ARTROMOT -E2 ARTROMOT -E2 COMPACT - Medcom Group

Warning! – Movements must not cause any pain or irritation. Shock hazard— – Patients must be fully conscious while being instructed in the use of the CPM device and during therapy. Strictly observe the following warnings. Failure to do so endangers the lives of the patient, the user and other persons involved. – The choice of the therapy parameters to program and of the therapy protocols to use is restricted to the responsible physician or therapist. It is the physician's or therapist's decision whether or not to use the CPM device on a specific patient. Before use allow the ARTROMOT -E2/-E2 compact to reach room temperature. If the device has been transported at temperatures below 0 C (32 F), leave it to dry at room temperature for about 2 hours, until any condensation has disappeared. The patient must be familiar with the functions of the ARTROMOT -E2/-E2 compact programming unit and the unit must be within easy reach of the patient, allowing him or her to stop therapy, if needed. Patients unable to operate the programming unit, e.g. paralytic patients, must never be left unattended during therapy. – The ARTROMOT -E2/-E2 compact must only be operated in dry rooms. When disconnecting the device from the power line, remove the plug from the wall outlet first, before disconnecting the cable from the device. When connecting the device to other equipment or when creating a medical system, check that the sum of leakage currents will not cause any hazard. Please contact ORMED.DJO, if you have questions in this matter. – Write the patient's name on the patient chip card. The card should only be used for this patient. If the patient chip card is used for another patient, be sure to delete the previous patient's data from the card first (see sections 4.1 and 5.3, paragraph "New Patient"). Use original chip cards only. – Do not use multiple portable socket outlets (MPSO) to connect the device to the power line. The ARTROMOT -E2/-E2 compact must be connected to a properly installed wall outlet with a non-fused earthed wire. Before connecting the power cord, it must be completely unrolled and placed such that it will not get caught in the moving parts of the device. All accessories used with the ARTROMOT -E2/-E2 compact must be approved by ORMED.DJO. – Do not allow parts of the body or any objects (such as blankets, cushions or cables) to get caught in the moving parts of the CPM device. – Before cleaning and service interventions, disconnect the device from the power line by removing the power cord from the wall outlet. Always seat the patient on a chair with four legs and without armrests when using the ARTROMOT -E2 compact. – Liquids must not be allowed to enter the CPM device or the programming unit. If liquids have entered into the device, the ARTROMOT -E2/-E2 compact must be checked by a service technician, before it can be reused. 58

Warning! Caution! Equipment malfunction— Preventing chafing and pressure sores — If your patient is adipose, very tall or very short, be sure to prevent chafing and pressure sores. Magnetic and electrical fields are capable of interfering with the proper performance of the device. For this reason make sure that all external devices operated in the vicinity of the CPM device comply with the relevant EMC requirements. X-ray equipment, MRI devices, radio systems, cell phones, etc. are possible sources of interference as they may emit higher levels of electromagnetic radiation. Keep the CPM device away from these devices and verify its performance before use. Caution! Equipment damage— Check that the voltage and frequency ratings of your local power line are those indicated on the nameplate. Refer repair and maintenance to authorized persons. The seat withstands a maximum continuous loadof 150 kg / 330 lb. Route all cables such that they will not get caught by the moving parts during operation and that they do not present a stumbling hazard. The arm support element withstands a maximum continuous load of 9 kg / 20 lb. Inspect the ARTROMOT -E2/-E2 compact for damage and loose connections at least once a year. Do not allow any objects (such as blankets, cushions, or cables) to get caught in the moving parts of the CPM device. Do not expose the ARTROMOT -E2/-E2 compact to direct sunlight, because some of the components may reach inadmissibly high temperatures. Be aware that the connectors can only be inserted in the correct orientation and secure all connections with the locks. 59 English Patient hazard, damage to the CPM device — The CPM device ARTROMOT -E2 must not be used to transport people.

4. Device setup Note: See device description on pages 2/3 and 268/269. Adjustment with programmed chip card 4.1 Connecting the ARTROMOT -E2/-E2 compact, performance check Insert the original patient chip card (17) into the programming unit (15). Press the START key. The CPM device automatically moves to the starting position (middle position of the set extension/flexion and pronation/supination values). 1. Connect the power cord to socket (18) of the device and connect the mains plug to a wall outlet with a non-fused earthed wire (100 to 240 Volt, 50/60 Hz). 2. Turn the power switch (19) on. Performance check 3. Follow these steps to set the carriage to the home position: If the programming unit can be operated as described above and the ARTROMOT -E2/-E2 compact moves to the home position (for home position values, please refer to sections 5.3), the CPM device has passed the performance check. Initial adjustment for new patients Write the patient's name down on the back of the chip card. Insert the original patient chip card (17) into the programming unit (15). The device also runs performance checks regularly during operation. This is what happens, if a problem is identified: Press the MENU key on the programming unit seven times in rapid succession or give it one long press to access programming level seven (with each key press, you advance one level). An audio signal sounds. The device switches off immediately. The message "ERROR" and an error code (e.g. ERROR 5) appear on the display. Press the "new patient" parameter key and select this function (a check mark appears in the circle next to the function). In this situation, you may attempt to restart the device by turning it briefly off and on again with the power switch. If the error message persists, have the device inspected by a Service technician, before using it again. Press the START key. The CPM device automatically enters the home position. If it has been determined that the ARTROMOT -E2/-E2 compact operates perfectly, ask the patient to sit down on the ARTROMOT -E2/-E2 compact chair. 60

ARTROMOT - E2 compact: positioning the chair and the CPM device 4.2 Adjusting the device to the patient For the following adjustments, the patient's arm should not yet be placed on the armrest. After you have adjusted the device to the approximate patient measurements, the patient can place his/her arm on the armrest for a check of the setup and for the fine adjustment. Only use chairs with four legs and without armrests. The patient must be seated safely and straight on the chair. Once you have set up the ARTROMOT - E2 compact, lock the brakes (22) of the castor wheels (25). The settings are numbered 1 through 5. For easy orientation, you will find the same numbers on the CPM device. Always set up the CPM device in this order. 4.2.1 Adjusting the ARTROMOT -E2 to the patient Write the settings down on the back of the patient's chip card. Before you adjust the ARTROMOT -E2/-E2 compact to the patient, you may have to convert the device for use on the left or right elbow joint. (see section 6.4 Conversion) Note: The individual steps are illustrated on page 4. @ a,b and c Horizontal Extension/Flexion (Fig. A) Before any treatment is possible, adjust the device as follows: Horizontal adduction/abduction is set manually. It is the purpose of the adjustment to achieve congruent axes of the motor axis and the elbow joint. ARTROMOT - E2: backrest, armrest To begin with, press knob (1). Leave it engaged in the open position. Before you start setting up the device for the exercise protocol, you must adjust it to a position that is anatomically correct for the respective patient. Now open screw (2). The double joint now moves freely. Set the motion element with motor A to the appropriate position. Make sure that a congruence of the axis of motor A and the elbow joint is achieved. Open thumbscrew (10) and adjust the backrest to a position that is comfortable for the patient (Fig. F). Push knob (1) in the opposite direction. Set the armrest for the healthy arm to a height that allows the patient to sit up straight (locking screw 14). Tighten screw (2). 61 English Before you start setting up the device for the exercise protocol, you must adjust it to a position that is anatomically correct for the respective patient. Note!

; Height adjustment (Fig. B) & Axis adjustment motor B (Fig. E) Before opening locking screw (4), hold the moving part of the CPM device by grasping the double joint (3), to prevent the part from falling down. In most cases the setting is 0 on the scale. In cases of a deformed forearm, the setting may have to be changed. Open screw (4) and set the motion element to the appropriate height. Ensure that the entire upper arm lies on the support (5). The patient should sit up straight and be relaxed. Open the locking screw (13) and perform the adjustment. Tighten the locking screw (13). Tighten screw (4). ( Backrest adjustment Now check the agreement of the axis of motor A and the elbow joint. If required, make a fine adjustment of the vertical orientation, using locking pin (6). (Fig. F) Set the backrest to the foremost position before setting the motion element to an angle of 0 for horizontal adduction/abduction. To do so, open adjusting screw (10), set the backrest to the foremost position and tighten the screw. Adjustment of the positioning angle (Fig. C) To achieve optimal congruence between the axis of motor A and the patient's rotational axis of the elbow joint, the backrest angle can be individually adjusted in all other horizontal adduction/abduction positions. Caution! Patient hazard / equipment damage— Hold motor B for this adjustment to secure the device. Checking the setup, fine adjustment Hold the motion element at bracket (30). Now open screw (7) and set the appropriate angle. Please check the following before using the CPM device on a patient: Tighten screw (7). Check settings 1 to 6 and make sure that the pivot of motor A agrees with the pivot of the elbow joint, i.e., that the axis of motor B vertically passes through the elbow joint. % Adjustment of the forearm length (Fig. D) Check that all locking screws and clamping levers are tight. Caution! Patient hazard / equipment damage— Hold motor B for this adjustment to secure the device. Open the cam lever (8) and set the appropriate length. Make sure that the slider (9) is free to move at least 2 cm in either direction. There must be enough space for the fingers between the hand support and motor B. Tighten the cam lever (8). 62

Open the cam lever (3) and set the appropriate length. Make sure that the slider (4) is free to move at least 2 cm in either direction. There must be enough space for the fingers between the hand support and motor B. 4.2.2 Adjusting the ARTROMOT -E2 compact to the patient Note: The individual steps are illustrated on page 82. Tighten the cam lever (3). Note: Step 1 does not exist for the ARTROMOT -E2 compact. & Axis adjustment motor B ; Height adjustment (Fig. A) In most cases the setting is 0 on the scale. In cases of a deformed forearm, the setting may have to be changed. Before opening locking screw (1), hold the moving part of the CPM device by grasping motor A (11), to prevent the part from falling down. Open the locking screw (7) and perform the adjustment. Tighten the locking screw (7). Open screw (1) and set the motion element to the appropriate height. Ensure that the entire upper arm lies on the support (20). The patient should sit up straight and be relaxed. Checking the setup, fine adjustment Please check the following before using the CPM device on a patient: Tighten screw (1). Now check the agreement of the axis of motor A and the elbow joint. If required, make a fine adjustment of the vertical orientation, using locking pin (26). Check settings 2 to 5 and make sure that the pivot of motor A agrees with the pivot of the elbow joint, i.e., that the axis of motor B vertically passes through the elbow joint. Adjustment of the positioning angle Check that all locking screws and clamping levers are tight. (Fig. B). Caution! Patient hazard / equipment damage— Hold motor B for this adjustment to secure the device. Hold the motion element at bracket (27). Now open screw (2) and set the appropriate angle. Tighten screw (2). % Adjustment of the forearm length (Fig. C) Caution! Patient hazard / equipment damage— Hold motor B for this adjustment to secure the device. 63 English (Fig. D)

5. Setting the treatment values Warning! 2. If a "Text" programming unit is operating with a formatted "Graphics" chip card Patient hazard— Before therapy, a test run consisting of several exercise cycles must be completed without the patient. Then repeat the test run with the patient and check that the movement does not cause any pain. the selected language automatically changes to the default setting: German. the reverse on load setting saved for motor A in the "Graphics" version is automatically used for both motors. Note: See also 2.2 and 2.3 a key lock set in the "Graphics" version will remain active, only when no changes were made with the "Text" version; the key lock function is not an option with the "Text" version. Note! Programming is only possible when the patient's chip card has been inserted. For information about therapy parameters and programming of special functions, please refer to sections 5.1 to 5.3. See section 5.4 for programming examples. 5.1 General information on programming the ARTROMOT -E2/ -E2 compact Important! The programming unit ARTROMOT -E2/-E2 compact "Graphics" can be connected to all products of the ARTROMOT family of elbow CPM machines. 1. You activate the programming mode by briefly pressing the MENU key on the programming unit. It is possible to exchange chip cards between the "Text" and "Graphics" versions. 2. The treatment parameters and functions are allocated to seven programming levels (four functions per level). Please note: 1. If a "Graphics" programming unit is operating with a formatted "Text" chip card To be able to program a parameter you will have to access the corresponding programming level. This is also done with the MENU key. With each brief key press you advance one level. The code M1, M2, etc. that appears in the middle of the display indicates the programming level. To back up one level, e.g. from level 2 to 1 or from level 1 to 7, hold the MENU key down for some seconds. the selected language of the "Text" version remains activated; it is irrelevant for the "Graphics" version. the reverse on load setting saved in the "Text" version is automatically used for both motors. the key lock is disabled. 64

3. You activate the treatment parameters and functions with the four parameter keys below the display. The symbols above the four parameter keys indicate the assigned parameters and functions. Note! Refer to section 5.3 for a description of the parameters. The corresponding symbol appears on the display in a larger format. To prevent accidental changes of the parameter settings, you can lock the keys. To do so, simultaneously press keys and – for approx. 3 seconds. The set value is displayed. The symbol above the parameter key appears in reverse video. 4. With the / - keys (plus/minus) you change the displayed value. When you press and hold the key, the value will change at a higher rate. Press both keys again for approx. 3 seconds to unlock. Some of the (special) functions can only be enabled and disabled. This is done by pressing the corresponding parameter key or with the / - keys. Active parameters are identified with a check mark in the circle next to the symbol. Selecting the "new patient" function will automatically delete the data on the patient chip card. When you have finished programming the unit and press the STOP key, the settings will automatically also be saved to the patient chip card. 5. Having programmed all parameters, press the STOP key to save the values. Emergency stop function: When any of the keys is pressed during therapy, the ARTROMOT -E2/-E2 compact switches immediately off. 6. Then press the START key: the ARTROMOT -E2/-E2 compact checks the set values, moves to the position halfway between the set extension and flexion values as well as to the set supination and pronation values and stops. – When the START key is pressed again in the synchronized mode and in the non-synchronized mode, the carriage will reverse its direction. 7. Press the START key again to start therapy. The CPM device will now begin with the set physiological motion pattern in the synchronized mode. The motor with the larger range of motion operates at the programmed speed, while the speed of the second motor is adapted. This ensures that both motors will reach their target positions at almost the same time. Patients with a programmed chip card First complete the mechanical adjustments. Then insert the chip card (the patient is not yet positioned on the CPM device). After activation of the START key in the non-synchronized mode the motors will perform random movements, each motor reversing after reaching the maximum values. The programmed speed is valid for both motors. Press the START key: the device will move to the starting position as specified by the parameters stored on the chip card and stops. Position the patient on the CPM device and press the START key to initiate therapy. 65 English To view the set parameter values, press the corresponding parameter key. Before, however, you have to press the STOP key and access the correct menu level. This is what happens when you press one of the parameter keys to select a parameter:

LEVEL 5: 5.2 Programming the ARTROMOT -E2/ -E2 compact - stretching in extension - stretching in flexion - stretching in pronation Different programming levels are provided to program the ARTROMOT -E2/-E2 compact. - stretching in supination You change between levels by pressing the MENU key repeatedly. LEVEL 6: The currently selected level is indicated on the display. - EROM repeat extension/ pronation The following treatment values, settings and information can be entered/viewed on the programming unit (15): - EROM repeat flexion/supination LEVEL 7: LEVEL 1: - transport setting - extension - new patient - flexion - operating mode synchronized/ non-synchronized - pronation - supination - Service menu LEVEL 2: Note! - pause While you adjust the values, the carriage will move to the set range. This allows you to easily and quickly determine the ROM where the patient does not experience any pain. - therapy timer - speed - warm-up protocol The angle entered last for the respective directions of motion will be saved in each case. LEVEL 3: - reverse on load - motor A - reverse on load - motor B - motor A ON/OFF - motor B ON/OFF LEVEL 4: - isola

patient chip card. The card should only be used for this patient. If the patient chip card is used for another patient, be sure to delete the previous patient's data from the card fi rst (see sections 4.1 and 5.3, paragraph "New Patient"). Use original chip cards only. All accessories used with the ARTROMOT -E2/-E2 compact must be