THERA TRAINER Instructions for Use A000-785 sw ver 2.0 Jan 2010

13 12 11 10 9 14 16

8 7 15 6

6 5

5 4 3 2

2

1

1

* Illustration shows optional equipment

THERA-live basic version

2

Exerciser components and controls

Congratulations! You have made an excellent choice with the purchase of your THERATrainer. This therapeutic exerciser is an innovative, high-quality product made in Germany.

1 Castors 2 Exerciser stand, extending and height compensating 3 Self-operated stabiliser straps (optional feature)

These instructions will help you to familiarise yourself with your THERATrainer. 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 therapeutic exerciser.

4 Infinitely adjustable cranks (optional feature) 5 Footrest 6 Angle adjuster for handlebar/upper torso exerciser

Before using the exerciser for the first time, please take careful note of the safety instructions on page 7.

7 Calf rests (optional feature) 8 Support tube for handlebar/Upper torso exerciser

If you have any questions or observations, the staff at medica Medizintechnik GmbH will be only too pleased to help.

9 Knurled-handle screw for reach adjustment on upper torso exerciser 10 Upper torso exerciser (optional feature)

Enjoy exercising and stay active with your THERA-Trainer.

11 Therapy grips 12 Control pad with touchscreen display (optional feature, THERA-vital only) 13 USB interface (THERA-vital) 14 Knurled-handle screw for height adjustment/upper torso exerciser 15 Foot fixing (optional feature) 16 Control pad (THERA-live) Use only genuine medica accessories.

3

Contents Exerciser components and controls ...3 1 1.1 1.2

Exerciser options ...5 Basic exerciser ...5 Options...5

2

Symbols used ...6

3

Intended use ...6

4

Safety...7

5 5.1 5.2 5.3 5.4 5.5 5.6 5.7

Notes on exercise therapy ...9 General observations ...9 Uses ...9 Correct posture...9 Exercise programme planning ...10 Active and Passive exercising ...10 Muscle hypertonia/spasms...11 Side effects...11

6 6.1 6.2 6.3 6.4

Transporting and commissioning ...12 Before using for the first time ...12 Transporting ...12 Connecting to the power supply ...12 Switching the exerciser on/off (standby mode) ...12

7 7.1 7.2 7.3

Operation ...13 Adjusting the exerciser stand...13 Footrests ...13 Adjusting crank length, 2-position cranks ...13 Infinitely variable crank length (optional feature) ...14 Foot fixings (optional feature) ...14 Calf rests (optional feature) ...15 Adjusting the handlebar (optional feature on THERA-live) ...16

7.4 7.5 7.6 7.7

7.8 7.9 7.10 7.11 7.12 7.13 7.14 7.15 7.16 7.17 7.18 8 8.1 8.2 8.3 8.4 8.5 8.6 8.7 8.8 8.9 8.10 8.11 8.12 8.13 8.14 8.15

Upper torso exerciser (optional feature) ...17 Forearm rests (optional feature) ...19 Wrist supports (optional feature)...20 Adjustable legs (optional feature) ...20 Stabiliser chocks (optional feature)...21 Self-operated stabiliser straps (optional feature) ...21 THERA-assist exercising software (optional feature for THERA-vital only) ...21 Printer for exercising data (optional feature on THERA-vital only) ...22 Cardio-Pulse set (optional feature, THERA-vital only ...22 THERA-vital: Control pad with colour screen ...23 THERA-live: Control pad ...28 Submenu (THERA-vital only, for experienced users)...32 Navigating the submenu ...32 Menu structure...33 Description of exerciser functions on submenu...34 Duration ...34 Forwards/backwards auto reversal...34 Bio-feedback ...34 Motor power ...34 Spasticity detection ...35 Spasticity program...35 Automatic speed adjustment ...35 Heart rate limit ...35 Muscle support ...35 Microphone sensitivity ...36 Contrast...36 Basic exercising settings ...36

4

9 9.1 9.2

Bio-feedback ... 36 Bio-feedback for leg exerciser ...36 Bio-feedback for upper torso exerciser 38

10

Analysis of session data (THERA- vital only) ... 39 10.1 Printing out session data...39 11

Motor power ... 40

12

Technical specifications ... 41

13

Cleaning and disinfection... 42

14

Replacing the fuse ... 42

15

Guarantee... 42

16

Recycling... 42

17

EC Declaration of Conformity ... 43

18

Tips and tricks ... 44

19

Notes on electromagnetic compatibility ... 46 Electrical leads, lead lengths and accessories ...46 Warning note about accessories used...46 Warning note about siting ...46 Compliance levels ...46 Interference emission ...46 Interference immunity ...47 Recommended safe distances between portable and mobile equipment, high-frequency telecommunications equipment and THERA-Trainers ...49

19.1 19.2 19.3 19.4 19.5 19.6 19.7

Index ... 50

1

Exerciser options

1.1

Basic exerciser

THERA-vital The basic version of the THERA-vital can be used for passive (driven by the exerciser) and active (where the motive power is provided by the patient) therapeutic exercise of the legs. The patient’s legs are held in the footrests by Velcro straps. For balance and stability there is also a handlebar that can be adjusted for height and angle. All important parameters can be set on the control pad. The exercising data is displayed on the colour screen. The THERA-vital can be fitted with different control pads:  Control pad with 5.7" colour screen  Control pad with 10.4" colour touchscreen The function of the THERA-vital is identical whichever control pad is fitted; the larger screen and touchscreen functionality offer a greater level of user-friendliness, however. THERA-live The basic version of the THERA-live can be used for passive (driven by the exerciser) and active (where the motive power is provided by the patient) therapeutic exercise of the legs. The patient’s legs are held in the footrests by Velcro straps. The THERA-live is equipped with a hand-held control pad and a 2" display screen.

1.2

Options

Handlebar (THERA-live only): the adjustable handlebar provides optimum support and stability, especially when exercising actively. Upper torso exerciser: Instead of the handlebar, the THERA-Trainer can be fitted with an upper torso exerciser. This has a separate motor, in other words both passive and active exercise are possible. It is controlled from the same control pad as on the basic exerciser. The patient holds onto the therapy grips. When exercising the legs, the therapy grips are replaced by adapter handles. Forearm rests, wrist straps, special TetraKnurled-handles and wrist supports: for more effective restraint of the lower arms, especially in cases of partial paralysis, there is a choice of various optional forearm rests, forearm rest straps, special Tetra-grips and wrist supports to suit the particular disability. Infinitely variable crank length: with the variable crank length option, the crank length and, therefore, extent of leg movement can be individually adapted to the patient without the use of tools. Calf rests: the pivoting and vertically adjustable calf rests help to secure and guide the lower legs, particularly in cases of partial paralysis. Foot fixings: The foot fixings are useful for patients to be able to quickly and easily strap their own feet into the footrests.

5

Stabiliser straps, self-operated: the self-operated stabiliser straps are simply hooked onto the wheelchair and tightens itself automatically. It prevents the wheelchair from tipping over when the patient is exercising with the THERA-Trainer. Height adjuster: the height adjuster enables the THERA-Trainer to be adjusted to the height of the patient's chair/wheelchair. Cardio-Pulse set (THERA-vital only): the Cardio-Pulse set (heart rate monitor with chest strap) monitors the patient’s precise heart rate with the aid of a chest strap. The heart rate is displayed on the colour screen. THERA-assist (THERA-vital only: the THERAassist software is an exercising program for recording, analysing and documenting exercising data. A USB memory stick is used to transfer the data from the exerciser to the computer on which the software is installed. Printer for exercising data (THERA-vital only): the printer can be connected to the THERA-vital via a Bluetooth connection. It enables quick and easy documentation of the exercising data. Control pad with 10.4" colour touchscreen: the large screen and touchscreen functionality offer a greater level of user-friendliness.

2

Symbols used

Symbol

Static discharge damage warning: connections marked with this symbol must not be touched with fingers or tools. Make sure you are not carrying any static charge by touching a metal part of the exerciser frame. Finish the exercising session before connecting a USB memory stick or other USB storage device to a USB interface.

The symbols used in this instruction manual and, if applicable, on the trainer are intended to draw your attention to possible dangers when using the trainer. You should make sure you understand the meaning of the symbols so that you can act accordingly and thereby use the exerciser effectively and safely. Symbol

Meaning Danger warning: read the Instructions for Use and follow the directions given. Danger of moving parts: do not reach into the cranks during an exercising session. Alternating current: the THERA-Trainer uses an alternating current power supply. Earth lead connection

Meaning

Important information not relating to dangers to people or property is marked with this symbol. ▶

Action



Cross reference to other places in the document or other documents



List item/bullet

3

Intended use

The THERA-Trainer is suitable for use in the home, in hospitals, care institutions and medical practices. It is intended to improve the mobility of persons suffering impaired mobility as a result of accidents, surgical operations or general conditions affecting the mobility of the support and locomotor systems. The THERA-Trainer can be used both as a leg exerciser and as an upper torso exerciser. It is suitable for passive exercise (where the patient’s limbs are moved by the machine) as well as active therapeutic exercise (where the patient provides the motive power). The transition from passive to active exercising is gradual. Operating both upper torso and leg exerciser at the same time is not possible. It is not possible to give specific details of the use of the THERA-Trainer in the case of the various possible medical conditions or to provide specific exercise programmes. The possible settings depend on the individual condition (age, build, physical constitution, fitness, …) of the patient. Consultation with a doctor and/or therapist is advisable. THERA-Trainers are therapeutic exercisers and not medical instruments for diagnostic purposes.

6

4

Safety

 Discuss with your doctor or therapist whether exercising on the THERA-Trainer without an assistant is advisable.  Before using the exerciser for the first time or if it has been transported some distance, leave it to stand for approximately 1 hour at room temperature.  Only move the THERA-Trainer on its castors on a firm and level surface (see page 12).  Always place the THERA-Trainer on a level and non-slip surface so as to ensure maximum stability. Make sure that the adjustable stand 2 is properly tightened (page 13).  The THERA-Trainer may only be connected to a power supply matching the specifications on the rating plate. Only connect the exerciser to a properly earthed power socket.  The power cord must be routed in such a way that it does not represent a tripping hazard, that it cannot become caught up in the cranks and that it cannot be damaged by other equipment. Never use the exerciser with a damaged power cord. Use only the original power cord supplied with the exerciser.  To prevent the RISK of electric shock, only connect the exerciser to an earthed power supply.  To prevent electric shock, the THERA-Trainer must never be used in wet, damp or very hot conditions.  Have your trained supplier or doctor/therapist show you how to operate the exerciser before using it for the first time.

 Do not wear shoes that have laces when exercising on the THERA-Trainer. The shoe laces could become caught in the cranks and cause injury as a result.  Always wear close-fitting clothing when using the exerciser. Do not wear any jewelry or accessories that could become caught up in the cranks of the upper torso or leg exerciser.  If the THERA-vital is to be used by a patient in a wheelchair, and if it is not possible to be absolutely certain that the wheelchair will not tip over backwards (e.g. with spastic or extremely active patients), wheelchair stabilisers 3 must be used (see page 21).  The THERA-Trainer is designed to be used in a sitting position only. Never stand on the footrests 5 with the full weight of your body.  Before commencing a leg exercising session, rotate the footrests by hand (without the motor) through one full revolution with the patient’s feet in position and the legs strapped in to ensure that the cranks can move freely, that the crank length is correctly set and that movement of the legs is not restricted (legs cannot become trapped). Perform a similar check before using the upper torso exerciser.  Never reach into or attempt to take hold of moving parts of the exerciser (e.g. cranks, crank length adjusters, footrests, calf rests, forearm rests, ...) when it is running.  Before starting an upper torso exerciser session, extend the exerciser stand 2 at least 210 cm (see page 13).

7

 When exercising with the THERA-Trainer, make sure that your posture is physiologically correct. Seek advice from a doctor/therapist.  In cases of partial paralysis, spasticity or instability of the legs, only use the exerciser with the optional calf rests 7.  In the case of muscle contractures or limited joint movement, the infinitely variable crank length option 4 must be used.  The crank length must not be altered when the motor is running. Do not adjust the crank length when the patient’s feet are in the footrests. Tighten the locking screw (see page 14) and check that it is tight before every exercising session.  Start with an exercising session of no longer than 15 minutes. You can gradually increase the length of subsequent exercising sessions to suit the patient’s individual capabilities.  Start the exercising session with a passive, motor-powered phase to loosen up.  The greater the distance between the THERA-Trainer and the patient’s seat/wheelchair, the more the knee, hip and arm joints are extended. Therefore, you should start at a close distance. Avoid over-extending the joints.  Before starting a leg exercising session, adjust the height of the handlebar/upper-torso exerciser so that the thighs/knees can not strike any part of the exerciser. Make sure that the height adjuster (see page 16/ 17) is properly tightened.

 During a leg exercising session, the cranks of the arm exerciser must be locked in a horizontal position. Otherwise they could trap the thighs.  The handlebar/upper torso exerciser must not be used as a support for standing – the exerciser could tip over.  The feet must not be placed in the footrests during an upper torso exercising session.  The adjustable-length cranks for the uppertorso exerciser must not be used without additional protection against shearing.  Make sure that the forearm rests are securely attached to the cranks/therapy grips (see page 19) during an upper torso exercising session. Make sure that the patient's arms cannot come out of the forearm rests.  If the patient suffers symptoms of illness brought on by an exercising session, consult a doctor immediately.  Children must always be constantly supervised when exercising on the THERA-Trainer. Never leave the THERA-Trainer unattended when there are children present.  The exerciser is only completely disconnected from the electrical power supply when the plug is removed from the power outlet socket.  Always unplug the power cord before opening the exerciser casing. Never run the THERATrainer with the casing open or if the casing is damaged.  Before starting the THERA-Trainer with upper torso exerciser attached, check that the forearm rests can rotate completely freely.

 So as to avoid any safety hazards, when exercising in an ordinary chair, it should be completely stable and sturdy and should not have castors.  When exercising in an electric wheelchair, the electronic controls/wheelchair movement functions must be switched off.  Exercising with only one footrest is not permissible.  When exercising the legs, both feet must be in the footrests.  Repairs may only be carried out by trained specialist dealers. If the exerciser is damaged/faulty or if it produces abnormal noises or smells, stop the exercising session immediately, unplug the power cord and contact your trained service engineer.  Never use liquids that contain solvents to clean the exerciser.  With a short crank length and a high motor power setting, the patient can be subjected to very strong forces. Limit the motor power to the level necessary for the patient and his/her exercising situation.  During upper torso exercising sessions using forearm rests on a THERA-vital with 10.4" screen, make sure that the patient's digits – especially the thumbs – cannot strike the screen.  Make sure that the coiled lead for the control pad (optional feature, THERA-live) does not fall into the area swept by the cranks. Otherwise the coiled lead could become caught in the cranks and cut off.

8

 Only accessories approved by the manufacturer (medica) may be connected to the USB connections.

5

Notes on exercise therapy

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 operation, injury or illness, i.e. at regaining mobility and strength. We recommend that the THERA-Trainer is 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 to no more than 70% of the user’s physical capability, being particularly careful to avoid over-exertion.

5.2

Uses

The THERA-Trainers can be used both as leg exercisers and as upper torso exercisers.  Using the THERA-Trainer as a leg exerciser: The patient sits on a chair or wheelchair. The THERA-Trainer stands on the floor in front of the patient. If possible the wheelchair footrests should be removed or folded to the side out of the way. The feet are placed in the exerciser footrests 5 and may be further secured by the calf rests 7 or the foot fixings 15. The leg exerciser is started by means of the control pad 12 or 16remote control.

 Using the THERA-Trainer as an upper torso exerciser: The patient sits on a chair or wheelchair. The THERA-Trainer stands on the floor in front of the patient. The patient’s feet are placed on the floor or the wheelchair’s footrests. The upper torso exerciser is adjusted to the correct height and reach. The arms are fixed to the therapy grips, wrist supports (optional feature), forearm rests (optional feature) or the special Tetra-grips (optional feature) (see page 19/ 20). The upper torso exerciser is then started from the control pad by an assistant. THERA-Trainers are specifically recommended for the following conditions:  Multiple sclerosis (MS)  Strokes, hemiplegia and apoplexy  Paraplegia, tetraplegia and spina bifida  Parkinson’s disease  Skull and brain trauma  Muscular diseases such as muscular dystrophy  Cerebral paresis  Cardio-vascular problems  Rheumatic conditions  Arthritis and osteoarthritis  Impaired mobility and ability to walk  General lack of mobility

9

5.3

Correct posture

Always make sure that the patient’s posture when exercising with the THERA-Trainer is in keeping with the purpose of the therapy. The greater the distance between the THERATrainer and the patient’s chair/wheelchair, the more the knee and hip or elbow and shoulder joints are stretched. Therefore, you should start the exercise programme with the THERA-Trainer positioned close to the patient’s chair/wheelchair. When exercising in an electric wheelchair, the height of the THERA-Trainer should be individually adjusted to suit. In that way you will avoid overstretching the joints or damaging muscles/tendons/ligaments. It is also important to ensure that the patient’s sitting position in the chair/wheelchair is as upright as possible.

5.4

Exercise programme planning

5.5

Active and Passive exercising

The frequency and duration of exercise sessions are heavily dependent on the patient's particular medical condition and should normally be individually planned and prescribed by a doctor or therapist. Therefore, only general guidance on exercise programme planning can be given at this point.

Active exercising means that the patient uses his/her own efforts and energy to turn the machine’s cranks against the set resistance level (see the section “Resistance/Power demand” on page 24).

Regular exercising with the THERA-Trainer is extremely important if improvements in mobility, and particularly in strength and endurance, are to be achieved. Short but frequent sessions are better than long strenuous ones.

 Resistance demand: the patient exercises against a set resistance level (see page 24).  Power demand: the patient works at a constant power output level (measured in watts). The resistance is automatically adjusted according to the pedalling speed (see page 24).  Heart rate limit: the patient exercises up to a level of intensity defined by a heart rate limit. If the patient’s heart rate rises above the set limit, the resistance is automatically lowered. This function requires the optional CardioPulse set.  Speed demand: A required cadence (pedalling speed) is set that is then held constant by the THERA-vital throughout the exercising session. The patient can thus make a physical effort by actively pushing on the pedals without having to co-ordinate the effort with the speed of rotation (see page 24).

You should therefore start with sessions of no more than 15 minutes of continuous exercise. Always start with a period of gentle passive exercise to warm up and then progress to light, active exercising with a low resistance setting. The length of the session, the cadence, the amount of active exercising and the resistance can be gradually increased a small amount at a time. You can also schedule several exercise sessions a day – always providing that no negative symptoms of illness occur and that the physical capabilities of the patient are not exceeded. The intensity of the therapy is correct if strength, endurance and mobility gradually improve and the patient feels well.

The THERA-vital offers the patient a number of options for active exercising:

Passive exercising means that the patient’s limbs are moved by the exerciser without any effort on the part of the patient. The motive power is provided by the THERA-Trainer.

10

When first switched on, the THERA-Trainer always starts with a passive exercising phase with a preset cadence. When the patient starts actively exercising with the same motion, the THERA-Trainer automatically changes over to active exercising mode.

5.6

Muscle hypertonia/spasms

Muscle hypertonia can generally be reduced by gentle and even circular motion on the THERAvital. The important consideration is that the distance between the THERA-Trainer and the patient’s chair/wheelchair is kept as small as possible. If this is combined with an upright sitting position and a short crank length (see “Adjusting crank length” on page 14), a reduction in the muscle hypertonia can generally be observed within a short time. Experience has shown that this effect can last for several hours.

When a spasm occurs, the THERA-Trainer stops and then continues to rotate forwards after a short delay (factory setting). That forward rotation stretches the muscles and allows the spasm to recede. Depending on the individual requirements, the direction of rotation after a spasm is detected can be changed:

5.7

 THERA-vital: Submenu, Spasticity program, see page 35  THERA-live: Permanently changing factory settings, see page 31

However, in our many years of experience, we know of virtually no side effects occurring.

In consultation with a doctor or therapist, an exercise programme should be drawn up so as to achieve the correct “degree” of hypertonia reduction. If a spasm (= sudden, involuntary increase in muscle tightness) occurs while exercising, the electronic circuitry of the THERA-Trainer detects it and immediately stops the motor – assuming the anti-spasm function has been activated (factory setting).

11

Side effects

In rare cases, exercising on the THERA-Trainer can cause undesirable side effects such as:  an increase in pain in some cases  over-reduction of muscle tone in some cases  skin injuries (e.g. pressure ulcers)

6

Transporting and commissioning

6.1

Before using for the first time

Remove the THERA-Trainer from the packaging and check for any signs of damage that may have occurred in transit. Also check that the power supply voltage specified on the rating plate matches that of your mains power supply. If you discover any damage or if the power supply voltage is incorrect, you should contact your supplier immediately.

6.2

Transporting

The THERA-Trainer is fitted as standard with castors for the purposes of transporting. To move the exerciser, tip it as shown and push it in front of you or pull it behind you.

You can also pull the THERA-Trainer closer to you when sitting in a chair/wheelchair so as to obtain the best distance from the machine when exercising. Tip the THERA-vital towards your chair/wheelchair so that it is balancing on its castors. Then pull it towards you until it is at the right distance. Without the handlebar/upper torso exerciser fitted, the THERA-live is easy to carry using the carrying grip. Take hold of the exerciser by the carrying grip with one hand and under the motor casing with the other.

6.3

The wheels are not suitable for moving the exerciser over uneven surfaces or unsurfaced ground.

6.4

▶ The exerciser must be carried up or down steps. This requires at least two persons.

As soon as the power supply is connected, the THERA-Trainer is ready for operation and an exercising session can be started (see page 24/ 28).

Connecting to the power supply

Connect the THERA-Trainer to the power outlet socket using the power cord. The exerciser is then ready for operation. You can start it from the control pad.

12

Switching the exerciser on/off (standby mode)

If no button is pressed on the THERA-Trainer for more than a certain period of time, the exerciser goes into standby mode. That is evident from the display:  On the THERA-vital, the screen backlighting switches off.  On the THERA-live the backlighting on the control pad switches off and the display shows three lines. Pressing any button brings the THERA-Trainer out of standby into normal operating mode. The screen lights up and, following a self-test lasting a few seconds, the THERA-Trainer is ready for use.

7

Operation

7.1

Adjusting the exerciser stand

The THERA-Trainer can be given greater stability by extending the stand. It is imperative that the exerciser stand is extended, especially for upper torso exercising. ▶ Tip the THERA-vital on its rear bottom edge. ▶ Undo the two fixing screws using the tool supplied.

7.2

Footrests

The feet can be securely fixed in the footrests with the Velcro straps provided. To do so, pull the Velcro strap over the top of the foot to the outer side of the footrest and press it against the Velcro strip.

▶ Extend the exerciser stand taking care not to exceed the maximum extension marked on the stand (12 cm).

▶ To level the THERA-vital on an uneven floor, the rubber feet on the exerciser stand can be adjusted (except with adjustable legs option).

▶ Do not wear shoes with laces. The shoe laces could become caught in the cranks and cause injury as a result.

7.3

Adjusting crank length, 2-position cranks

The THERA-Trainers are fitted as standard with cranks that have 2 length settings. They can be adjusted by a technically competent person. Using a 6 mm Allen key, the crank length can be set to the suitable position. Please note that the right-hand crank has a right-hand thread (unscrewed by turning anticlockwise) and the left-hand crank a left-hand thread (unscrewed by turning clockwise). Make sure you tighten the screws properly again after changing the crank length.

▶ Retighten the fixing screws.

▶ Tip the THERA-vital forwards again into its normal position.

Do not wear open shoes when exercising on the exerciser. If shoes with open heels are worn, the feet can slip backwards out of the footrests.

The footrests are designed for exercising with or without shoes.

Before every exercising session, check that your feet are correctly positioned in the footrests and are securely held by the Velcro straps.

The 2-position cranks are not suitable for frequently changing the crank length. Optional infinitely variable cranks are available for such cases. Exercising must only ever be undertaken with both footrests fitted.

▶ Undo the lock-nut with an open-ended spanner (size 10 mm) and unscrew the rubber foot until the THERA-Trainer stands firmly. ▶ Re-tighten the lock-nut.

13

7.4

Infinitely variable crank length (optional feature)

If the exerciser has the optional infinitely adjustable cranks, the crank length can be infinitely adjusted. Thus the degree of movement can be adjusted individually to suit each patient’s mobility.

▶ Adjust the opposite crank in the same way. Make sure that both cranks are set to the same length (the cranks are marked with a scale to facilitate adjustment). In certain cases, it may be beneficial for therapeutic reasons to have different crank lengths on each side (e.g. if the patient’s legs are different lengths or have different degrees of mobility). If the crank lengths are set differently on each side, no useful analysis of symmetry is possible when using the Bio-feedback function.

7.5

Foot fixings (optional feature)

The foot fixings allow the feet to be secured in the footrests quickly, safely and in many cases by the patient. Risk of injury: ▶ Only fasten/unfasten the foot fixings while the THERA-Trainer is not running. To secure the foot in the footrest: ▶ Press the locking button on the foot fixing. The retainer strap will spring open. ▶ Place the foot in the footrest.

Exercising must only ever be undertaken with both footrests fitted.

▶ Switch off the THERA-Trainer by pressing the “STOP” button.

If the crank length needs to be changed frequently (e.g. in hospitals, medical practices, etc.), infinitely variable cranks with T-bar Allen key are available as an option.

▶ Unplug the power cord. ▶ Remove the feet from the footrests. ▶ Undo the variable-crank locking screw. ▶ Slide the footrest along the crank to the desired position and firmly tighten the locking screw.

14

▶ Close the foot fixing so that it holds the foot securely without being too tight.

To undo the foot fixing:

7.6

▶ press the retainer strap down slightly while pressing the locking button on the foot fixing.

The calf rests help to secure the legs in cases of paralysis. They are connected to the footrests by a pivoting joint so as not to impair movement of the ankles.

▶ Let go of the retainer strap while still pressing the locking button. The retainer strap will open so that the foot can be removed from the footrest.

Calf rests (optional feature)

Fitting the calf rests Risk of injury: ▶ if the calf rests are not used, the pivoting arms must be folded out of the way. They are held in that position by a magnet behind the footrest. The pivoting arm for attaching the calf rest is integrated in the footrest. ▶ Fold the pivoting arm upwards. ▶ Undo the knurled-handle screw on the calf rest and pass it through the slot in the pivoting arm.

The pad on the foot fixing is attached by a Velcro strap.

▶ Secure the calf rest by tightening the knurledhandle screw.

▶ Position the pad so that it fits the foot/shoe as snugly as possible.

15

Positioning the calf rests ▶ Adjust the height of the calf rests so that the cups fit around the calves. Secure the lower legs with the Velcro straps.

▶ Take the weight off the locating pin by lifting the handlebar upwards. Do not withdraw the handlebar out of the handlebar/upper torso exerciser support tube any further than the minimum insertion mark. No more than half of the STOP label should be visible..

Make sure that patients whose legs are held in the THERA-Trainer by Velcro straps are able to undo the straps on their own or else can always call on the assistance of another person.

7.7

▶ Allow the locating pin to snap into position and tighten the knurled-handle screw by turning it clockwise. ▶ If you wish to adjust the handlebar horizontally, you must slightly loosen the eight screws using the tool supplied. ▶ Move the handlebar to the desired position and then retighten the screws.

▶ Pull out the locating pin and move the handlebar to the desired height.

Adjusting the handlebar (optional feature on THERA-live)

If you wish to exercise actively but suffer from muscle hypertonia or a lack of abdominal stability, the handlebar provides extra stability and balance. You can adjust the handlebar position to suit your individual size and sitting position.

Set the handlebar position so as to obtain as upright an exercising position as possible.

Height adjustment is effected by means of a locating pin and clamp function: ▶ Loosen the knurled-handle screw on the support tube by turning it anticlockwise (approx. one turn).

16

7.8

Upper torso exerciser (optional feature) Before exercising with the upper torso exerciser, the cranks must be unlocked (see page 18).

7.8.1

Do not withdraw the upper torso exerciser out of the handlebar/upper torso exerciser support tube any further than the minimum insertion mark. No more than half of the STOP label should be visible..

Adjusting the upper torso exerciser

The upper torso exerciser for the THERA-Trainer can be adjusted to suit the size and sitting position of the patient. The upper torso exerciser should be adjusted so as to obtain as upright an exercising position as possible. The crank spindle should be roughly at shoulder height. ▶ Consult your doctor or therapist as to the best position for the upper torso exerciser. Adjusting the height Adjust the upper section to a height at which the thighs/knees cannot strike the upper torso exerciser at any point. Height adjustment is effected by means of a locating pin and clamp function: ▶ Loosen the knurled-handle screw on the support tube by turning it anticlockwise (approx. one turn). ▶ Take the weight off the locating pin by lifting the upper torso exerciser upwards.

▶ Pull out the locating pin and move the handlebar to the desired height. When using the upper torso exerciser, make sure that the exerciser stand 2 is extended at least 10 cm (see page 13).

▶ Allow the locating pin to snap into position and tighten the knurled-handle screw by turning it clockwise. Adjusting the reach

7.8.2

The ideal reach setting for the upper torso exerciser is one at which the arms are not quite fully straightened when the exerciser grips are at their furthest position from the body.

The adapter handles convert the upper torso exerciser into an upper section with handlebars in a few simple operations.

▶ Undo the knurled-handle screw on the underneath of the upper torso exerciser by turning it anticlockwise (approx. one turn). ▶ Adjust the upper torso exerciser horizontally to the desired position. ▶ Re-tighten the knurled-handle screw by turning it clockwise.

17

Adapter handles for upper torso exerciser

Fitting the adapter handles ▶ Press in the locating pin on the exercising grip/forearm rest and pull the exercising grip/forearm rest off the crank. ▶ Press in the locating pin on the adapter grip and push the grip onto the crank.

▶ Release the locating pin and push the adapter grip fully home. The locating pin should audibly snap into place.

▶ To unlock the cranks, pull the arrester knob downwards, turn it a quarter turn and let it go. 7.8.3 To use the upper torso exerciser with adapter handles as a handlebar, the cranks must be locked by means of the arrester knob (see following section). The adapter handles are not designed to support the full weight of the body or for carrying the exerciser. Locking/unlocking the cranks ▶ Turn the arrester knob a quarter turn and then let go of it. ▶ Turn the cranks to a horizontal position so that the arrester knob audibly snaps into position. It should now not be possible to rotate the cranks.

Therapy grips for upper torso exerciser

The therapy grips offer a variety of holding positions for the hands. The therapy grips should only be used for upper torso exercising if the patient is capable of gripping them sufficiently well and securely. To fit the exercising grip: ▶ press in the locating pin on the exercising grip and carefully slide the exercising grip onto the crank spindle and push it fully home. ▶ Now release the locating pin. The exercising grip should snap audibly into position. ▶ Repeat the operation with the second exercising grip.

18

To remove the exercising grip: ▶ press in the locating pin and pull the exercising grip off the crank spindle. ▶ Repeat the operation with the second exercising grip.

7.9

Forearm rests (optional feature)

The purpose of the forearm rests is to help patients with symptoms of paralysis, muscle hypertonia, spasms or lack of hand/arm mobility to obtain a secure hold. Apart from the forearm rests for the therapy grips, all forearm rests can and should be individually adjusted. Combinations of forearm rests are also possible, as is the use of only one forearm rest. Adjustment by a doctor or therapist is essential. Elastic Velcro straps allow the forearms to be secured in the forearm rests.

Forearm rest for therapy grips

Special Tetra-grip

Forearm rest with knob grip

Wrist band for forearm rest

Forearm rest with vertical bar grip

Forearm rest with horizontal bar grip

You can either ▶ place the arm in the forearm rest after the forearm rest has been attached to the upper torso exerciser -or▶ fix the forearm rest to the arm first and then slide the forearm rest onto the spindle on the crank. During upper torso exercising sessions on a THERA-vital with 10.4" screen, make sure that the patient's digits – especially the thumbs – cannot strike the screen. ▶ If necessary, hold the thumbs in place with the Velcro strap.

19

7.10

Wrist supports (optional feature)

If the patient’s hand is paralysed, the wrist support allows it to be quickly and easily secured to the handlebar, therapy grip or special Tetra-grip.

Wrist support

7.11

Adjustable legs (optional feature)

The adjustable legs enable the THERA-Trainer to be adjusted to the height of the patient's chair/wheelchair:

▶ Loosen the knurled-handle screw on one of the legs by turning it anticlockwise (approx. one turn). ▶ Take the weight off the locating pin by lifting the THERA-Trainer slightly. ▶ Pull out the locating pin and adjust the THERA-Trainer to the desired height.

20

▶ Allow the locating pin to snap into position and tighten the knurled-handle screw by turning it clockwise. ▶ Adjust the other three legs in the same way.