Equipment Operation. Checklist Exercises
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- Nancy Anderson
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1 Equipment Operation MedX medical machines provide two phases of operation: 1. Static testing (torque readings of isometric contractions at selected angular positions). 2. Dynamic exercise (lifting and lowering a selected level of weight stack resistance). Inherent in each of these tests is a rangeof-motion assessment (ROM), which can be considered a third function of each machine. The computer system monitors and records each of these operations, but does not control the patient in any way. The clinician must set the patient into the machine, instruct them what to do, and use the machine s software to execute each function. The clinician can also use the software to crunch data and issue reports. Thorough exploration of this manual is necessary to gain full command of this equipment s capabilities. This section is devoted to the barebone basics of mechanical operation of the equipment. Checklist Exercises On the Lumbar Extension Machine, a computer monitor stationed atop the footboard provides visual feedback to the patient. The checklists that follow 104 points on the Lumbar and 100 points on the Cervical were adapted directly from the hands-on spinal certificatin test at the University of Florida. As an exercise to assess skill with operating the machinery, it involves an isometric test followed by a dynamic exercise set, immediately followed by another isometric test. This is also known as the FRT (fatigue response test (see pages 3-9, 10). Performing this exercise successfully indicates a solid command of the technology. 3. Equipment Operation Page 3 1
2 PT PREPARATION 1. Greet pt., explain purpose of visit 2. Have pt. perform static stretches 3. Have pt. void, if necessary 4. Have pt. remove belt & empty pockets 104-POINT CHECKLIST Lumbar Machine Patient Test, Exercise Sessions CALIBRATION 5. Move to calibrate, calibration update 6. CounterWeight (CW) unlocked 7. Angle selector locked at Loosen chain, remove pins from weightstack 9. Pot/SG count # s within range [if not within range, contact MedX Tech Support ] TEST SETUP 10. Select file for test (retrieve or new) 11. Explain: -test sequence (pre/dyn/post) 12. need for stabilization (isolation) 13. should feel pressure from restraints 14. should not feel pain/numbness 15. should not feel dizzy, short of breath, etc. The lap belt, left, and thigh restraint, right. 3. Equipment Operation Page 3 2
![Engage angle selector, fl ip switch [act. strain gauge] 33. Zero torso mass with CW adjustment 34. Flip switch to accept 35. Move pt.](/docs-images/95/122609968/images/3-3.jpg "to upright position, engage angle selector 36. Loosen restraints (release to pt. comfort) 37. Enter gauge reading 38.")
3 Lumbar Machine Patient Test, Exercise Sessions (cont.) 16. Align iliac crests wnh centerline of pelvic restraints 17. Secure thigh restraint 18. Select femur restraint ht. (legs parallel to seat; 15 ) 19. Position feet on footboard (toes turned inward) 20. Secure femur restraint (heels 1/2 inch) 21. Check for pelvic rotation (pt. reach for toes) 22. Adjust head pad (base of occipital bone) 23. Find max angle extension 24. Engage angle selector, fl ip switch (or press F10) 25. Find max angle fl exion (no pelvic restraint rotation) 26. Engage angle selector, fl ip switch 27. Move pt. to upright position, engage angle selector 28. Explain TDC & have pt. fi nd angle (check twice) 29. Engage angle selector, fl ip switch 30. level and lock CW at angle of TDC. 31. Move pt. to 0 or greatest angle of extension 32. Engage angle selector, fl ip switch [act. strain gauge] 33. Zero torso mass with CW adjustment 34. Flip switch to accept 35. Move pt. to upright position, engage angle selector 36. Loosen restraints (release to pt. comfort) 37. Enter gauge reading 38. Enter femur restraint height (patient positioning) 39. Enter seat pad if applicable (patient positioning) 40. Type test remark (PRE FRT) After tighten- lap belt (left ing photo) and foot board (above), have patient lean to touch toes while you see if pad rotates (photos directly left). Also have patient attempt to raise his or her heals. If there is much lift, or any rotation in the pelvic pad, continue tightening restraints. 3. Equipment Operation Page 3 3
4 Lumbar Machine Patient Test, Exercise Sessions (cont.) Position head (occipital lobe) pad, left, and after locating the patient s TDC (top dead center), set the counterweight (this photo and the one below). 41. Explain isometric test: -multiple testing angles sec rest between angles 43. demonst. force application 44. don t push w/head; legs ok 45. build force slowly (3-1-3 s) 46. maintain loose grip 47. exhale during contraction 48. max effort for test accuracy 49. don t push until instructed 50. Ask if pt. understands test instructions 51. Press ENTER to bring up isometric test grid 52. Tighten and check restraints PRE FRT (ISOMETRIC) TEST 53. Move pt. to full flexion, engage angle selector 54. Have pt. relax, record SE at each angle 55. Force built slowly (3-1-3 s) 56. Exhale during contraction 57. Peak effort reached (contractions not cut short) 58. Encourage / motivate patient 59. Maintain pelvic stabilization (check restraints) sec rest between angles / stretch patient 61. Move patient to upright position 62. Engage angle selector 63. Loosen restraints (release to pt. comfort) 64. Press ENTER to save test Make sure the patient understands that this system is an effort-dependent measurement. For both valid testing and effective exercise, the patient must give an all-out effort. 3. Equipment Operation Page 3 4
5 Lumbar Machine Patient Test, Exercise Sessions (cont.) DYNAMIC EXERCISE 65. Determine correct wt. load for DYN (50% max TFT) 66. Set exercise weight on weightstack, tighten chain 67. Enter exercise weight 68. Enter DYN remarks (DYN), bring up test grid 69. Explain DYN: -speed of movement (2-1-4 s) 70. as many reps as possible 71. full ROM (listen for tone) 72. fatigue sensation 73. exhale during contraction 74. maintain loose grip 75. don t push until instructed 76. Ask if pt. understands test instructions 77. Tighten & check restraints 78. Move pt. to full flexion, engage angle selector 79. Release MA lock 80. Flip switch as patient begins to move 81. Controlled speed of movement 7.0 s per rep) 82. Pt. moves through full ROM (tone) 83. Pt. motivation (last repetition = partial or 140 s limit) 84. Flip switch to end DYN (while pt. in full flexion) 85. Engage MA lock 86. Move patient to upright position 87. Engage angle selector 88. Loosen restraints (release to pt. comfort) 89. Press ENTER to save DYN POST FRT (lsometric) TEST 90. Enter test remarks (POST FRT w, r, t ) 91. No more than 70 s rest (50 to 70 s) 92. Tighten & check restraints 93. Move pt. to full flexion, engage angle selector 94. Have pt. relax, record SE at each angle 95. Force built slowly (3-1-3 s) The angle selector (left hand), movement arm lock (right hand), along with the force/ angle switch are located to the patient s right side of machine. 96. Exhale during contraction 97. Peak effort reached (contractions not cut short) 98. Encourage / motivate patient 99. Maintain pelvic stabilization (check restraints) sec rest between angles / stretch patient 101. Move patient to upright position 102. Engage angle selector 103. Loosen restraints, remove pt. from machine 104. Press ENTER to save test 3. Equipment Operation Page 3 5
![Loosen chain, remove pins from weightstack Angle selector. 10. Lock gate 11. Pot/SG count # s within range [if out of range, contact MedX Tech Support, 800-528-3159] TEST SET-UP 12.](/docs-images/95/122609968/images/6-1.jpg "Select file for test (retrieve or new) 13. Explain: -test sequence (iso/dyn) 14. need for stabilization (isolation) 15. should feel pressure from restraints 16. should not feel pain/numbness 17.")
6 100-POINT CHECKLIST Cervical Machine Patient Test, Exercise Sessions PT. PREPARATION 1. Greet pt., explain purpose of visit 2. Have pt. perform static stretches 3. Have pt. void, if necessary 4. Have pt. empty shirt pockets 5. Have pt. remove hair accessories, glasses, etc. CALIBRATION 6. Move to calibrate, calibration update 7. Counterweight (CW) unlocked 8. Angle selector locked at Loosen chain, remove pins from weightstack Angle selector. 10. Lock gate 11. Pot/SG count # s within range [if out of range, contact MedX Tech Support, ] TEST SET-UP 12. Select file for test (retrieve or new) 13. Explain: -test sequence (iso/dyn) 14. need for stabilization (isolation) 15. should feel pressure from restraints 16. should not feel pain/numbness 17. should not feel dizzy, short of breath, etc. 18. Instruct patient to sit upright 19. Place movement arm out of the way 20. Align adam s apple with machine axis (seat ht.) 21. Fasten seat belt & shoulder harness (loosely) 22. Lock gate, (snug torso restraint) 23. Select light wt. (1-2 wt. plates) 24. Tighten chain 25. Have pt. move to full flex., engage angle selector 26. Release MA lock 27. Have pt. perform 5-6 slow reps thru full ROM Seat height setting. 3. Equipment Operation Page 3 6
7 Cervical Machine Patient Test, Exercise Sessions (cont.) 28. Adjust seat ht. to eliminate head sliding on pad 29. Have pt. move to full flexion 3O. Engage MA lock 31. Move pt. to upright position (MA out of way) 32. Engage angle selector 33. Release gate, tighten harness (secure) 34. Lock gate, tighten torso restraint (secure) 35. Check restraints (shoulder shrug) 36. Find max angle extension 37. Engage angle selector, flip switch (or press F10) 38. Find max angle flexion 39. Engage angle selector, flip switch 40. Locate TDC with pt. looking straight ahead 41. Engage angle selector at pt s TDC, flip switch 42. Level and lock CW at angle of TDC O 43. Move patient to 18 (or greatest angle of extension, if more upright) 44. Engage angle selector, flip switch 45. Zero head mass with CW adjustment 46. Flip switch to accept 47. Move pt. to upright position, engage angle selector 48. Loosen torso restraint (release to pt. comfort) 49. Enter gauge reading 50. Enter seat height (patient positioning) 51. Enter seat pad, if applicable (patient positioning) 52. Turn stored energy OFF (test options) 53. Type test remark (Initial IM) 54. Explain 1M test: -multiple testing angles sec rest between angles 56. demonstrate force application 57. apply force wi back of head 58. build force slowly (3-1-3 s) 59. rest hands on gate / cross on lap 60. exhale during contraction 61. max effort for test accuracy 62. don t push until instructed Once shoulder straps are applied, and gate is closed, see if the patient can elevate (shurg) his or her shoulders (loer photo). If there s any perceptible movement, tighten restraints. 3. Equipment Operation Page 3 7
8 Cervical Machine Patient Test, Exercise Sessions (cont.) 63. Ask if pt. understands test instructions 64. Press ENTER to bring up isometric test grid 65. Tighten and check restraints ISOMETRIC TEST 66. Move pt. to full flexion, engage angle selector 67. Force built slowly (3-1-3 s) 68. Exhale during contraction 69. Peak effort reached (contractions not cut short) 70. Encourage / motivate patient 71. Maintain torso stabilization (check restraints) sec rest between angles / stretch patient 73. Move patient to upright position 74. Engage angle selector 75. Loosen torso restraints (release to pt. comfort) 76. Press ENTER to save test 99. Loosen restraints, remove pt. from machine DYNAMIC EXERCISE 100. Press ENTER to save DYN 77. Determine correct wt. load for DYN (80% max TFT) 78. Set exercise weight on weightstack, tighten chain 79. Enter exercise weight 80. Enter DYN remarks (DYN), bring up test grid 81. Explain DYN: -speed of movement (2-1-4 s) 82. as many reps as possible 83. full ROM (listen for tone) 84. fatigue sensation 85. exhale during contraction 86. don t push until instructed 87. Ask if pt. understands test instructions 88. Tighten & check restraints 89. Move pt. to full flexion, engage angle selector 90. Release MA lock 91. Flip switch as patient begins to move 92. Controlled speed of movement ( 7.0 s per rep) 93. Pt. moves through full ROM (tone) 94. Pt. motivation (last repetition = partial or 140 s limit) 95. Flip switch to end DYN (while pt. in full flexion) 96. Engage MA lock 97. Move patient to upright position 98. Engage angle selector 3. Equipment Operation Page 3 8
9 Clinical Fatigue Response Testing Purpose The Fatigue Response Test (FRT) is a 3-part test procedure designed to measure the endurance characteristics of a specific muscle group. Information obtained from the FRT can be used to further delineate an exercise prescription based upon the patient s amount of fatigue consequent to the test. It is recommended that the FRT be administered clinically under the following conditions: 1) The patient is not limited by joint pain when performing dynamic exercise 2) The patient is able to exercise to volitional muscular fatigue 3) The patient has demonstrated reliable efforts with previous isometric testing 4) The patient has not responded to the recommended standard protocol Two tests of functional strength. The top of the shaded area shows the level of fresh strength, while the bottom shows remaining strength after the subject was exercised. The shaded area between the two curves is fatigue from the exercise. The dips in the midrange of movement indicate abnormal function. The fact that the same abnormal shape was produced during both tests indicates valid test results FRT - ABNORMAL CURVE DEVELOPED FROM A SEVEN POSITION ISOMETRIC TEST Exercise Effec t FRT (Fatigue Response Test) RANGE OF MOTION ( 72 o ) <- Pre Test <- Post Test Procedure To perform the FRT, a patient is seated and restrained in the MedX machine in order to isolate the target muscle group. The patient then performs a series of maximal effort isometric contractions at multiple joint angles through a pain-free ROM (Pre FRT). After a brief rest, the patient performs as many dynamic variable resistance repetitions as possible using a weightload equal to 50% (lumbar extension) or 80% (cervical extension) of the peak torque from the Pre FRT. Each repetition should be performed through the full painfree ROM in a slow, controlled manner. The patient should perform the concentric portion of the repetition for 2 seconds, pause at full contraction for 1 second, then complete the eccentric portion over a 4 second period (total 7 seconds per repetition). Repetitions should be performed until the patient is unable to move the weightload through a full ROM (volitional fatigue). Immediately following the dynamic repetitions (within 1 minute) the patient performs maximal effort isometric contractions at the same joint angles selected for the Pre FRT (Post FRT). The patient is then released from the machine. Interpretation The difference between the Pre FRT and Post FRT isometric tests represents the fatiguing effect of the dynamic exercise. The amount of fatigue (inroad) will vary among individuals, and is indicative of the fiber type characteristics of the lumbar extensor musculature. For example, an inroad > 30% reflects fatigue characteristics of fast twitch muscle fibers, which have a low tolerance to exercise (poor endurance). An inroad < 10% reflects fatigue characteristics of slow twitch muscle fibers, which have a high tolerance to 3. Equipment Operation Page 3 9
10 Clinical Fatigue Response Testing (cont.) exercise (high endurance). An inroad between 10% and 30% reflects fatigue characteristics of an unknown mixture of fast and slow twitch muscle fibers, with a moderate tolerance to exercise (moderate endurance). Exercise Prescription When a motivated individual fails to demonstrate progress (progressive increase in isometric strength, progressive increase in dynamic weightloads) using the standard treatment protocol, his/her exercise prescription may need to be altered based upon the findings from the FRT. Use the following table as a guide: Percent Fatigue from FRT Muscle Group Time Under Load Repetition Range Exercise Frequency 10% Lumbar/Cervical s X/WK 30% Lumbar 56-84s X/WK Cervical s X/WK 3. Equipment Operation Page 3 10
11 DOs and DON Ts of Testing 1. ALWAYS have one hand on the movement arm and one hand on the angle selector when moving from angle to angle (excluding Cervical Extension machine). 2. NEVER disengage the angle selector while in the dynamic mode (when movement arm lock is down). 3. NEVER exceed a patient s range of motion. 4. COMMUNICATE with the patient before and during testing and training. Explain what they should feel, where they should feel it, and what they should not feel. 5. REMEMBER that you are performing an effort-dependent measurement of spinal function. You must get the patient s maximal effort. 6. MAINTAIN proper body stabilization throughout the testing/training session. 7. DON T cut an isometric contraction short. Allow enough time for motor unit/muscle fiber recruitment. 8. SELECT the proper weightload for training. CHECK your selection by getting eye-level to the weight stack. 9. MOTIVATE the patient. They will always reach momentary mental failure before reaching momentary muscular failure. The last repetition of a set should be a partial one, performed in a slow, controlled manner. 10. DON T allow the patient to exercise too quickly. Each repetition should take approximately 7 seconds (2 second concentric, 1 second hold, 4 seconds eccentric). The average time per repetition (total exercise time divided by total number of repetitions) should fall between 6.5 and 8.0 seconds per repetition. 11. RELY on patient feedback, but do not allow the patient to control the test. This is especially important during the stabilization procedure, and dynamic training. 12. DON T get button/lever happy. When in doubt or confused, STOP and READ THE SCREEN. 3. Equipment Operation Page 3 11
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