Innovations in Education - Canadian Memorial Chiropractic College

Transcription

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Innovations in
Education
Force Sensing Table Technology™
Assembly and Operations Manual
(To view the most updated version and/or a video of
applications of FSTT™ in the classroom, go on line to
http://www.cmcc.ca/fstt)
Copyright© CMCC 2016
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This product is made possible by the
Canadian Memorial Chiropractic College ("CMCC")
6100 Leslie Street, Toronto, Ontario, Canada M2H 3 J1
416-482-2340
Patent information: Manipulative treatment training system and mannequin: international patent
pending, FSTT™ system, No.2869517
The FSTT™ system is not a medical device, it is intended to be used for teaching and learning,
assessment and research purposes.
Disclaimer Statement:
CMCC assumes no liability what-so-ever from the user’s FSTT™ system’s assembly and set-up. CMCC has
provided this Assembly and Operations Manual as an aid in the set-up and use of your purchased FSTT™
system to its best knowledge and understanding. The careful and proper installation and set-up is the
purchaser’s sole responsibility. Pieces of the system have been identified as being heavy. Caution needs
to be exercise when handling these components. Components of the system have been identified in the
manual as being heavy. Please contact CMCC should you require additional information in the assembly
of your FSTT™.
CMCC is a repackaging agent assembling components to create the FSTT™ and HAM™ products and
accessories. CMCC assumes no responsibilities in any form for the accuracy or adequacy of any test
results, data, or conclusions, which may result from the user’s application of the system or equipment.
WARNINGS with respect to the assembly and usage of the table, including “sitting” on inappropriate
parts of the table should be adhered to.
Contact Information:
Please contact Mr. Steve Tran at [email protected] or 416-482-2340, 188 should you have any questions
regarding the set-up and use of your FSTT system. Routine hours are Monday to Friday (excluding
Canadian statutory holidays) between 9:00 a.m. and 5:00 p.m. Canadian Eastern Time zone.
For a secondary contact, call 416-482-2340 and request the office of the Dean, Graduate Education and
Research.
No part of the publication may be reproduced or transmitted in any form or by any means, electronic or
mechanical, including photocopying or any information storage and retrieval system without permission
in writing from CMCC. The manual is protected under copyright by CMCC.
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Table of Contents
Page #
I.
II.
III.
IV.
V.
VI.
VII.
VIII.
IX.
X.
XI.
XII.
XIII.
XIV.
XV.
XVI.
XVII.
XVIII.
XIX.
Disclaimer and Contact Information………………………………………………………..…………… 2
Table of Contents………………………………………………………………………………………………….. 3
Checklist……………………………………………………………………………………………………………….. 4
Unpacking your FSTT™ and HAM™ System ……......................................................... 5
Basic Assembly Diagram …………………………………………………………………………………….. 7
Assembly Steps ……………………………………………………………………………………………………. 7
Operating the Dynamic Lower Body Support ……………………………………………………….. 10
Operating the Drop Piece of the Dynamic Lower Body Support (if so equipped)….. 11
Operating the Dynamic Headpiece (if so equipped) ……………………………………………… 11
Introductory comments on measurements of manual procedures ………………………. 12
Fidelity and interpretation of measurements with the FSTT™…………………………………. 12
Error Sources …………………………………………………………………………………………………………. 14
Biomechanical Reference Frames …………………………………………………………………………. 18
Navigating FSTT™ Software …………………………………………………………………………………… 19
Opening the Program: (Figures W1 to W4) ...………………………………………………………….. 19
Multiple Event Recordings: (Figures M1 to M13) ……………………………………………………. 23
Single Event Recordings: (Figures S1 to S11) …………………………………………………………... 36
Accurate Mode Measures ……………………………………………………………………………………… 47
Defining Target Joint Position and Orientation for “Accurate Mode” estimates
(Figures AM 1 to AM8) ……………………………………………………………………………………………. 47
XX.
User input to the Accurate Mode – defining surrogate patient/mannequin posture… 47
XXI.
Assembling for Lateral recumbent Accurate Mode …………………………………………………. 49
XXII. Assembling the Side Barrier…………………………………………………………………………………….. 49
XXIII. Assembling the Artificial Shoulder …………………………………………………………………………... 50
XXIV. Positioning for Lateral Recumbent Accurate Measure …………………………………………….. 51
XXV. Seated Maneuvers ………………………………………………………………………………………………….. 52
XXVI. Cleaning and maintenance………………………………………………………………………………………. 52
XXVII. On-line version of manual & video of in-classroom use…………………………………………… 53
XXVIII. Warranties……………………………………………………………………………………………………………….. 54
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Check List: The following check list is recommended for posting in plain sight where the FSTT™ system is
installed.
Recommended Procedures for Safe Table Operation
____ Explain and demonstrate proper use and operation of the FSTT™ system to all personnel and
students who will be interacting with it.
____ People mounting and dismounting the table as a surrogate patient should be attended by an
assistant in the same manner that a health care provider would attend a real patient to guard
against loss of balance or falling.
____ Explain the proper placement of hands, arms and feet to those mounting the table to be sure that
no body part is near the motorized mechanism when it is in use. Failure to do so may result in
severe injury.
____ Operating the motorized lower body support using the foot switches should never be done while a
person is mounting or dismounting the table. To do so may result in severe injury.
____ Explain the proper use of the dynamic head piece (if so equipped) to avoid sitting on the head
piece at any time and that it remains locked when not in use.
____ Explain the daily check of appropriate gaps between components of the system to minimize
measurement errors that will otherwise occur.
____ Regular, periodic and hygenic cleaning of the table is recommended. See the Manual for “Cleaning
and Maintenance”.
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Unpacking your FSTT™ and HAM™ System.
Thank you for purchasing the CMCC Force Sensing Table Technology™ (FSTT™) and Human Analogue
Mannequin™ (HAM™) system for teaching and learning of manual therapy skills.
We recommend that personnel who unpack and assemble the FSTT™ and HAM™ be persons familiar with
its intended use and are physically able to do so.
The shipper has constructed custom built crates for transporting your table system. As a result, the
configuration of the shipment may differ to some degree from the following description.
Fundamentally, the FSTT™ system can be described as having 10 subunits.
Subunit 1: FSTT™ and Human Analogue Mannequin™
o HAM™ mannequin assembled
o Circular plate – may be used as a cover to close the neck if you
should decide to remove the head
Subunit 2: Lower body support assembly with motor & drop mechanism – if so
equipped
Subunit 3: Headpiece assembly with dynamic headpiece and drop mechanism
– if so equipped
Subunit 4: Thoracic support and sensor unit (WARNING HEAVY)
Subunit 3:
Subunit 4:
Subunit 2:
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WARNING: Do not sit on or
lift from the headpiece
cushions (Subunit 3) at any
time.
WARNING: Until assembled
to Subunit 2, Subunit 3 is
susceptible to tipping.
forward
Subunit 5: Lumbar accessory component – artificial shoulder assembly; if so equipped (new
models have a linear, threaded shaft rather than the ‘z’ shape shown below on the left.)
Subunit 6: Amplifier sensor unit (boxed)
NIDAQ , Amplifier & HP
computer from front.
NIDAQ , Amplifier & HP
computer from back.
Subunit 7: NIDAQ – digital analogue converter – (boxed)
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Subunit 8: Viewsonic computer monitor – (boxed, not shown)
Subunit 9: HP Computer – (boxed)
Subunit 10: Cables, DVD software backup, side barriers (2) components of lumbar accessory (boxed).
Basic Assembly Diagram
The figure below is an overview of how the hardware components of the assembled system are linked
together.
Assembly Steps –
It is recommended that assembly and installation be on a flat and
horizontal floor surface. If installation is to be on a smooth, hard surface a friction mat (see Step #2
below) similar to that provided must be used to stabilize the table.
1) Locate the Subunits 2 – 4, the three main components of the table system.
2) Locate the rubber mat material, usually packaged with Subunit 2. This material is to be used if
you are installing the system on a smooth floor surface. Cut pieces to fit under the “feet” of
Subunits 2 and 3 as well as the steel plate under Subunit 4.
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3) Position Subunit 4 (Warning: Heavy assembly. Use assistance to lift/position). The cephalic end
is toward the headpiece section of the table and is where the cable for the amplifier attaches.
4) Move Subunit 2 so that it slips under the force plate of Subunit 4.
5) Remove the 2 bolts and rubber dampers from the cephalic end of Subunit 2.
Dampers
6) Move Subunit 3, the headpiece section, to the opposite end.
7) Align the holes of Subunit 3 with the holes of the cephalic end
of Subunit 2 and replace the bolts. Tighten firmly (See Figure
Bolts) to bridge over the steel plate of the Subunit 4 support
structure for the force plate.
2 Bolts
in place
Figure Bolts: View of 2 bolts and rubber dampers
from above, through the frame of Subunit 2 with the
force plate removed.
Force plate & platform (thickness
of platform varies)
Steel frame.
“Bridge” formed by bolting Subunits
2 & 3 together.
Steel plate of Subunit 4.
8) Connect the force plate cable to the force plate and the opposite end to the amplifier as shown.
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Cable from force amplifier to
NIDAQ.
BNC connector (6)
pig tail end of
cable from
amplifier to
NIDAQ
Cable from force plate.
9) Assemble the HP computer, Viewsonic monitor, keyboard, mouse and power cables.
10) Connect the cable from the NIDAQ into the computer as shown in the figure of Step 8.
11) Identify the power cable, foot pedal controls and pressure-valve “off” switch for the lower body
support Subunit 2
and
Pressure-valve “off” switch
Power inlet plug
connect
to the table.
Drop piece lever
Table cycle speed controls
Foot pedal on-off switch
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12) IMPORTANT: now adjust the height of Subunits 2 and 3 such that the bottom of the “bridge”
under the force plate is at least ¼ inch above the steel plate of Subunit 4 (See Figure “bridge”,
below).
13) Check critical “gaps”. There should now be 3 gaps that, together, isolate the force plate sensing
unit from the remainder of the system.
Headpiece Gap
Bridge Gap
Pillar Gap
14) Congratulations! Your system is ready to use. You may now turn the computer on and access the
software to run the FSTT™ system.
Operating the Dynamic Lower Body Support
The lower body support is constructed from a standard Leander™ flexion/extension table base.
1) Powering the flexion/extension function – the “on/off” switch is located at the foot of the table
where the control cords attach.
2) Cycling of flexion/extension is controlled by the right hand knob shown in the Figure for
Assembly Step 11. The range of motion of the table is approximately 10 degrees with each
stroke.
a. Manual setting: the table cycles when triggered “on” and “off” by the foot switch.
Squeezing the pneumatic bulb will also stop the cycling and is operated by the surrogate
patient as necessary should they feel discomfort with any table movement.
b. Timed setting: the table cycles for the fixed time set on the timer dial.
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Operating the Drop Piece of the Dynamic Lower Body Support (if so
equipped)
The drop piece tension is set by the knurled knob handle at the base of the cocking lever (Figure for
Assembly Step 11). To cock the drop piece, simply lift on the lever. To activate it to drop, simply push
down on the table surface or, if simulating a drop procedure treatment, push on the surrogate patient at
the appropriate landmark.
Operating the Dynamic Headpiece (if so equipped)
The Dynamic Headpiece option is designed to eliminate the report of paradoxical (i.e. contrary to
expected) loading of the spine that occurs with a static headpiece during upper thoracic maneuvers. This
paradoxical load arises from the neck deformation, as the thorax is loaded, pushing the face into the
headpiece. This causes compressive force to pass back through the neck to the force plate sensing
system and can confuse the interpretation of results if the desire is to measure input loads during these
procedures. Unlocking the head piece allows it to float horizontally in a cephalo-caudal (head-foot)
direction and will eliminate this confounding load component.
The figures below are from above the head piece, visualizing the space between the cushions. The black
plastic (flagged in the image by the hexagonal screw nuts) slides toward the center of the head piece to
open and back toward the lateral side to lock. It is easily accessed by reaching between the cushions. To
lock, slide the head piece to its docked position at its most caudal position and then push the slide lock
closed.
Slide Lock
Open
Slide Lock
Closed
NOTE: Always lock the headpiece when not in use for its intended operation per above.
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WARNING: The system is not designed to sit on or lift from the head piece cushions.
WARNING: The head piece, is not intended for
sitting or leaning on, leaning or sitting on the
unlocked headpiece might result in loss of balance
or unexpected movement. CMCC accepts no
liability for use of the headpiece in any way other
than as described.
Introductory comments on measurements of manual procedures.
The FSTT system is setup to give you two methods of recording:
a) Multiple Event – allows the user to set the length of time the system will continuously record, during
which the user may perform multiple procedures. The display will appear with the sequence of
procedures shown to allow direct visualization of consistency or difference in performance. Results
may be saved for later comparisons.
This recording methods is commonly used during class room or reflection lab coaching or rehearsals.
b) Single Event – allows the user to set the length of time (default is 4 seconds) to record a single
event. The event is then displayed with automatic measures of typical parameters. Results may be
saved for later comparisons.
This recording method commonly may be used in assessments or for rehearsals.
Fidelity and interpretation of measurements with the FSTT™.
Figure 1:
Measurement precision is a reflection of the consistency of the resultant measure
on repeated testing of a given input. Essentially, it is how well measures cluster
together. Accuracy is dependent on the method of data capture and any error
sources while seeking to identify a true value. In Figure 1, if the goal is to hit the
“bullseye” at “dead center” there is one more accurate measure and three
measures that have high precision but less accuracy. Notice that the true dead center has been
estimated best by the more accurate measure but still contains some error.
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The FSTT™ system is set up to facilitate two modes of measurement.
a) Relative Mode – Comparison of a procedure against itself, a previously recorded procedure or
against a faculty defined “gold standard”.
This method reports the loads (forces and moments) that directly act on the force plate without
consideration of the body part that is being targeted by the applied procedure (e.g. body weight is
zeroed out). Displayed/stored values for the loads in the Relative Mode are real, but are different from
the loads acting through the target joint. If the same procedure is repeated using the same
mannequin/surrogate patient positioning, then the relative comparison will identify any change that has
occurred between the two applications. As such, relative measures quantify changes in performance,
which may be useful for teaching and learning of procedures and in research. Correct interpretation of
measurements made in Relative Mode is made in the context of change or difference scores rather than
as absolute values.
The Relative Mode may be used for both learning and research projects and generally include
procedures for cervical, thoracic, lumbar and extremity maneuvers.
b) Accurate Mode (See p 45) – Report of loads passing through the target joint. This mode
requires additional user input to define the location and orientation of the body part with respect to
the force plate. Default values for the distance and orientation with respect to the center of the
force plate are both 0. The default Accurate Mode is equivalent to the Relative Mode of operation.
This mode allows the user to estimate the accurate loads passing through the body segment at the level
of the applied procedure. By selecting this option, the system will prompt for user input as to the
location (in centimeters) and orientation angle (in degrees) of the body part with respect to the force
plate reference point (Figure 2). The user prompts give reminders of how these measures are to be
made. Values reported back to the user will reflect the loads acting at a targeted level. Accuracy of the
output depends upon the accuracy of the location and orientation input and estimates the true loads.
The Accurate Mode may be used in both learning and research projects. Note special comments related
to cervical and lumbar procedures under the section on “Error Sources” below.
Figure 2: Force plate reference point – “0”
location for table reference system as the
caudal right hand corner of the force plate
surface.
“0” Reference
Point
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Fidelity (repeatability of true measures) for these types of measures has been tested and reported in the
literature (Rogers, C.M. and Triano, J.J. Biomechanical measure validation for spinal manipulation in
clinical settings. JMPT 26 (9) 539-548, 2003.)
A note about manual measures and precision - There are many tools for making these measures
including simple tape measures and inclinometers up to high tech methods optoelectronic systems. All
of them will still require your judgement in approximating the location and orientation of the joint
within the body. As a consequence, this approximation is the limiting factor in the accuracy of final
estimations and translates to a practical sense that measures that attempt precision greater than a
centimeter or 10 degrees orientation are unlikely to be meaningful.
Error Sources
Error sources are inevitable in any time of measurement. The FSTT™ is designed to minimize the
complexity and expense of large numbers of sensors while retaining as much flexibility as possible. To
achieve this, it is important that certain constraints be kept in mind.
1. Table assembly and location
a. The assembled table requires that the head piece frame / cushions as well as the lower
body support pillar / cushions (Figures 3 & 4) do not come into contact with the force
plate or its stand, forming “gaps” between these parts. A sheet of rubber has been
supplied to be placed under the feet of the table (Figure 5) if the system is installed on a
smooth floor. This will minimize inadvertent movement of the table during normal use.
It is good practice when turning the system on to visually inspect for the required gaps
between the table components and the force plate.
Figure 3: Gap required between head piece
and force plate support.
Figure 4: Gap required between force plate
support.
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Figure 5: Rubber mat placement for smooth floors are placed under the feet of the head piece and the
force plate support frame, in example.
Rubber matting
b. A third critical “gap” is required between the steel support frame for the force plate
(Figure 6) and the bridging connection of the head piece to the lower body support. Be
sure that the adjustable feet of the table are set so that there is at least a ¼ inch gap the
full length of the bridge (Figure 7).
Figure 6: Force plate frame arches over the “bridge” connecting the head piece to the lower body
support frame.
Force plate top
Support frame
Bridge
Figure 7: ¼ inch gap between support frame and
bridge.
1/4 “ Gap
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c. The floor on which the table rests is a mechanical membrane that will transmit
vibrations. To observe this, with the table turned on and recording, simply jump and
land on the floor next to it. The vibration recorded is called “base motion”. Under
normal circumstances in a typical commercial building, such artifact is negligible.
However, if the system is positioned near or in an adjacent area to heavy mechanical
equipment or therapeutic devices (e.g. whole body vibration systems) that cause
vibration of the room, it will affect measurements. As a rule of thumb, if you can feel the
floor/room shake, so will the force sensing system!
2. Table contact by operators – contact to the force plate (e.g. Figure 8 a, b) by any person or
object other than the mannequin/surrogate patient will introduce error. Perform procedures
without directly leaning on or touching the force plate or its cushions.
Figure 8a:
Incorrect Knee leaning
on the sensor
system.
Figure 8b:
Correct Sensors are
isolated with
force acting
only through
the surrogate
patient.
3. Cervical spine procedures
a. Neck procedures clinically can be performed with the head either elevated by the
provider off the head piece cushion or with the head resting on the cushion.
i. Head elevated maneuvers – measure obtained with the head elevated are
transmitted through the patient to the force plate and represent the net load
acting by the provider’s supporting hands.
ii. Head resting on the cushion –
1. For tables that are not equipped with the dynamic head piece option (or
with the head piece locked), the portion of the applied load passing
through the spine to the force plate will be recorded. Some of the total
force will be absorbed by the head piece.
2. For tables equipped with the dynamic head piece option, release of the
head piece will allow the system to float along the spinal axis and the
full axial load transmitted through the spine will be recorded.
3. For tables outfitted with the drop head piece, the loads induced through
the spine to the force plate will be recorded.
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4. Lumbar spine procedures
a. Procedures performed in the Relative Mode require no accessories and can be
performed as typically used clinically (avoiding any table contact as in #2 figure 8b
above).
b. Procedures performed in Accurate Mode require use of the accessory barrier and
artificial shoulder features. Users typically feel awkward, at first, in a fashion similar to
learning any new technique. Most are able to accommodate and quickly become
capable of providing reproducible results.
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Biomechanical Reference Frames:
Figures below display the definition of the reference systems assumed based on the force plate table
versus those that move as the mannequin or surrogate patient changes in posture on the table occur.
Reference frame naming conventions used in the system follow those recommended by the
International Society of Biomechanics (Journal of Biomechanics 35, 2002 p 543–548) for the spine and
by AMTI manufacturer for the force plate. Instructions in this manual speak of body-fixed [BF] (Figure 9)
reference frames or force-plate [FP] (Figure 10) reference frames explicitly.
[BF] is always with respect to a person’s anatomical rest position:
[BF]= X+ from posterior to anterior, Y+ toward the head, Z+ toward the right side of the body
It is located, by the user, at the location (joint/structure) of interest.
Figure 9:
Y+ = Cephalad
[ BF ]
X+ = Anterior
Z+ = Right
[FP] is always from the perspective of standing at the foot of the table:
[FP] = X+ to your right, Y+ toward the foot of the table, Z+ toward the floor
Figure 10:
[ FP ]
X+
Y+
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Navigating FSTT™ Software.
Opening the program (Figures W1 to W4)
Double click on the software icon “FSTTv#*******”. The “******” is the abbreviation for your
institution’s name. The Welcome Screen will appear.
Figure W1: Welcome Screen
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Figure W2: Use the “File” drop down menu to exit the program.
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Figure W3: The “Help” drop down will link you with contact information if you have questions.
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Figure W4: To get started, go to the “Select Program” drop down menu and click on either the
“Single Event” or “Multiple Event” operational options.
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Multiple Event Recordings: (Figures M1 to M16)
Figure M1: Opening Screen - The system will open with the last settings as default. Therefore,
the first time you open the program there is no default and the screen will look like the one
below.
File handling
Setting Controls
Manual curse, magnification controls
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Figure M2: After setting up and recording a series of procedures, the screen will look something
like that below.
Direction pane.
Target corridor
panes and controls.
Autocursed critical
points.
Descriptive
variables panes.


“Recording Window”: Enter the duration of time you wish to record in seconds. Can be changed
at any time.
Open the “File” control drop-down menu.
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Figure M3: File Drop Down Menu – 4 options; 1) Open existing file, 2) Export current data, 3) Switch
application to Single Event Recording, 4) exit
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Figure M4: File Drop Down Menu – 4 options; 1) Component Analyzed, 2) Component(s) Displayed, 3)
Procedure Type, 4) Maneuver, 5) Set Reference Frame (only on versions 1.2 and above).
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Figure M5: “Component Analyzed” - Indicate the load component on which you wish the system to
automatically define (e.g. autocurse) characteristic parameters when reporting.
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Figure M6: “Component(s) Displayed” - Load component display: Enter the one or more load
components you wish to display [Fx, Fy, Fz, Fmagnitude; Mx, My, Mz, Mmagnitude].
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Figure M7: “Procedure Type” – Select the procedure type you wish to have recorded.
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Figure M8: “Maneuver” – Select the maneuver descriptors of the procedure type (e.g. HAM™ or
surrogate patient orientation/posture, body region, procedure name.) from the sequential drop down
menus.
Cervical options are shown. Naming is customized per customer request prior to shipping the system.
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Figure M9: “Maneuver” – Cervical options are shown. Naming is customized per customer request prior
to shipping the system.
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Figure M10: “Maneuver” – Lumbar options are shown. Naming is customized per customer request prior
to shipping the system.
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Figure M11: Note that changing the “Maneuver” is linked to matched labeling on the direction pane.
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Figure M12: Setting of the Target Bands can be achieved at any time.












Select the body region and procedure name from the drop-down menu.
Set the value for target band values to define the corridor of target performance that you wish
the learner’s effort be compared against. (1 to 3 bands are permitted. Default values are 0,0)
Select “Start” and begin recording. Allow 1 second before initiating procedure performance. The
system will zero the force plate and then begin recording. Repeat as many procedures as you
wish during the selected time interval.
On completion of the selected time, the program will display the procedures performed, the
comparison bands.
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Figure M13: (Versions 1.2 and above) “” allows you to elect display of the outputs in either “Body Fixed”
reference frame orientation or in “Native Forceplate” frame orientation.


“Body Fixed” orientation: Displays the direction of the force vectors parallel to the
standard “[BF]” reference frame as described in Figure 9 of the “Biomechanical
Reference Frames” of this manual and are consistent with the positioning you input
under the “Maneuver” settings.
“Native Forceplate” orientation : Displays the direction of the force vectors parallel to
the preset directions built into the force plate “[FP]” as described in the “User Input to
the Accurate Mode” section of this manual.
The selection of display orientation will persist through out your recording session and will be the
definition of any data saved/exported to file on your computer. The selection also appears in the
“Current Settings” box as a reminder.
Set Reference Frame
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Single Event Recordings: (Figures S1 to S11)
Figure S1: Opening Screen - The system will open with the last settings as default. Therefore,
the first time you open the program there is no default and the screen will look like the one
below.
File handling
Setting Controls
Manual curse, magnification controls
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Figure S2: The screen is divided into display sections and control sections.
Characteristic Values
Report Pane
Direction Pane
Current
Settings:
Defaults to
last session
Force Components
Pane
Select
“Autocurse”
component: Can
be changed any
time.
Moment Components
Pane
Start recording:
1) Will prompt for manual “zero” of force
plate (button on the amplifier).
2) Prompts to preload the HAM™ or
surrogate patient.
3) Hit “Record”
4) Prompts procedure delivery with a
“chime”.
5) Recording will occur based on preset
window duration.
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Run “Autocurse”:
Select after
recording the
procedure.
Export Data: Will prompt for file
name.
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Figure S3: File handling choices – 1) Open existing file, 2) Export data to new file, 3) Toggle
Switch to Multiple Event Program, 4) Exit
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Figure S4: The ”Settings” drop down menu provides for selection of 1) Mode
(Relative/Accurate), 2) Recording Window length (secs), 3) Display Options, 4) Procedure type,
5) Maneuver, and 6)Load Transform Properties (Only if Accurate Mode is selected.)
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Figure S5: Mode Select drop down menu – Relative mode or Accurate mode. The relative mode
allows comparisons from one procedure effort to another. Forces reported are very close to
those at the target site. Moments, however, will be amplified by the moment arm to the force
plate and other inertial loading factors. They will still be useful for comparing the same
procedure by the same operator to the same or similar subject from time to time, on a relative
basis.
The Accurate mode requires additional information that is input through the “Load Transform
Properties” screen and corrects for the moment arm effect. (See pages 45 -49)
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Figure S6: Setting the recording window length in seconds is done by using the drop down
menu from “Settings” and then entering the desired window length in seconds to the pop-up
window.
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Figure S7: “Display Options” allows you to select one or more of the force components and / or
the moment components to be displayed.
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Figure S8: “Procedure Type” allows selection between high velocity, low amplitude;
mobilization or other types of procedures.
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Figure S9: “Maneuver” allows you to set the HAM™ or surrogate patient orientation/posture,
region of procedure and name (based on your instructions prior to shipping the system).
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Figure S10: Setting the posture and the region will link automatically to the labeling of the
Direction Pane.
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Figure S11: “Load Transform Properties” - Upon selection of the “Accurate Mode” from the
drop down menu, the linked screen to upload measures related to the location and orientation
of the target site is activated.
See the section on “Defining Target Joint Position and Orientation for ‘Accurate Mode’
estimates” below for how to obtain the appropriate information.
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Accurate Mode Measures
Defining Target Joint Position and Orientation for “Accurate Mode”
estimates.
The default position and orientation are [0,0,0] and [0,0,0] respectively. This makes the default
equivalent to the Relative Mode.
It is recommended that the target joint position be defined as the position of the joint with respect to
the [FP] after the clinician has positioned the patient in preload prior to application of the treatment
force. The clinician holds the preload position as the measures are taken before proceeding with the
treatment effort.
User input to the Accurate Mode – defining surrogate patient/mannequin posture
The FSTT™ system defines the starting position for a treatment procedure as being the Preload.
Figure AM1 displays the reference landmark of the table from which distance measures should be
entered. Enter the measure in centimeters along the axes of the [FP] reference frame. Remember that
[FP] is always from the perspective of standing at the foot of the table:
[FP] = X+ to your right, Y+ toward the foot of the table, Z+ toward the floor
Figure AM1: Force plate laboratory/global reference frame measure origin
When standing at the foot of the
table, the corner of the force plate
closest to you and on your right is
defined (red circle) as the global
reference frame origin [FP] = [0,0,0].
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For example, Figures AM2a,b,c below demonstrates measure to a thoracic spine target.
Figure AM2a: X-axis = - x cm.
Figure AM2b: Y-axis = +y cm.
Figure AM2c: Z-axis = - z cm.
(Note: Enter the “-“ (minus sign) as noted above for correct orientation on the X and Z axes. The Y axis
input will prompt you to identify whether the measure is cephalic to the reference corner or caudal to it)
The correction factor for the accurate (see the section on accuracy and error sources) estimates is now
set as (x,y,z) position and (0,0,0) orientation. To correct the orientation in the thoracic spine, assuming
no scoliosis, simply measure the angle of the curvature of the kyphosis at the target site. If < 10 degrees,
it will make only a negligible difference. If greater, enter the value as the flexion/extension angle (Figure
S11). Be sure that you put in the proper orientation of “+” or “-“ for rotation about the [FP] X-axis. If
scoliosis is present in a surrogate patient, you might try to estimate lateral bending or rotation angles at
the target site from the curvature and rib hump, however, these will only be approximations. Unless
they are larger than 10 degrees, they are negligible.
Figure AM3 demonstrates the manner of evaluating the rotation during a lateral recumbent maneuver.
Depending upon your selection of patient positioning, you may find it more
accurate to measure at the site and enter that value; the difference between
the torso rotation above the site and below the site and enter that value.
Your selection of procedure and the nature of the biomechanical question
you wish answered will dictate which is the best estimate.
Figure AM3:
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Assembling for Lateral recumbent Accurate Mode
Lateral recumbent Accurate Mode measures are achieved through the use of three accessory
components: a) side barrier, b) artificial shoulder and installed c) seat belt. Figure AM4a and AM4b show
the assembled configuration. The purpose of these accessories is three fold; a) through the side barrier
and seat belt, to ensure stability of the HAM™ or surrogate patient while on the table for the procedure,
b) through the artificial shoulder, to ensure stability of the operator; c) to fully capture the loads acting
across the table surface; and, d) to ensure isolation of the force plate from redundant inputs as might
occur if the operator puts his/her hands on the HAM™ or surrogate patient’s shoulder instead of the
artificial shoulder.
WARNING: Attempting to conduct a lateral recumbent measure without use of all 3 accessory
components to ensure stability can result in loss of balance or fall. CMCC accepts no liability for use in
any manner other than described.
Side Barrier
Figure AM4a
Artificial Shoulder: Exact
shape varies depending
on table height.
Figure AM4b
Assembling the Side Barrier
The side barrier “L” shaped steel arm slips snugly into a rectangular slot towards the cephalad end of the
force plate. There are two barriers; one right and one left, identifiable by the lower leg of the “L”.
Properly fit, the lower leg points caudally.
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Assembling the Artificial Shoulder
The artificial shoulder comes preassembled with the exception of putting the threaded rod of the round
finial (“shoulder”) into the arm itself (Figure AM5). The arm has two hex nuts, one for each side of the
female fitting to lock it into place.
Finial (“shoulder”)
Threaded rod
Press these levers
independently to adjust the
angle of the arm “joints” so that
the finial is next to the
surrogate patient’s shoulder.
Arm
Figure AM5:
Figure AM6 shows the lower end of the Artificial Shoulder. The “T” bars connect the actuators that allow
for arm repositioning. Figure AM7 demonstrates how the arm attaches to the base of the system.
Figure AM6
Figure AM7
Locate the rectangular female receiver attached to the central pillar support of the lower body support
and slide the fitting into it. A separate quick-release pin slips through the opening to anchor the base
rigidly.
Positioning for Lateral Recumbent Accurate Measure
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Figures AM8a and AM8b demonstrate a positioning of a surrogate patient for a lateral recumbent,
accurate mode measure.
Figure AM8a
Figure AM8b
Gap
As noted in the section on Error Sources, there should be no additional contact with the force plate
sensor (including the side barrier) other than the HAM™ or surrogate patient’s body. The gap between
the operator and the side barrier is indicted in Figure AM8A by the red arrow.
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Seated Maneuvers
The FSTT™ is capable of conducting measures of seated maneuvers as an example of alternative
applications. While it is technically feasible to do so in the Accurate Mode, the Relative Mode is likely to
be the more useful as there are no studies on the biomechanical contributions of upper body inertial
effects on measures. On the same basis as the explanations under Relative Measures, seated cervical
maneuvers can be compared from one time to another.
To achieve this, a surrogate patient is seated on the thoracic cushion with the accessory side barrier in
place and acting as a back rest. Figures SM1 and SM2 demonstrate positioning for maneuvers performed
from the front and from the back.
Figure SM1
Figure SM2
Once again, is important that only the surrogate patient’s body be in contact with the thoracic cushion or
the side barrier.
Cleaning and Maintenance
The FSTT™ system is not designed for routine exposure to bodily fluids other than healthy skin oils or
exhaled breath. Periodic cleaning of the table is recommended following good hygenic practice. CMCC
accepts no responsibility for the user’s failure to maintain a hygenic condition or environment.
Vinyl covering materials may be generally maintained with use of warm water. For spot cleaning of general
surface areas, use Windex™ followed by a light coat of baby oil rubbed into the whole surface using a soft
cloth.
For sensitive surfaces more susceptible to saliva, condensation of breath or nasal secretions, an
antimicrobial soap in diluted solution is recommended. For the upholstered surfaces, this should then be
followed by Windex™ and baby oil rub.
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Other components of the FSTT™ or HAM™ do not require routine maintenance. Consult the warranty
materials for details related to any component.
On-Line Version of Manual & Video of in-classroom use
Contents of the manual may change without notice. For a most recent version of the manual, you can
down load it from the CMCC website at http://www.cmcc.ca/fstt.
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Warranties
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Innovations in Education - Canadian Memorial Chiropractic College

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