The list in Table 1.2 includes all accessory cables supplied with the System 4 Multi Joint Device
for which the manufacturer of this equipment claims compliance to EN 60601-1-2 when used with
the System 4 Multi Joint Device.
Cable Description Part No. Cable Length

Motor Power Cable Biodex #830-210-E752 10ft
Dyna Sensor Cable Biodex #830-101-E700 10ft
Power Input Cable Biodex #850-111 10ft
CDS Pwr Input Cable Biodex #835-210-E721 15ft
Table 1.2 System 4 Multi Joint Device cables
CONTENTS
DECLARATION OF CONFORMITY
Em issio ns
Emissions
Manufacturer’s
Manufacturer’s d
declaration
eclla
aration eelectromagnetic
lectromagn
gnetic emissions
emissions
The Sy
The stem 4 M
System Multi
ulti Joint
Joint Device
Device is in
intended
tended for
for use
use in
in the
the electromagnetic
electromagnetic environment
environment sspecified
peciffiied below.
below. The
The customer
customer or
or the
the
user of
user of tthe
he System 4 M
System Multi Joint Device
ulti Joint Device should assure
should assure that
that it
it is
is used
used in
in such
such an environment
an environment
est
Emission ttest
Emission Comp liance
Compliance El
Electromagnetic environment
ectromagnetic environment
RF emissions
emissions Group
Gr oup 1 Thee System
Th System 4 Multi
Multi Joint
Joint Device generates
Device ge nerattes R
RF energy
F en ergy o
only for its
nly for its
CI SP R 1
CISPR 111 internal
in
nterrn
nal functions.
functions. Therefore,
Therefore, its
its RF
RF emission
emission is
is very
very low
low and
and is not
not
li
likely cause any
kely to cause an y interference
inter fer ence in
in nearby electronic equipment
nearb y electronic equipment
emissions
RF emissions Class A
Class The
The SySystem
stem 4 Multi
Multi Joint
Joint Device
Device is ssuitable
uitaable for
for use
use in all
all
CISPR
CI SP R 11
11 es tablishments other
establishments other th
than
an domestic
domestic and
and those
those directly
diirrectly connected
con
nnnected to the
to the
ublliic low-voltage
public
pu low-voltage power
power ssupply
upply ne
network
twwork supplying buildings used
suppl ying buildings used
fo
forr d omestic purposes.
domestic purposes.
Harmonic
Ha distorrttion
armonic distortion Class A
Class
EN 61000-3-2
61000 -3-2
Vo lttaage fluctuations
Voltage fflluctuations Complies
Complies
an
andd flicker
ffllicker
EN 6 61000-3-3
1000-3-3
Immunity
Immunity
Manufacturer’s
Manufacturer’s d
declaration
eclla
aration eelectromagnetic
lectromagn
gnetic immunity
immunity
Th
Thee Sy
System
stem 4 Multi
Multi JJoint
oint Device
Device is inintended
tended for
for use
use in
in the
the electromagnetic
environment specified
speciffiied below.
below. The
The customer
customer or or the
the
us
user
er o the Sy
off the System Multi JJoint
stem 4 Multi oint Device
Device shshould
ould assure
assure tthat it is
hat it is used
used in
in such
such an environment.
an environment.
Immunity
Immu nity test test IEC
IEC 6 60601-1-2
0601-1-2 IEC
IEC 6 60601-1-2
0601-1-2 Electromagnetic
El ectromag gn
netic environment
environment – g guidance
uidance
Te
Test
st llevel
evel Compliance
Co mplliiance level
lleevel
El
Electrostatic discharge
ectrosttaatic discharge ±6k kVV contact
contact Contact
Co ntact ± 6 kV
kV Floor
Fl oor should
sh
hould b bee wood,
wood, concrete
concrete oror ceramic
ceramic
(ESD)
(ESD) ± 8 kV airair Airr ± 8 kV
Ai kV tiles.
tiles. If
If fflo
floor
loor is is covered with synthetic
covered with sy
ynnthetic
IEC 6
IEC 1000 -4-2
61000-4-2 material,
ma aterial, the
the relative
relative humidity
humiditty
y should
should bebe at
at
least
le ast 30%
El
Electrical
ectrriical fast
fast ± 2 kV for for p
power
ower lines
lines Power ± 2 kV
Power kV Ma ains p
Mains power
ower quality
qualitty
y should
should be
be that of a
that of
transients/burst
transients/burst ± 1 kV for input/outtput
for input/output Signal ± 1 kV
Signal kV ty
typical
yp
y pical commercial
commercial or or hospital environment
hospital environment
IEC
IEC 6 61000-4-4 44
1000 -4-4 lin
lines
es
Surge
Sur ge ± 1 kV differential
differential mode
mode ±1 k
kV
V diff.
diff. mode
mode Mains
Ma ains power
power quality
qualitty
y should
should be
be that
that of
of a
IEC
IEC 661000-4-5
1000 -4-5 ±2 k V common
kV common mode
mode ±2 kV com.
kV com. mode
mode ty
typical
yp
ypical commercial
commercial oror hospital environment
hospital environment
CONTENTS
Immunity
Immu nity test
test IEC
IEC 660601-1-2
0601-1-2 IE
IEC
C660601-1-2
0601-1-2 Electromagnetic
Electtromag
gn
netic environment
environment – g
guidance
uidance
Test evel
Test llevel Compliance
Co mplliiance level
lleevel
Voltage dips,
Voltage dip s, short
short < 5%
5% U UTT ((>
> 95%
95% o off d
dip
ip in
in < 5%
5% UUT T ((>
> 95%
95% of of dip
dip Maains power
Mains qualitty
power quality should be
y should be that
that of
of a typical
tty
yp
ypical
interruptions
in
nterrrrup and
ptions and UT
UT)) for
for 1
1/2
/2 cycle
cycle in UT
UT)
T) ffor
or 1/2 ycle
1/2 ccycle commercial
co mmercial or
or hospital enviirronmentt. If
hospital environment. If a be
better
tttter
voltage
volltage v variations
ar iations on
on 40
40%
%U UTT (6
(60%
60% ooff di
dip
ip in
in 40
40%%U UTT (6
(60%
60% o off di
dip
ip mains
maains power
power quality
qualitty
y is requiirred, it
is required, it is
is
po
power
wer supply
suppl y iinput
npu
ut UT for 5 ccycle
UT)) for ycle in UT)
UT) ffor yccle
or 5 ccycle re
recommended
commended that
that the
the Sy
System
stem 4 Multi Joint
Mullti Joint
lin es
lines 70
70%
%U UTT ((30%
30% ooff di
dip
ip in
in 70
70%%U UTT ((30%
30% o off di
dip
ip vice is p
Device
De powered
owered from
from an uptible
an uninterruptible
uninterrru
IEC
IE 61000-4-11
C 61000-4-11 UT
UT)) for
for 25 cycle
25 cycle in UT)
UT) for
for 25 cyccle
25 cycle power ssupply
power upply
< 5%
5% U UTT ((>
> 95%
95% o off dip in
dip in < 5%
5% UUTT ((>> 95%
95% o off d
dip
ip in
in
UT for 5 ssec
UT)) for ec UT) for 5 sec
UT) for sec
Power r eq uency
Power ffrequency 3 A/m
A/ m A/ m
3 A/m image distortion
If image distortion occurs,occurs, it it may
may be b e necessary
necessar y
(50/60
(50/60 H
Hz)
z) m agnetic
magnetic to p position
osition the the Sy System
stem 4 Multi Joint Device
Multi Joint Device
field
field display
di splay further
furrtther fromfrom sources
sources of of power
power
IEC 6
IEC 1000 -4-8
61000-4-8 fr equency m
frequency agnetic fields
magnetic fields or to to iinstall magnetic
nstall magnetic
sshielding.
hielding. The The power ffrrequency magnetic
power frequency magnetic field
ffiield
sh
should
ould be measurred in
be measured in thethe intended
intended installation
installation
location to
location to assure
assure th that at it it is sufffiiciently low
is sufficiently low
Conducted
Co RF
nducted R F 3 Vrms,
V rms, 3 Vrms,
V rms, Portable
Porttaable and and mobile
mobile RF RF communications
communications
IEC
IEC 61000-4-6
61000-4-6 15 0 KHz
150 KH z tto
o 80 M Hz
MHz 15 0 K H z to 8
150KHz 800M Hz
MHz equipment should
equipment should be be used used no no closer
closer to to any
an y papart
arrtt
Radiated RF
Radiated RF V / m,
3 V/m, 3 V/m,
V / m, of the
the Sy System
stem 4 M Multi
ulti Joint
Joint Device,
Device, including
iin
ncluding
IEC
IEC 61000-4-3
61000-4-3 80 MMHzH z to2.5
to2.5 GHz
GH z 80 MMHz to2.5
H z to 2 .5 GHz
GH z cables,
caables, than than thethe recommended
recommended separation separattion
di
distance
stance calculated
calculaated from ffrrom the the equation applicable
equation applicable
to the
the frequency
frequency of the the transmitter.
transmitter.
Re
Recommended
commended separation separation distance: distance:
d=1 . 2! P 1
1.2! 5 0 KHz
150 KH z to 8 800M MHzHz
d=1 .2! P 80 MHz
1.2! MHz to 8 00 M
800 Hz
MHz
d=2 .3! P 80
2.3! 800 0 MHz
MHz to 2. 2.5 5 GHz
G Hz
where
where P is is tthe
he maximum
maximum output output power rating of
power rating
the transmitter
the transmitter in watt watt (W) (W) according
according to the the
transmitter
transmitter manufacturer,
manufactur er, and and d is the the
re
recommended
commended separation separation distance disttaance inin meters
meters
(m
(m). ).
Field
Field strengths
strengths from ffrrom fixed
ffiixed RF transmitttters, as
RF transmitters, as
determined
de ter mined by b y an
an electromagnetic
electromagnetic site survey, a
site survey,
should
should be b e lless
ess than
than the the compliance
co mp liance le level
vel in
ffrrequency range.
each frequency range. b
In
Interference
terference may ma y occur
occur in in the vicinit y of
the vicinity of
equipment
eqquipment marked marked with with the the following
following symbol:
sy
ym
mbol:
No
Note
te 1
1.. U
UT T is
is tthe
he a.c.
a.c. mains
mains voltage
voltage prior
prior to
to application
aap pplication of
of the
the test
test level.
level.
No te 2
Note 2.. A
Att 80 MHz
80 MHz aand nd 800
800 MHz,
MHz, tthe
he higher
high ffrr equency range
her frequency range applies.
aappplies.
Note 3.
Note 3 . These
These g uidelines may
guidelines may not apply
apply in
in all
all situations. Electromagnetic propagation
situations. Electromagnetic propagation is
is affected
affected by
b y absorption
absorrp
ption and
and
n reflections
reffllections
fr
from
om structures,
structtu objects and
ures, objects and people
people
a
Field
Field strength
strength from
from mixed tr ansmitters, such
mixed transmitters, such as
as base
base stations
stations for
for radio
radio telephones
telephones andand land
land mobile
mobile radios,
r adios, amateur
amateur radio,
radio, AM
or FM
FM b broadcast and T
roadcast and TVV broadcast cannot be
broadcast cannot be predicted
predicted theoretically
theoretically with
with accuracy.
accuracy. ToTo assess
assess the
the electromagnetic
environment due due
to ffi
fixed
ixed RF transmitters, an
RF transmitters, electromagnetic site
an electromagnetic site survey
survey should
should be
be considered.
considered. If
If the
the measured ffiield strength
measured field strength inin th
thee location
lo cation in
in
wh
whichich the
the Sy stem 4 Multi
System Multi Joint
Joint Device
Device is u used
sed exceeds
exceeds the the applicable
applicable RF
RF compliance
comppliance levels
levels above,
above, thethe Sy stem 4 Multi
System Joint
Multi Joint
Device
Device should
should bebe observed
observed to
to verify
veriffy
y normal
norrrm
mal operation.
operation. If
If abnormal
abnorrm
mal performance
performance isis observed,
observed, additional measures may
additional measures may be be necessary,
necessarrry
y,
such aass reorienting
such reorientting or relocating
relocating the
the System Multi Joint
System 4 Multi Joint Device.
D evice.
b
Over
Over tthe
he frequency r ange 150
frequency range 150 KHz
KHz ttoo8 80
0MMHz,
Hz, field
field sstrengths
trengths should
should be
be less than 3 V/m.
less than V/m.
CONTENTS
Recommended Separation Distances
Re
Recommended
commended separation
seep
paratiio
on distances
distances between
bettw
ween portable
portabllee and
and mobile
mobile RF
RF communications
communicatiio
ons equipment
equipment and
and the
the Sy
System
stem 4 Multi
Mullttii
Joint
Joi
int D eviice sy
Device system.
steem . Table
Tab le 6
Th
Thee Sy
System
stem 4 Multi Joint Device
Multi Joint Device is in
intended
tended for
for use
use in
in the
the electromagnetic environment in
electromagnetic environment in which
which radiated
radiaated RF urbance are
RF disturbance
disttu are
controlled. The
controlled. The cu
customer
stomer or or the
the user
user of the System
of the System 4 M Multi Joint Device
ulti Joint Device cacan
an help
help prevent
prevent electromagnetic interference by
electromagnetic interference by
aintaining a minimum
maintaining
ma minimum distance
distance be
between
ttw
ween portable
porrttable and
and mobile
mobile RF
RF communication
communication equipment (ttransmitters) and
equipment (transmitters) and the
the System
System
4MMulti
ulti Joint Device as rrecommended
Joint Device ecommended below, below, according
according toto the
the maximum
maximum output
output power
power of
of the communication equipment.
the communication equip ment.
Ra
Rated
ted maximum
maximum output
outtpp ut Separation
Se
eparattiion d distance
istance according
according toto frequency
frequency ofof transmitter
transmitter [m]
[m]
power
power o off transmitter
transmitter [[W]
W]
15
150
0 kHz
kHz toto 80 MHz
MHz 80 MHz
MHz ttoo 800 MHz
MHz 800
800 MHz
MHz ttoo 2.5
2.5 G GHz
Hz
d=1 .2 ! P
1.2! d=1 .2 ! P
1.2! d=2 .3 ! P
2.3!
0.01
0.01 0.12 0.12
0.12 0.23
0.23
0.1
0.1 0.38
0.38 0.38
0.38 0.73
0.73
1 1.2
1.2 1.2
1.2 2.3
2.3
10 3.8
3.8 3.8
3.8 7.3
7.3
100 12 12 23
Fo
Forr ttransmitters
ransmitttters rated
rated at
at a maximum output power
maximum output power not not listed
listed above, the recommended
above, the r ecommended separation distance d in
separation distance in meters
meters (m)
(m) cancan
estimated using
be estimated using the
the equation
equation applicable
p icab
appl ble to
to the
the frequency
frequency of the n mitttter, where
the transmitter,
trans where P is
is the
the maximum
maximum output
output power
power
rating
ra
ating of tthe
he transmitter
transmitttter in
in watts
watts (W)
( W) according
according to to the
the transmitter
trransmitter manufacturer.
manuffacttu urer.
No te 1
Note 1.. At
At 80
80 MMHz
Hz and
and 8800
00 MMHz,
Hz, tthe separation distance
he separation distance for
for the
the higher
higher frequency
ffrr equency range applies.
range applies.
Note 2.
Note 2 . These
These g uidelines may
guidelines may not
not apply
appl y in
in all uations. Electromagnetic
all situations.
sittua Electromagnetic propagation
propagation isis affected
affected by
b y absorption
absorrpt
pttion and reffllection
and reflection
from
from structures,
structtu objects and
ures, objects and people.
people.
Operating Temperature
Do not expose the equipment to a temperature change of more than 5° F (3° C) per hour.
Limits of low and high operating temperature ranges are 59° to 86° F (15° C to 30° C).
CONTENTS
GENERAL PRODUCT WARRANTY
A. Warranty
BIODEX MEDICAL SYSTEMS warrants that all products covered hereby shall be free from
defects in workmanship and materials and shall conform to published specifications or other
specifications accepted in writing by BIODEX for:
Description: Parts: Labor:

Controller 1 year 1 year
Dynamometer 1 year 1 year
Clinical DataStation 1 year 1 year
Printer 1 year 1 year
Cables 1 year 1 year
Adjust. Positioning Chair 1 year 1 year
Attachments 1 year 1 year
Threads 1 year 1 year
Knobs 1 year 1 year
Upholstery 60 days 60 days
Straps 60 days 60 days
Pads 60 days 60 days
under normal use as prescribed in the operator’s manual. The foregoing warranty does not apply
to any products which have been subject to use other than as specified as standard operating pro-
cedure in the system manual, neglect, accident or modification. BIODEX’s sole obligation to buyer
hereunder for products failing to meet aforesaid warranty shall be, at BIODEX’s discretion, to
replace or repair the non-conforming product (parts and labor) or issue buyer credit for the pur-
chase price of the non-conforming product where within warranty period:
1. BIODEX has received written notice of any nonconformity and
2. After BIODEX’s attempts to remedy such nonconformity, BIODEX has

determined that the nonconformity is not a result of improper use,
accident, repair or other misuse by buyer.
Any replacement product shall carry the unexpired term of the warranty which was applicable to
the replaced product or a period of 30 days, whichever is longest.
BIODEX MAY RETAIN THE RIGHT TO VOID ALL SYSTEM WARRANTIES IF PAYMENT IS
NOT RECEIVED AS PRESCRIBED IN TERMS OF PURCHASE.
EXCEPT AS SPECIFICALLY PROVIDED HEREIN, THERE ARE NO OTHER WARRANTIES,

EXPRESS OR IMPLIED, INCLUDING, BUT NOT LIMITED TO, ANY IMPLIED WARRANTIES
OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE.
IN NO EVENT SHALL BIODEX BE LIABLE FOR LOSS OF PROFITS, INDIRECT, SPECIAL, CON-
SEQUENTIAL, OR OTHER SIMILAR DAMAGES ARISING OUT OF ANY BREACH HEREOF.
CONTENTS
B. Warranty Period
Warranty time period stated in paragraph “A”, is from date of invoice (shipment) unless other-
wise specified in writing by BIODEX.
C. Repaired or Replacement Products (out of warranty)

BIODEX MEDICAL SYSTEMS, for a period of 60 days, warrants that its standard products
repaired or replaced hereunder shall be free from defects in workmanship or materials under nor-
mal use as described in the system’s Operator’s Manual. Warranty period will begin upon ship-
ment of repaired or replacement products. The sole responsibility of BIODEX under this warran-
ty is, at its option, to repair or replace any defective component parts of such products. This war-
ranty does not apply to:
1. Products which have been repaired or altered other than under specific
instructions from BIODEX’S Service Department instruction as listed in
system’s manuals or procedures previously approved in writing by
BIODEX Service Department,or
2. Products which have been subject to use other than described as standard use in the system’s
operator’s manual, neglect or accident.
THIS WARRANTY IS NOT TRANSFERABLE (SITE, OWNERSHIP, ETC.) WITHOUT THE WRIT-
TEN PERMISSION OF BIODEX MEDICAL SYSTEMS. WARRANTY IS VOID UNLESS EQUIP-
MENT IS INSTALLED BY BIODEX PERSONNEL.
BIODEX
Biodex Medical Systems, Inc.
20 Ramsey Road, Shirley, New York, 11967-4704, Tel: 800-224-6339 (Int’l 631-924-9000), Fax: 631-924-9338, Email: info@biodex.com, www.biodex.com

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BIODEX MULTI-JOINT SYSTEM - PRO

! Attention, consult accompanying documents.

1. CONTROLS AND ADJUSTMENTS ..............................................................................................1-1

— III — TABLE OF CONTENTS

Congratulations, you’ve made an excellent choice!

NOTE: PRODUCT ENHANCEMENTS AND MODIFICATIONS

• This system should be operated only by qualified personnel.

—V— BEFORE PROCEEDING

• Pour les mouvements d'examen ou d'entraînement nécessitant une chaise accessoire,

• La technologie BIODEX nécessite une expertise professionelle pour choisir la tech

Figure 1.1. The Biodex Multi-Joint System - PRO positioning configuration.

— VII — BEFORE PROCEEDING

Figure 1.2. Dynamometer positioning controls and adjustments.

Dynamometer Rotation: To rotate the dynamometer in a horizontal plane, loosen

CONTROLS AND ADJUSTMENTS — 1-1 —

Dynamometer Tilt: Permits rotation of the dynamometer

(Dynamometer Tilt Degrees)

Dynamometer height: The dynamometer can be raised or lowered over a range of

NOTE: The weight of the dynamometer is counterbalanced by a pneumatic assembly in the

! Point Rouge Sur L'Axe Du Dynamometre.

— 1-2 — CONTROLS AND ADJUSTMENTS

! Comfort Stops (Dynamometer, Remote): These buttons

! ATTENTION: Redoubler de précautions pour reprendre la rotation de l’arbre du dynamomètre en

CONTROLS AND ADJUSTMENTS — 1-3 —

Dynamometer Position Color Code

Seat Rotation: The positioning chair offers 360 degrees of rotation

— 1-4 — CONTROLS AND ADJUSTMENTS

CONTROLS AND ADJUSTMENTS — 1-5 —

Figure 1.3. Positioning

Figure 1.4. Positioning Chair

CONTROLS AND ADJUSTMENTS — 1-6 —

SEAT BACK BRACE

2. Line up one rod-end swivel of the Seat Back

3. Release the seat back handle and lower the

5. Position the patient per protocol, then lock

6. To rotate the seat to the opposite 0 degree

Figure 1.7. Seat Back Brace installed and

— 1-7 — CONTROLS AND ADJUSTMENTS

ThE CONTROLLER (Located at the bottom, rear, of Computer Data Station)

Main Power Switch

Dynamometer Power Switch

Computer Power Switch

CPU ON/OFF Switch

Status/Diagnostics Panel (LEDs)

Figure 1.8. Figure 1.9.

CONTROLS AND ADJUSTMENTS — 1-8 —

Figure 1.10. Shoulder/Elbow Adapter

NOTE: Ensure finger guard is

NOTA: S’assurer que le doigtier

Figure 1.13. Wrist

— 1-9 — CONTROLS AND ADJUSTMENTS

! NOTE: Ensure finger guard is in place

! NOTA: S’assurer que le doigtier est bien

NOTE: See "Using The Combination Ankle Attachment

CONTROLS AND ADJUSTMENTS — 1-10 —

USING ThE COMBINATION ANKLE ATTAChMENT

A. Footplate Rotation Lever

Figure 1.17 The Combination Ankle Attachment adjustment mechanisms.

The footplate color codes are as follows:

White “P” to Red Dot: Plantar/Dorsiflexion