BALANCE-Trainer Instruction Manual 80 000 034-001

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Congratulations! You have made an excellent choice with the purchase of your BALANCE-Trainer. This Balance- and Standing-Trainer will provide you with excellent service. It was developed and designed according to the latest medical and therapeutical findings and is an innovative high-quality product, “Made in Germany”. These instructions will help you to familiarise yourself with the BALANCE-Trainer. They will guide you carefully through its functions and operation and offer numerous tips and hints on getting the best use out of your new Balance- and Standing-Trainer. Before using the device for the first time, please take careful note of the safety instructions on page 8. If you have any questions or observations, the staff at medica Medizintechnik GmbH or your local dealer will be only too pleased to help. Enjoy activity with your BALANCE-Trainer.

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Table of contents 1

DEVICE OPTIONS ...2

1.1

Basic configuration: ...2

2

INTENDED USE ...2

3

DEVICE- AND CONTROL ELEMENTS ...2

4

SAFETY...2

5

THERAPY INFORMATION ...2

5.1

General observations...2

5.2

Correct posture...2

5.3

Exercise programme planning ...2

6

TRANSPORTING AND COMMISSIONING...2

6.1

Before using the exerciser...2

6.2

Transport ...2

7

OPERATION ...2

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IM - Balance Trainer English Item No.: 7001-000 Doc. Rev. No.: 004 Page 7 of 22 7.1

Adjustment of height of the therapy desk ...2

7.2

Adjustment of hand rails ...2

7.3

Adjustment of balance resistance ...2

7.4

Adjustment of the function balancing or blocking...2

7.5

Knee pads (Accessory) (K and B6) ...2

7.6

Hip pads (Accessory) (J) ...2

7.7 Mechanical belt system (Accessory) (H)...2 7.7.1 Adjustment of the function stand or release ...2 7.7.2 Standing up – Sitting down ...2 7.8 Electric belt system (Accessory) ...2 7.8.1 Before using the electric belt system ...2 7.8.2 Mount the electrical belt system ...2 7.8.3 Connecting the cable connection in the electrical belt chassis ...2 7.9

Lifting harness for the patient with base (Accessory)...2

7.10

Lifting harness for the patient with pelvic harness (Special accessory) ...2

8

CLEANING AND DISINFECTION ...2

9

SIGNS AND SYMBOLS ...2

10

TECHNICAL DATA: ...2

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GUARANTEE ...2

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RECYCLING...2

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EC DECLARATION OF CONFORMITY...2

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1 1.1

Device Options Basic configuration:

The BALANCE-Trainer is used in its basic configuration by users who are able to stand up by themselves and only need slight support to stay in an upright position. A lifting harness stabilizes the hips. Fixing foot belts and heel cups give additional support. BALANCE-Trainer allows to stay in an upright (or almost upright) posture for patients with congenital or acquired restrictions resp. loss of the controlled stamina.

2 Intended use BALANCE-Trainer is suitable for use in the home, in hospitals, care institutions and medical practices. It is intended for the mobilization of persons, whose mobility and/or perception is restricted due to accidents, surgeries, or in general, due to diseases causing defects of the locomotor system and/or the perceptivity. BALANCE-Trainer allows standing up safely out of the wheelchair, depending on the situation of the patient with or without help, and the following combined Standing- and BALANCE-training. The user is supported in the standing position (depending on the accessories) on the feet, the knees, and the hip. BALANCE-Trainer allows to stay in an upright (or almost upright) posture for patients with congenital or acquired restrictions resp. loss of the controlled stamina. BALANCE-Trainer is a therapeutical exerciser and no medical device for diagnostic purposes.

3 Device- and control elements 1 Switch lever sit / stand (Actuation while standing) A D 2 Switch lever BALANCE-training D 3 Therapy desk A 4 Belly Pad A 5 Switch lever sit /stand (Actuation while sitting) A C 6 Knee pads B 80 000 034-001

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Foot fixation (Velcro Belt) B Heel cup B Foot plate B Manual belt system H Hand rail A Lateral bar A

14 Rollers with fastener L 14a Fastener L 15 Lifting Harness E 15a Velcro E 15b Buckle receivers E 16a Fastener - table F

16b Fastener - hand rail F 17 Balance resistance M 18a-d Quick Snapper G K 19 Blocking liner B 20 Belt reel C 21 Star handle K

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4 Safety • • • • • • • • • • • • •

Always place BALANCE-Trainer on a level, non- slip surface so as to ensure maximum stability. Before exercising make sure that all the four wheels (L14, L14a) are blocked. The BALANCE-Function has to be blocked while transferring into the sitting/standing position. Have your doctor or supplier show you how to operate the BALANCE-Trainer before using it for the first time. When exercising with the BALANCE-Trainer, make sure you adopt a physiologically correct position. Seek advice from a therapist. If symptoms of a medical condition occur during or after an exercise session, consult a doctor immediately. Never leave the BALANCE-Trainer unattended when children are present. Repairs to the exerciser may only be carried out by properly trained specialists. If the device is damaged, immediately stop training and contact your service technician. If using a device with a manual belt system (C), check if the lifting harness (15) fits properly before standing up. If using a device with a manual belt system (C), make sure that you use the Hip pads (J) for safety reasons together with the manual belt system while using the BALANCE-Function. Only use the BALANCE-Trainer under the supervision of an auxiliary person. Do not use liquids containing solvents to clean the exerciser.

If there is a defect of the manual belt system (C) while exercising, react the following way: (This applies only for users that cannot sit down again using the strength of their own arms.) In order to release the patient safely out of the lifting harness (E15) at least one auxiliary person is needed. If the person is a right hander, proceed this way (left handers have to proceed in a right-left reversed order): 1. The auxiliary person swivels the wheel chair a bit to the left so that he stands right behind the user. However, the patient still has to able to sit back into the wheel chair. 2. Standing stably behind the user, the auxiliary person opens the Velcro (E15a) at the lifting harness (E15). 3. Similarly to the first aid rescue grip the auxiliary person grasps around the rib cage of the patient with the right arm. 4. The auxiliary person now opens the buckle receiver (E15b) with the left hand. 5. Afterwards grasp under the patient’s bottom with the left hand and guide him back slowly to the wheelchair.

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5 Therapy information 5.1

General observations

The object of therapy depends on the medical condition of the patient and may be aimed at maintaining mobility (preventative therapy) or at rehabilitation after an accident, an operation or injury, i.e. at regaining mobility and strength. We recommend that the BALANCE-Trainer be used as part of a planned exercise programme prescribed by a doctor or therapist. Begin exercise sessions slowly and then increase the level of intensity gradually according to the user’s physical capabilities. Be particularly careful not to exceed the patient’s ability to cope with physical stress. BALANCE-Trainer is particularly recommended at: Impaired mobility and ability to walk Multiple sclerosis Parkinson’s disease Para-, Tetraplegia Stroke, Hemiplegia Muscular diseases Distortion of perception Uses BALANCE-Trainer can be used as a STANDING-Trainer or BALANCE-Trainer: Depending on the physical constitution the user betakes to the exerciser and positions himself in the BALANCE-Trainer. Patients with a wheelchair go to the BALANCE-Trainer and bring themselves, depending on the individual physical situation, with the manual belt system into the standing position. The support of an auxiliary person may be required. The device should be prepared according to the patient’s situation so the BALANCE-Training and STANDING-Training can be started.

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5.2

Correct posture

Always pay attention to the patient’s posture and that it does not conflict with the aim of the therapy. The therapy desk has to be adjusted in height so that the belly pad sits right above the pelvic.

5.3

Exercise programme planning

The frequency and duration of the BALANCE-Training and STANDING-Training should normally be individually planned and prescribed by a doctor or therapist. Regular exercising with the BALANCE-Trainer is extremely important if improvements in mobility are to be achieved. Start out with short sessions in order to accustom your body, the circulation in particular, to this positive stress. The length of the session can be gradually increased a small amount at a time, always taking great care not to exceed the physical capabilities of the patient. If longer breaks cannot be avoided, it may become necessary to restart the training with shorter exercise sessions.

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6 Transporting and Commissioning 6.1

Before using the exerciser

Remove your BALANCE-Trainer from its packaging and check for any damage suffered in transit. If you have a devices with a manual belt system (C), the switch lever sit/stand (A1) is packed to the manual belt system. Stick the switch lever (A1) into its mount and fasten the hex socket head screw firmly. Adjust the therapy desk (A3) to the proper height. The lower clamping fastener (F16a) has to be fastened again on both sides with normal hand power.

6.2

Transport

BALANCE-Trainer is serially equipped with lockable transport rollers (L14). If you want to transport the exerciser, the BALANCE-function (D2) has to be blocked (see the mark “block” on the therapy desk). Be careful to lock (L14a) the rollers (L14) safely after each relocation.

7 Operation Only use the BALANCE-Trainer if the transport rollers (L14, L14a) are locked and the device stands on solid and plane surface.

7.1

Adjustment of height of the therapy desk

The adjustment of the therapy desk height (A3) is supported by two integrated gas springs. In order to adjust the height, open the two lower clamping fasteners (F16a) and adjust the therapy desk to the needed height. Fasten both clamping fasteners (F16a) again on both sides with normal hand power. It is recommended to adjust the therapy desk (A3) so that the belly pad (A4) sits right above the pelvic. The marks on the bars showing the height make it easier to adjust the therapy desk horizontally.

7.2

Adjustment of hand rails

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IM - Balance Trainer English Item No.: 7001-000 Doc. Rev. No.: 004 Page 14 of 22 The height of the hand rails (A11) depends on the requirements of the user. In any case they should be high enough, so that they can be reached easily during the exercise. In order to adjust them in height, open both of the upper clamping fasteners (F16b) and adjust the therapy desk to the required height. Fasten the two upper clamping fasteners (F16b) again with normal hand power.

7.3

Adjustment of balance resistance

The balance resistance (M17) can be adjusted variably for the BALANCE-Training. Patients with a high instability of their trunk have to chose a high elasticity (lever up). To adjust his the BALANCE-function has to be blocked (switch lever for the BALANCE-function in the position “block”). Adjust the lever to the desired height and be careful that it snaps in properly. Attention: The balance resistance of both the left and the right spring have to be adjusted to the same height.

7.4

Adjustment of the function balancing or blocking

It is recommended to perform the first training with an auxiliary person who received special training with BALANCE-Trainer. If you want to start the BALANCE-Training while standing, move the switch lever (D2) to the correlative position (see mark on the desk top). After finishing the BALANCE-Training the user has to have enough strength to move autonomously to the centric standing position. This is essential to switch to the position “block” (see mark on the desk top). If this is not guaranteed, help must be provided.

7.5

Knee pads (Accessory) (K and B6)

The knee pads give safe support for standing up/balancing/sitting down. For standing up/sitting down the knee pads have to be always mounted to the BALANCE-Trainer, if the user is not able to stand for a longer time without any support of the knees. The knee pads can be adjusted in various ways to fit the very individual needs of the user. Adjustment of height: Open the quick snapper (G18a) at the right and left and adjust the knee pad mounting to the desired height. Be careful that the quick snapper snaps in properly afterwards. Adjustment in depth flection/extension in the knee joint: Every knee pad can be adjusted separately in depth to achieve the desired flection/extension of the knee joint. Open the quick snapper (G18d) at the right and/or left and adjust the knee pads to the required depth. Be careful that the quick snapper snaps in properly afterwards. Abduction: Open the star handles (K21), adjust the required distance and fasten the star handles (K21) again firmly. 80 000 034-001

IM - Balance Trainer English Item No.: 7001-000 Doc. Rev. No.: 004 Page 15 of 22 For functional exercises (e.g. lunge exercises) by a therapist the whole knee pad mounting can be completely removed so that the therapist has free access to the legs of the patient. However, you have to assure that the patient can still keep himself safely in an upright position. In order to remove the knee pad mounting, open the star handle counterclockwise and take them off. After that open the two quick snappers and remove the knee pad mounting from the holding pins. The knee pads (B6) have to be adjusted so that the knees are located right in the pad. All adjustments of the BALANCE-Trainer have to be chosen for every patient to prevent overstretching of the joints or damages to the muscles and tendons.

7.6

Hip pads (Accessory) (J)

The hip pads help to stabilize the user sideways and to support the user while standing/balancing. Usually an auxiliary person attaches them to the hand rails. The hip pads can also be used to support patients who can stand by themselves and who can use the BALANCE-Trainer without the manual belt system. Slide the hip pad mounting (J1) onto the hand rails (A11) and attach them in the desired position with the clamp rings (J2).

7.7

Mechanical belt system (Accessory) (H)

7.7.1 Adjustment of the function stand or release In order to stand up or sit down the switch lever for the balance function (D2) has to be on “block” (see mark on desk top). Be careful that the blocking liner (B19) is snapped in properly. Before you move the switch lever of the manual belt system (A1) to “release”, make sure that you are standing safely. Both belts stay locked in the position “release” as long as they under stress to prevent an unintended releasing (unrolling of the belts). The lock is disengaged by relieving both belts by a little forward movement.

7.7.2 Standing up – Sitting down The mechanical belt system makes it easier for patients with sufficient arm power or with support of an auxiliary person to stand up and get into a vertical position. The process of standing up has to be performed in this order: 1. Depending on the type of wheelchair the side parts and footrests have to be swivelled away or removed. The wheelchair should be as close as possible. Lock the parking brakes of the wheelchair. 80 000 034-001

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Set up the lifting harness for the patients (different versions available as an accessory). Move the switch lever to position “standing”. Unroll the belts and connect them to the belt buckles at the lifting harness. Move the switch lever to “stand”. Push up your body with your arms. The belt clicks into place in every position automatically. This way the user can move up safely step by step. In the standing position the belts should run slightly sloped upwards to the belt reels (C20), a bit higher than the buckle receivers. 7. Perform the STANDING-Training or BALANCE-Training. 8. To sit down again, move the switch lever to position “release”. 9. A little forward movement of the hips releases the locked belts. The user is not supported by the belt system anymore and can sit down again. 10. Release the belts from the harness by depressing the red button on each belt buckle and pulling the two items apart.

Attention: The patient has to have enough arm power to sit down controllably or an auxiliary person has to provide help and support.

7.8

Electric belt system (Accessory)

This system controls the lift to the upright position and back to the sitting position. It is useful for persons who are not able to lift up themselves to the standing position and back to the sitting position. For independent usage, the user needs enough strength in the upper body. The electric belt system is also useful if the user needs support, for example from a therapist or relative, to lift up the patient into the upright position or back to the sitting position. In this situation the electric belt system takes over the user’s weight and the gives the therapist a free hand to support the patient.

7.8.1 Before using the electric belt system If the BALANCE-Trainer is fitted with the electrical belt system, the emergency stop (N4) has to be placed somewhere useful on the table. Therefore the emergency stop is fitted with “duotec” self-adhesive tape. Place the second “duotec” self-adhesive tape (N7) somewhere useful on the table as well. Please click in the emergency stop after approx. one hour (N4).

7.8.2 Mount the electrical belt system In case of the modular concept of the BALANCE-Trainer you can add on the electrical belt system quite easy. Place the Chassis (N1) instead of the standard belt system or the mechanical belt system (H). Therefore unscrew both of the cross-head screws (O1) from the holder (O2). If present -unlock both quick snap (N6) and remove the belt system. Place the electrical belt system (N1) in the same way.

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7.8.3 Connecting the cable connection in the electrical belt chassis General information: All 3 plugs’ are with different number of pins and with different color marks. 1. Hand controller: Connect the hand controller (N2) plug with the respective colored socket at the electric belt chassis (N1) Please keep in mind the numbers of pins and the color (P). 2. Pneumatic mouth tube): Connect the tube (N3+U) with the counterpart (P). There is only one possibility. 3. Emergency stop: Connect the emergency stop (N4) plug with the respective colored socket at the electric belt chassis (N1) Please keep in mind the numbers of pins and the color (P).. Please keep in mind: The red button must be pulled. 4. Transformer: (N5+R): a. Please check the domestic power 115V or 220-250V. Check the position of the Transformer fuse (S) and change (turn 180°) if necessary to 115V or 250V. b. Connect the red cable (T1) plug with the respective socket of the transformer (R1). c. Connect the red cable (T1) plug with the respective socket of the electric belt chassis (N1+P). d. Connect the power cable (T2) plug with the respective socket of the transformer (R2). e. Connect the power cable plug with the power socket. f. Please keep in mind: The “on” / “off” switch (S) at the transformer is illuminated in the “on” position. The green light (P1) on the electric belt chassis indicates that the unit is on and attached to an electric current. The mechanism is controlled by the hand controller. The hand controller has two buttons which control the up and down movement. The mechanism will only operate when the red emergency stop button is in the pulled position. A pneumatic mouth tube can also be used to activate the unit by sucking or blowing. The electric belt system operates with an emergency stop. Push the red emergency stop button if necessary.

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Check the emergency stop function: Use hand controller button (2) or pneumatic mouth tube (3) and push the red emergency stop button (4). The motor function must be stopped. To deactivate the stop function, please pull the red emergency stop button back. The electric belt system is now ready for use.

7.9

Lifting harness for the patient with base (Accessory)

The lifting harness has put on in a way so that the bottom line is wedged in between the bottom of the patient and the wheelchair seat and that the Velcro belt can be closed.

7.10 Lifting harness for the patient with pelvic harness (Special accessory) On request.

8 Cleaning and disinfection Never use cleaning agents that are abrasive or caustic or contain solvents to clean/disinfect the exerciser. The outer surfaces of BALANCE-Trainer can be cleaned using commercial disinfectants.

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9 Signs and symbols

Note the security advices, resp. read the instruction manual.

Maximum payload BALANCE Resistance Balance resistance (maximal)

Balance resistance (minimal)

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If the switch lever (D2) points to „Stop“ the table is blocked, the BALANCE-Function is deactivated If the switch lever (D2) points to „Balance“ the table is free for f BALANCE-Function

Switch lever position “standing”

Switch lever position “release”.

If using a device with a manual belt system (C), make sure that you use the Hip pads (J) for safety reasons together with the manual belt system while using the BALANCE-Function.

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