THERA vital Instructions for Use 80 000 066-005

M

N

O

P

23

23

25

24

Q

15

R

27

26

U

V 31

28

S

T 12

Congratulations! You have made an excellent choice with the purchase of the THERA-vital. This therapeutic exerciser is an innovative, high-quality product made in Germany. The THERA-vital is the first therapeutic exerciser to feature a colour display screen. It also functions according to the very latest therapeutic advances.

These instructions will help you to familiarise yourself with the THERA-vital. 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. Before using the exerciser for the first time, please take careful note of the safety instructions on page 34.

If you have any questions or observations, the staff at medica Medizintechnik GmbH will be only too pleased to help. Enjoy exercising and stay active with the THERA-vital.

Operation... 33 Footrests... 33 Adjusting crank length, 2-position cranks... 33 Adjusting crank length, infinitely adjustable cranks (optional feature)... 33 Calf supports (optional feature) ... 33 Foot retainer pads (optional feature)... 33 Adjusting the handlebar ... 33 Adjusting the exerciser stand... 34 Upper body exerciser (optional feature)... 34 Exercising handles for upper body exerciser ... 34 Adapter handles... 35 Adjusting the position of the control pad ... 35 Armrests (optional feature) ... 35 Heart rate sensor ... 35 Control pad with colour screen ... 37 Submenu (for experienced users) ... 40 Navigating the submenu ... 40

Menu structure... 41 Description of exerciser functions on submenu ... 42

Contents Exerciser Options ... 27 Intended Use ... 27 Exerciser Components and Controls... 28 Interfaces ... 28 Safety ... 29 Symbols Used ... 30 Notes on Exercise Therapy ... 30 General observations... 30 Uses... 30 Correct posture ... 31 Exercise programme planning ... 31 Active and passive exercising... 31 Muscle hypertonia/spasms ... 32 Transporting and Commissioning... 32 Before using for the first time... 32 Transporting... 32 Connecting to the power supply ... 32 Switching the exerciser on/off... 32

31

Exercising time ... 42 Automatic direction reversal ... 42 Biofeedback ... 42 Motor power... 44 Spasticity detection... 44 Spasticity program ... 44 Automatic speed adjustment ... 44 Heart rate limit ... 44 Muscle assistance ... 44 Microphone sensitivity ... 45 Contrast ...45

Analysis of Session Data... 45 Activating Basic Exercising Settings... 46 Technical Data ... 46 Cleaning and Disinfection... 47 Replacing a fuse... 47 Guarantee Terms ... 47 Recycling ... 47 EC Declaration of Conformity ... 47 Tips and Tricks ... 48

Exerciser Options Basic exerciser: 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 feet are held in the footrests. There is also an adjustable handlebar for balance and stability. All important parameters can be set on the control pad. The training data is displayed on the large screen. The cranks can be set to two different lengths with the aid of suitable tools. Upper body exerciser option: Instead of the handlebar, the THERA-vital can be fitted with an upper body 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 exercising handles. When exercising the legs, the exercising handles are replaced by adapter handles. Option with armrests, wrist straps and Tetra-handles: For more secure fixing of the forearms, particularly in cases of partial paralysis, there is a choice of various armrests, wrist straps or Tetra-handles to suit different degrees of disability. Infinitely variable crank length option: 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 support option: The pivoting and vertically adjustable calf supports help to secure and guide the lower legs, particularly in cases of partial paralysis.

Intended Use Foot strap option: The foot straps are useful for patients to be able to quickly and easily strap their own feet into the footrests.

32

The THERA-vital 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 upper and lower limbs. The THERA-vital can be used both as a leg exerciser and as an upper body 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 body and leg exerciser at the same time is not possible. It is not possible to give specific details of the use of the THERA-vital 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 is advisable. The THERA-vital is a therapeutic exerciser and not a medical instrument for diagnostic purposes.

Exerciser Components and Controls

Interfaces

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

28

Control pad with screen Handlebar Locking screw with knurled knob for adjusting height of handlebar/upper body exerciser F Footrest Crank with two length settings Exerciser stand, extending and height compensating S Transport wheels A Inclination adjuster for handlebar/upper body exerciser G Transmission casing Support tube for upper section Handlebar support post Control pad inclination adjuster Upper body exerciser Exercising handles I Crank on upper body exerciser Locking screw with knurled knob for adjusting reach of upper body exerciser H Calf support D Infinitely adjustable crank C ) Foot retainer pad E Adapter handle J Armrests for exercising handles K Armrests with knob handle L Armrests with bar handle M and N Wrist straps for armrests O Special Tetra-handle P Arrester for crank Q Opto heart rate sensor with ear clip R

33

29 30

31

USB interface for control pad V : For connecting a memory stick for updating the software. Fused power connection B : For connecting the power cord. PC interface (for servicing only) B : This interface is required for commissioning and servicing. Interface for Opto heart rate sensor/ Cardio-Pulse set U : For connecting Opto heart rate sensor/ Cardio-Pulse set.

☞ Use only genuine medica accessories.

Safety

❑ Always wear close-fitting clothing when us-

❑ In cases of partial paralysis, spasticity or in-

❑ The THERA-vital is intended for supervised

ing the 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), a wheelchair bracing/stabilising device must be used. ❑ The THERA-vital is designed to be used in a sitting position only. Never stand on the foot rests 4 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 body exerciser. ❑ Never reach into or attempt to take hold of moving parts of the exerciser (e.g. cranks, crank length adjusters, footrests, calf supports, armrests, …) when it is running. ❑ Before starting an upper body exerciser session, extend the exerciser stand at least 10 cm (see page 39). ❑ When exercising with the THERA-vital make certain that your position is physiologically correct. Seek advice from a therapist.

stability of the legs, only use the exerciser with the optional calf supports. ❑ In the case of muscle contractures or limited joint movement, the infinitely variable crank length option 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 ( C ) 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. ❑ For the purposes of loosening up, always start a THERA-vital exercising session with a passive exercising phase powered by the motor. ❑ The greater the distance between the THERA-vital 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. ❑ For a leg exercising session, set the height of the handlebar/upper body exerciser so that the thighs do not touch it at any time. Make sure that the height adjuster (knurled-handle screw, 3) is fully tightened. ❑ The handlebar/upper body exerciser must not be used as a support for standing – the exerciser could tip over.

use only. Therefore, patients must not use the THERA-vital without being supervised by an assistant. ❑ 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-vital on its wheels on a firm and level surface (see page 37). ❑ Always place the THERA-vital on a level and non-slip surface so as to ensure maximum stability. Make sure that the adjustable stand (6) is properly tightened (page 39). ❑ The THERA-vital 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 electric shock, the THERA-vital must never be used in wet, damp or very hot conditions. ❑ Have your doctor or supplier show you how to operate the exerciser before using it for the first time.

34

❑ The feet must not be placed in the footrests during an upper body exercising session. ❑ The upper body exerciser 13 must not be combined with the infinitely variable crank length option ( C ) without additional safety attachments. ❑ Make sure that the armrests 21 are securely attached to the exercising handles ( K ) during an upper body exercising session. Make sure that the arms cannot come out of the armrests 21. ❑ If the patient displays symptoms of illness during or after an exercising session, consult a doctor immediately. ❑ Children must always be constantly supervised when exercising on the THERA-vital. Never leave the THERA-vital unsupervised when children are 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 THERA-vital with the casing open. ❑ Repairs may only be carried out by trained specialist suppliers. 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 service engineer. ❑ Never use liquids containing solvents to clean the exerciser.

Symbols Used

Notes on Exercise Therapy

The symbols used in this instruction manual and, if applicable, on the exerciser are intended to draw your attention to possible dangers when using the exerciser. You should make sure you understand the meaning of the symbols so that you can act accordingly and thereby use the exerciser more effectively and safely. Danger warning: read the Instructions for Use and follow the directions given.

General observations

~

Danger of moving parts: do not reach into the cranks during an exercising session. Alternating current: the THERA-vital uses an alternating current power supply.

œEarth lead connection

35

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 or injury, i.e. at regaining mobility and strength. We recommend that the THERA-live 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 according to the user’s physical capabilities, being particularly careful to avoid over-exertion.

Uses The THERA-vital can be used as a leg exerciser and as an upper body exerciser: ❑ Using the THERA-vital as a leg exerciser: The patient sits on a chair or wheel chair. The THERA-vital stands on the floor in front of the patient. If possible the wheelchair footrests should be removed. The feet are fixed in the exerciser footrests 4 and may be further secured by the calf supports 17 (optional feature) or the foot retainer pads 19 (optional feature). The exerciser is then started from the control pad 1. ❑ Using the THERA-vital as an upper body exerciser: The patient sits on a chair or wheel chair. The THERA-vital stands on the floor in front of the patient. The feet are placed on the wheelchair footrests. The upper body exerciser is adjusted to the correct height and reach. The arms are fixed

to the exercising handles 14, armrests 21 to 24 (optional feature) or Tetra-handles 25 (options). The exerciser is then started from the control pad 1 by an assistant. The THERA-vital is specifically recommended for the following conditions: ❑ Impaired mobility and ability to walk ❑ General lack of mobility ❑ Multiple sclerosis ❑ Rheumatism ❑ Cardio-vascular problems ❑ Arthritis and osteoarthritis ❑ Parkinson’s disease ❑ Paraplegia and tetraplegia ❑ Strokes and hemiplegia ❑ Dialysis patients ❑ Muscle wastage

Correct posture Always make sure that the patient’s posture when exercising with the THERA-vital is in keeping with the purpose of the therapy. The greater the distance between the THERA-vital 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 exerciser positioned close to the patient’s chair/wheelchair. 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.

Exercise programme planning

Active and passive exercising

The frequency and duration of exercise sessions on the THERA-vital 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. Regular exercising with the THERA-live 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. You should therefore start with sessions of no more than 15 minutes of continuous exercise. Always start with a period of gentle passive exercise and then progress to light, active exercising with a low resistance setting. The length of the session, the speed, 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.

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 exerciser. When first switched on, the THERA-vital always starts with a passive exercising phase with a preset resistance and speed. When the patient starts actively exercising with the same motion, the THERA-vital automatically changes over to active exercising mode. 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 setting” on page 43). There are several different ways in which the patient can set up the machine for active exercising: Set resistance: the patient exercises against a set resistance level (see page 43. Set power: the patient works at a constant power output level (measured in watts). The resistance is automatically adjusted according to the pedalling speed (see page 43). 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.

36

Muscle hypertonia/spasms

Transporting and Commissioning

Muscle hypertonia can be effectively reduced by gentle and even movement on the THERA-vital. The important consideration is that the distance between the THERA-vital and the patient’s chair/wheelchair is kept as small as possible to begin with. If this is combined with an upright sitting position and a short crank length (see “Adjusting crank length” on page 38), a reduction in the muscle hypertonia can generally be observed within a short time. Experience and scientific investigations have shown that this effect can last for several hours. 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 occurs while exercising, the electronic circuitry of the THERA-vital detects it and immediately stops the motor – assuming the anti-spasm function has been activated (factory setting). The type of spasm suffered by most patients is an “extension spasm”. On occurrence of a extension spasm, the THERA-vital stops and then continues to rotate forwards after a short delay. That forward rotation stretches the muscles and allows the spasm to recede (for details of settings, see page 49). In the event of the less common type of spasm, the “flexion spasm”, the THERA-vital rotates backwards after a spasm occurs (for details of settings see page 49).

Before using for the first time

B Connecting to the power supply

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

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

Transporting A The THERA-vital is fitted as standard with

transport wheels 7 . 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-vital 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 wheels 7 . Then pull it towards you until it is at the right distance. The wheels are not suitable for moving the exerciser over uneven surfaces or unsurfaced ground. The exerciser must be carried up or down stairs or steps. This requires at least two persons.

37

Switching the exerciser on/off If the screen is not illuminated, the THERA-vital is in stand-by mode. Press any button to switch the THERA-vital to normal operating mode. The screen will light up and, following a self-test lasting about 5 sec., the THERA-vital is ready for use. By pressing the green “START” button on the control pad, you can start the THERA-vital and begin exercising. Pressing the “STOP” button on the control pad 1 during an exercising session pauses the exerciser. Pressing the button a second time ends the exercising session and the session analysis is displayed. Pressing and holding the “STOP” button (for at least 5 sec.) sets the exerciser to stand-by mode – the screen illumination switches off

Operation Footrests The footrests 4 are designed for exercising with or without shoes. The feet can be securely fixed in the footrests 4 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 4 and press it against the Velcro strip. Before every exercising session, check that your feet are correctly positioned in the footrests 4 and are securely held by the Velcro straps.

Adjusting crank length, 2-position cranks The THERA-vital is fitted as standard with cranks that have two length settings. Using an open-ended spanner (size 13 mm) the crank length can be set to the best position. please note that the right-hand crank has a righthand thread and the left-hand crank a left-had thread. Make sure you tighten the screws properly again after changing the crank length.

C Adjusting crank length, infinitely adjustable cranks (optional feature) If the exerciser has been fitted with the 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.

❑ Switch off the THERA-vital by pressing the “STOP” button. ❑ Remove the feet from the footrests. ❑ Undo the locking screw. ❑ Slide the footrest along the crank to the desired position and firmly tighten the locking screw. ❑ 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). 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). For leg-amputee patients it may be necessary to completely remove one of the footrests. To do so, undo the locking screw far enough to be able to slide the footrest together with the sliding adjuster off the end of the crank.

D Calf supports (optional feature) The calf supports 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. ❑ Adjust the height of the calf supports so that the cups fit around the calves. Secure the lower legs with the Velcro straps. Patients who are secured to the THERA-vital by the Velcro straps must not be left unattended.

38

E

Foot retainer pads (optional feature)

The foot retainer pads allow the feet to be secured in the footrests quickly, safely and in many cases by the patient: ❑ Fold the foot retainer forwards. ❑ Place the foot in the footrest. ❑ Fold the foot retainer back again.

F G Adjusting the handlebar 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. ❑ Undo the knurled-knob locking screw 3 on the support tube. ❑ Adjust the handlebar to the desired height and firmly retighten the knurled knob 3! Make sure that the handlebar support post 11 is inserted to a depth of at least 10 cm in the support tube 10 – the post has a line marking the minimum insertion depth. ❑ If you wish to adjust the reach of the handlebar, you must undo the eight screws 8 a small amount using the tool supplied. ❑ Move the handlebar to the desired position and then retighten the screws 8. The handlebar position should be set so as to obtain as upright an exercising position as possible.

S Adjusting the exerciser stand The THERA-vital can be given greater stability by extending the stand 6 . This is useful for upper body exercising in particular. ❑ Tip the THERA-vital on its rear bottom edge. ❑ Undo the two fixing screws using the tool supplied. ❑ Extend the exerciser stand taking care not to exceed the maximum extension marked on the stand (12 cm). ❑ Retighten the fixing screws. ❑ Tip the THERA-vital forwards again into its normal position. To level the THERA-vital on an uneven floor, the rubber feet on the exerciser stand can be adjusted. ❑ Undo the lock-nut with an open-ended spanner (size 13 mm) and unscrew the rubber foot until the THERA-vital stands firmly. ❑ Retighten the lock-nut.

Upper body exerciser (optional feature) F H Adjusting the upper body exerciser The upper body exerciser for the THERA-vital can be adjusted to suit the size and sitting position of the patient. The upper body exerciser should be adjusted so as to obtain as upright an exercising position as possible.

☞

Adjusting the height ❑ Undo the knurled-knob locking screw 3 on the support tube. ❑ Adjust the upper body exerciser to the desired height and firmly retighten the knurled knob 3. Make sure that the support post 11 of the upper body exerciser is inserted to a depth of at least 10 cm in the support tube 10 – the post has a line marking the minimum insertion depth. The upper section should be adjusted to a height at which the knees cannot hit the upper body exerciser at any point. Adjusting the reach The ideal reach setting for the upper body exerciser is one at which the arms are not quite fully straightened when the exerciser handles are at their furthest position from the body. ❑ Undo the knurled-knob locking screw 16 on the underneath of the upper body exerciser a small amount.

39

❑ Adjust the reach of the upper body exerciser as required. ❑ Retighten the knurled-knob locking screw 16. When using the upper body exerciser, make sure that the exerciser stand 6 is extended at least 10 cm.

I

Exercising handles for upper body exerciser

The exercising handles 14 offer a variety of holding positions for the hands. The exercising handles should only be used for upper body exercising if the patient is capable of gripping them sufficiently well and securely. The exercising handles 14 are easy to remove from the spindle on the crank 15 . To do so, press in the locating pin with your thumb and pull the exercising handle 14 off the spindle. Repeat the operation with the other second exercising handle 14. To refit the exercising handle 14 , press in the locating pin on the exercising handle 14 and carefully slide the exercising handle onto the spindle on the crank 15 as far as the stop. Now release the locating pin. The exercising handle 14 should perceptibly snap into position.

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

Q Locking the cranks ❑ Turn the arrester knob 26 a quarter turn and then let go of it.

❑ Turn the cranks to a horizontal position so that the arrester knob 26 audibly engages. It should now not be possible to turn the cranks 15. To unlock the cranks, pull the arrester knob downwards, turn it a quarter turn and let it go. Fitting the adapter handles

❑ Press in the locating pin on the exercising handle 14 and pull the exercising handle off the spindle I . ❑ Press in the locating pin on the adapter handle and slide it onto the spindle on the crank J . ❑ Release the locating pin and push the adapter handle as far as the stop. The locating pin should audibly snap into position The adapter handles are not designed to support the full weight of the body or for carrying the exerciser.

T Adjusting the position of the control pad The position of the control pad on the THERA-vital upper body exerciser 13 can be adjusted to suit the size and sitting position of the patient. ❑ Undo the screws 12 on both sides of the upper body exerciser a small amount. ❑ Adjust the control pad to the desired position and firmly retighten the screws 12 . For transportation, the control pad can be folded back/down completely. ❑ Completely unscrew the screws 12 on both sides of the upper body exerciser. ❑ Fold the control pad fully back/down. ❑ Refit the screws 12 to fix the control pad in position for transportation.

K to P Armrests (optional feature) The armrests are a useful option for helping patients with symptoms of paralysis, hypertonia, muscle spasms or lack of hand/arm mobility to obtain a secure hold. Apart from armrest K all armrests can and should be individually adjusted. Combinations of armrests are also possible, as is the use of only one armrest. Adjustment by a doctor or therapist is essential. Elastic Velcro straps allow the forearms to be secured in the armrests. You can either:

40

❑ place the arm in the armrest after the armrest has been attached to the upper body exerciser or

❑ fix the armrest to the arm first and then slide the armrest onto the spindle on the crank.

Heart rate sensor R Opto heart rate sensor with ear clip The THERA-vital is supplied as standard with an Opto heart rate sensor with ear clip. The Opto heart rate sensor is used to monitor the heart rate (see page 49, „Heart rate limit“). Due to insufficient accuracy, the Opto heart rate sensor must not be used to monitor the heart rate limit for patients with heart and circulation conditions. In such cases the CardioPulse set (optional feature) is required. ❑ Plug Opto heart rate sensor 27 ( R ) into the bottom of the control pad (Interface 31, U ). ❑ Then attach the ear clip to the ear lobe after first rubbing the ear lobe to ensure there is good circulation. ❑ Attach the coiled cord to clothing using the cable clip.

Cardio-Pulse set (optional feature)) The chest-band heart rate sensor (CardioPulse set) measures the heart rate more accurately and for that reason can be used to monitor the heart rate limit of patients with cardio-vascular conditions (see page 49, „Heart rate limit“). ❑ To connect it to the THERA-vital, plug the receiver connector into the socket on the bottom of the control pad (Interface 31, U ) so that the flat side is facing towards the patient. ❑ Slightly moisten the inside of the chestband and strap it around the chest (close to the heart) so that the transmitter is facing towards the THERA-vital. To prevent interference when several THERA-vital exercisers are being used with Cardio-Pulse sets, there should be a gap of at least 3 m between exercisers. A simple test can be performed to check that the heart rate sensor is functioning properly. The screen only shows a green heart symbol and a heart rate if the signals from the heart rate sensor are sufficiently strong and regular. If there is no heart rate signal, the heart symbol is grey. A weak/irregular heart rate signal is indicated by an orange heart symbol.

☞

41

Control pad with colour screen The colour screen always shows all important settings and exercising session data. The basic start screen view shows the following information: Resistance level (see page 43): shows the exerciser resistance level on a scale from 1 - 15 or the set power level from 0 - 80 watts. You can change the setting before or during the exercising session by pressing the + and – buttons.

Heart rate: shows a heart rate and a green heart symbol if the heart rate sensor is connected and supplying a good heart rate signal. If the signals are weak, the heart symbol is red. If no heart rate sensor is connected, the heart symbol is grey.

Speed (see page 43): when exercising actively shows the actual speed of rotation of the cranks; when exercising passively shows the preset speed, which is the speed of the motor. Press the + and – buttons to alter the setting.

Anti-spasm function (see page 43): this is active if the symbol is solid red or inactive if the symbol is white. The button next to the symbol changes the setting.

Direction of rotation (see page 43) Change the setting before or during an exercising session by pressing the button next to the symbol.

Leg/Upper body exerciser selector (see page 43). The active option is shown. Change the setting as required before starting the training session press the button next to the symbol. Only possible if an upper body exerciser is fitted. Stops the exercising session (see page 44)! Pressing once pauses the exercising session. Pressing a second time ends the exercising session and displays the analysis for the last session.

Power output: only shown when exercising actively; indicates power output in watts (Neuro mode) or energy consumption in kcal (Ortho mode).

Assisted entry (see page 44). Activate/deactivate Assisted entry mode by pressing the button next to the symbol. If Assisted entry mode is active the symbol is green.

Remaining session time

Distance completed

42

Starts the exercising session with an initial speed of 10 rpm and starts recording a new session analysis (see page 44).

Resistance/Power setting You use this control to set the difficulty or power level for the exercising session. The following settings are possible: Resistance (Neuro mode): In Neuro exercising mode (see page 47) you can set the resistance level. The current resistance level is shown on a scale from 1 to 15. The maximum resistance depends on the preset motor power (see page 49) and has a maximum level of 12 Nm. The resistance can be increased by pressing the + button. To increase the resistance one increment at a time, press and release the button. The resistance can be reduced by pressing the – button and has a minimum setting of zero. If you press and hold the + or – button, the setting increases/decreases continuously up/ down to the maximum/minimum. The set resistance remains constant at all speeds. A higher cadence means a higher power output. Power setting in watts (Ortho/Cardio mode): in Ortho and Cardio exercising modes (see page 47) exercising is based on a power output setting (up to a maximum of 80 watts). The power level is set by pressing the + or – button. The THERA-vital automatically modulates the resistance level according to the pedalling speed so that the set power must always be delivered.

Speed The speed can be increased by pressing the + button. To increase the speed one increment at a time, press and release the button. If you press and hold the + or – button, the speed increases/decreases continuously up/down to the maximum/zero. An exercising session always starts with a speed of 10 rpm. Spasticity The spasticity detection function on the THERA-vital protects spastic patients or those with sensitive bones or joints from undue stresses. Pressing the button switches spasticity detection on or off. When the function is active, the symbol is shown in solid red. If the THERA-vital detects a spasm, it stops immediately. The display indicated “SPASM”. After a pause of about 5 sec. the machine continues at a passive exercising speed 5 rpm lower (see also “Spasticity program” on page “Spasticity program” on page 49). Read the notes on page 37 under the heading “Muscle hypertonia/spasms”.

☞

43

Direction of rotation The current direction of rotation is indicated by the solid arrow. Pressing the button reverses the direction of rotation. A change of direction is always performed with a smooth transition. All other parameters (speed, motor power, arm/leg exerciser, spasticity detection) remain the same. Leg/Upper body exerciser You can select either the leg exerciser or the upper body exerciser. The symbol indicates which exerciser is currently active. You can only switch between the leg exerciser and the upper body exerciser if you have first ended the current exercising session by pressing STOP. While an exercising session is in progress or if there is no upper body exerciser fitted, the button is deactivated. Before starting an upper body exercising session, the exercising handles 14 or the armrests 21 to 25 must be fitted (see page 39) and the cranks unlocked (see page 40).

Assisted entry You can use the Assisted entry function to move each pedal to an easy position for getting the feet in. ❑ Press and release the button and wait until the footrest has moved to the easy entry position (crank at lowest position). ❑ Place the first foot in the footrest that is at the bottom. ❑ Press the button again and wait for the other footrest to move to the easy entry position. ❑ Now secure the first foot in the footrest at the top and then place the second foot in the footrest at the bottom. ❑ Press the button again and wait for the footrests to reach the first position again. Now secure the second foot.

Changing the session time When an exercising session is in progress, two buttons for changing the session time are shown at the bottom left and right of the screen. Pressing the + button increases the session time. To increase the session time in one second increments, press and release the button. Pressing and holding the + or – button increases/decreases the session time continuously up/down to the maximum/minimum.

44

Start/Stop When in stand-by mode, the THERA-vital is activated by pressing any button. The screen then lights up. Following a self-test lasting about 5 sec. the THERA-vital is ready for use. Pressing the START button then starts an exercising session with the basic settings. The exerciser starts at a speed of 10 rpm. By actively turning the cranks at a speed greater than that of the motor, you can change over to active exercising at any time. You can pause an exercising session in progress by pressing the STOP button once and resume it by pressing the START button. Pressing the STOP button twice during an ongoing exercising session ends the session. The display then shows the analysis for that exercising session (see page 50).

Submenu (for experienced users) The THERA-vital has a number of exercising programs that are based on the needs of typical patient groups. For each patient group, the exercising parameters can be set on a submenu. The complete menu structure is shown on page 46.

Navigating the submenu To open the submenu press the two minus buttons simultaneously.

The submenu comprising the items Neuro, Ortho, Cardio and Technical is displayed. The function of the buttons changes as well:

Current submenu item

Current selection (inverted colours)

Up/More This button scrolls the display up. In the case of menu items which require entry of an amount (e.g. motor power), this button increases the setting.

Down/Less This button scrolls the display down. The menu item selected is highlighted by inverted colours. In the case of menu items which require entry of an amount (e.g. motor power), this button decreases the

Cancel/Discard changes This button takes you back up to the next higher menu level. Any changes previously saved by pressing ✔ are retained, those not saved by pressing ✔ are lost.

Save changes/Continue This button saves your settings. If the menu item selected has further options, this button takes you to the next menu option.

45

Menu structure The parameters of the exercising programmes and systems settings are set out within the following menu structure: 1st Level

2nd Level

Possible Settings, Functions

Factory setting

See page

Duration Automatic direction reversal Biofeedback Motor power Spasticity detection Spasticity program Automatic speed adjustment Heart rate limit

1 to 60 minutes On/Off Symmetry bars/road, Passive, Off 2 to 22 Nm High/Medium/Low sensitivity Forwards/Backwards/Opposite On/Off 60 to 160

15 min Off Symmetry bars 15 Nm Medium Forwards Off 100 bpm

47 47 47 49 49 49 47 49

Duration Biofeedback Motor power Muscle assistance Heart rate limit

1 to 60 minutes Symmetry bars/road, Off 2 to 22 Nm Off/On 60 to 160

15 min Symmetry bars 15 Nm On 100 bpm

47 47 49 49 49

Duration Biofeedback Motor power Heart rate limit

1 to 60 minutes Symmetry bars/road, Passive, Off 2 to 22 Nm 60 to 160

15 min Symmetry bars 15 Nm 100 bpm

47 47 49 49

Microphone sensitivity Language Contrast Date/Time Service settings

1 to 10

5

50

1 to 40 Year/Month/Day/Hour/Minute Security code

15 – –

Neuro

Ortho

Cardio

Technical

46

Four digits (0 to 9)

Description of exerciser functions on submenu The first menu level comprises the following items: ❑ Neuro ❑ Ortho ❑ Cardio ❑ Technical Neuro (basic setting): Exercising programmes for patients with neurological conditions, e.g. hemiplegia, paraplegia, MS, Parkinson’s disease… The method of exercising is set as Set resistance. The resistance level set remains constant whatever the pedalling speed. Higher pedalling speeds mean greater power output. Ortho: Exercising programmes for orthopaedic patients, e.g. following a knee or hip operation. In this exercising mode, the method of exercising is preset to Set power. The patient is given a set power level at which to exercise. The THERA-vital modulates the resistance automatically according to the pedalling speed so that the amount of power required is always the same. Cardio: Exercising programmes for cardio-vascular patients whose heart rate must be kept below a certain limit. In Cardio exercising mode, a heart rate limit is set. The THERA-vital reduces the resistance as soon as the patient’s heart rate reaches that limit.

Technical: The menu option Technical allows you to make basic settings for options such as microphone sensitivity, language, date and time, etc. Entry of a security code also allows access to technical service functions. Exercising time The length of the exercising session can be set to between 1 and 60 minutes in all exercising modes. The default setting in each case is 15 minutes. Automatic direction reversal When the Automatic direction reversal function is active, the exerciser automatically changes the direction of rotation every four minutes when the patient is exercising passively. When the patient is exercising actively the direction of rotation is not reversed.

47

Biofeedback The purpose of the Biofeedback function is to provide the patient with feedback about the progress of the session. The top part of the screen shows the following information: ❑ Current resistance/power setting ❑ If a heart rate sensor is connected, the current heart rate ❑ The patient’s current power output ❑ The current speed of rotation of the cranks ❑ The distance completed ❑ The remaining exercising time. Symmetry bars/road: These two Biofeedback diagrams show how symmetrically active exercising is being performed, i.e. how great the power difference between the right and left legs for each direction of rotation (forwards and backwards, see page 43). The bar diagram shows the distribution of power output between the two sides. The total of the two bars always adds up to 100 %.

The “START” figure shows the starting level during the first minute of exercising. The filled section of the bar and the percentage figure at the bottom (56% in this example) show what percentage of the set motor power is currently being used to move the legs.

With the road diagram, a bicycle moves to the left or right on the road according to distribution of power output between the left and right sides. In addition, the pedalling speed is indicated is indicated by the speed at which the dotted line down the middle of the road moves. At irregular intervals, obstacles appear on the road. If an obstacle is “avoided“ by appropriate “one-sided“ exercising (obstacle on the left → more activity on the right) the obstacle changes to green.

The results are corrupted if…

❑ the cranks are not adjusted to the same length on both side (see page 38),

❑ the patient’s seat is not positioned centrally relative to the exerciser,

❑ a leg is “pulling” as well as “pushing”. It is not possible to use the symmetry function with the upper body exerciser because it is normal to push and pull with the upper body exerciser. Passive mode display: When the patient is exercising passively, the colour screen shows a bar representing the motor power currently required to move the legs. The maximum height of the bar represents 100% of the motor power setting (see page 49).

48

Changing the crank length has a substantial effect on this Biofeedback display. The percentage figures from two different exercising sessions are only comparable if the crank length and the maximum motor power (submenu) settings are the same for both sessions. This data is not suitable for drawing clinical conclusions. Its purpose is to show the patient how tight or loose his/ her limbs are or if muscle hypertonia has been reduced.

☞