PRONE STANDER Use r s Manual 1 TABLE OF CONTENTS Preface Precautions Required Tools Components Assembly Fitting Instructions Adjustment Overview Adjustments Options Prone Neckrest and/or Shoulder Pads Outriggers Placing Child in the Stander Maintenance 3 3 4 4 5-9 10 11 12-15 16-18 16-17 18 19 19 2 PREFACE: These pages provide information to professionals for the set up and use of the Prone Stander. The Mulholland Standing Systems are designed to provide individuals requiring prone, vertical, or supine standing, precise postural control at the upper trunk, pelvis, knees and ankles. All standers adjust from prone to vertical to offer therapists the opportunity to provide graduated weightbearing to promote more normal tone distribution and stability, and selective extension of the spine. Standers also stimulate head-righting, weight-bearing on the forearms and mid-line hand use. Standing provides an additional opportunity for peer socialization and interaction, and upper extremity activities should be an integral part of the standing program. PRECAUTIONS: Standing should always be prescribed by the child's physician with recommendations for the duration, frequency, and contraindications.The standing program should be closely monitored by the child's therapist. USE OF THE STANDER SHOULD BE UNDER DIRECT ADULT SUPERVISION AT ALL TIMES. 3 REQUIRED TOOLS: Tape Measure Allen Wrenches (3/16 , 5/32 ) (Included in tool pouch) COMPONENTS: Refer to Figure 1. 1. Tray 2. Sternum Rest 3. Trunk Support 4. Hip Support 5. Knee Blocks 2 1 3 6. 7. 8. 9. 10. Column Foot Supports Base Pitch Bar Tray Support Bars 4 10 5 9 6 7 8 4 PRONE STANDER ASSEMBLY: 1. Unpack and unwrap all of the parts. 5 2. Slide the Knee Blocks on to the bottom of the main column and secure it into place with the push pin. Slide the Foot Support on to the bottom of the main column and secure it with the push pin. 3. Lay the column down flat, and insert the bottom of the column into the bracket on the base, until the end of the column is flush with the far side of the bracket. Tighten the allen screws. 6 4. Pivot the column upright and insert the pitch bar from the column in to its corresponding piece from the base. Secure in place with the push pin at the desired pitch angle. 7 5. To attach the tray, insert the two short black bars in to the slots on the sides of the column. 8 6. Place the corresponding holes under the tray inside the ends of the bars, and secure the tray support arms onto the pitch bar with a push pin. Secure the tray onto the column by placing the silver safety pin(a) into the short black bar that has the appropriate hole. a 9 FITTING INSTRUCTIONS: The following measurements are required prior to fitting the Prone Stander: 1. Heel to iliac crest: This is the measurement to the top of the hip support. ____ 2. Groin to mid-scapula: This is the measurement to the top of the trunk support. ____ 3. Floor to mid-knee: This is the measurement to the middle of the knee support. ____ 4. Hip width: This is the measurement of the width of the Hip Support. ____ 5. Trunk width: This is the measurement of the width of the Trunk Support. ____ 6. Leg length discrepancy: The amount of distance that the individual foot support must be lowered on the longer side. ____ 10 ADJUSTMENT OVERVIEW: The separate and combined adjustments are critical to the effectiveness of the Prone Stander. The therapist is encouraged to try various adjustment combinations to find the optimal position for weight-bearing, tonal balance and head-righting. It is further recommended that an on-going adjustment schedule be identified to meet the needs of physical growth, reduction or increase in postural support and weight bearing activities. Column Tilt (Pitch): Affects the child's orientation in space, postural tone and distribution of weight. Hip and Trunk Supports: Provide not only lateral, but also anterior/posterior support. Although the hip support should always be snug, the trunk support can be graded to allow for lateral movement as the child acquires increased trunk control. Knee Supports: Knee blocks provide not only anterior support, but can also change in angle to accommodate flexion at the knees. Foot Supports: The Full Foot Plate was designed for a level weight bearing surface. The 5-Way Adjustable Shoe Holders can accommodate anterior/posterior adjustment, leg length discrepancies, plantarflexion/dorsiflexion, and rotation. The 6-Way Adjustable Shoe Holders do all of the above, plus pronation/supination Tray Height: Tray height adjustment can provide an upper extremity weight-bearing surface (to assist with head control), and a surface for activity placement. 11 ADJUSTMENTS : Note: The adjustments for height are made with the hip support as the stationary mid-point. All adjustments are made up or down from this point. Removal of the tray is necessary to make the adjustments. NEVER MAKE THESE ADJUSTMENTS WITH THE CHILD IN THE STANDER! Trunk Support: Pushing in on the push pin (A), pull the pin and move the upper column up to the desired distance from the hip support. Replace the pin. Remove pin (B) and adjust the height of the sternum support to fit to mid sternum. This is not a chin rest! Replace the pin. Pitch: Remove the push pin (C) while holding on to the upper portion of the stander. Slowly move the stander to the desired pitch and replace the pin. Hip and Trunk Support Widths: (You may need to loosen the straps to increase the width.) Loosen the black inside knobs (D) and slide the bars to the appropriate width. It is very important to make sure that the outsides of the bars are an equal distance from the mid-line of the column. If they are not, the child may not be weight bearing evenly. Tighten the knobs and re-velcro the inside strap. This will be adjusted later as part of the "fine tuning" while the child is in the stander. Complete this adjustment for both the upper and lower supports. Tray Support: Adjust the angle of the tray by removing the push pin, while supporting the front of the tray, and lifting or lowering the tray to the desired angle, then replacing the pin. 12 D B A C 13 14 Adjustable Knee Supports: a) Angle: Loosen the allen screws (A) and tilt to the appropriate angle to support the knees. Retighten. b) Width: Loosen screws (A) and slide to the correct width to assist in alignment of the lower extremity. Retighten. c) Height: Small height adjustments can be made by loosening the single lever screw (B) and moving the knee pad on the vertical post. d) Depth: Loosen the single lever screw (C), place the Knee Block at the appropriate depth, and retighten. Foot Support Adjustments: a) Footplate. Height: Release the push pin (D), and adjust the height. b) 5-Way & 6-Way Foot Supports: 1) Height: Release the push pin (D), and adjust the height. 2) Leg length discrepancy: Lower foot support to accommodate the lower leg by releasing the push pin (D) and placing it at the appropriate height. Then unscrew the side with the shorter leg and adjust accordingly. 3) Abduction: Loosen the screws under the shoe holders (E) and adjust the width between the shoe holders. Note: Excessive abduction may cause increased weight-bearing on the medial borders of the feet. 4) Plantarflexion/Dorsiflexion: Loosen the same screws as for abduction (E) and adjust. 5) Rotation: Loosen the nuts under the shoe holders and pivot. 6) Inversion/Eversion: Loosen the allen screws (F) and adjust the angle. Retighten. 7) Pronation/Supination: Loosen the same screws as for Inversion/Eversion (F) and adjust. c) AFTER ADJUSTING FOOT SUPPORTS, RECHECK TO MAKE SURE THAT ALL OF THE SCREWS HAVE BEEN TIGHTENED. An appropriate fitting is that which supports the child securely and promotes symmetrical weight-bearing. B A C F D E 15 PRONE STANDER OPTIONS: Prone Neckrest and/or Shoulder Pads: 1. Assembly: a) Mark the position of the foot and knee supports and then remove them from the main column. To remove the foot supports, first remove the column from the base. To do this, unscrew the two screws on the base bracket that hold the bottom of the man column, and gently pull them apart. Then pull out the push pin and slide the foot support off the column. To remove the knee supports, do the same, as well as loosen the two allen screws securing it in place. b) Slide the mounting support tube (A) into place, with the tube sticking out backwards between where the knee blocks go. c) Reattach the knee and foot supports to their original positions. Then replace the main column into the bracket on the base, and secure it in place by tightening down the two screws. d) Attach the remaining segments to the mounting tube e) Measure the height to the top of the child s shoulders and then to the mid ear. f) Adjust the height of the shoulder pads to the height of the top of the shoulders, and the middle of the neckrest to the mid-ear height, using the foot supports as the baseline. 2. Fitting: a) Remove the mounting by pulling out the push pin (C). b) Place the child into the stander (follow the instructions). c) Release the shoulder pad pivots by pulling the ring back to release and swing open (pointing away from 16 the column.) d) With the child in the stander, slide the mounting column (B) onto the horizontal tube (A) close to the child and reinsert the push pin. e) Adjust the depth of the neckrest by releasing the two allen screws that attach it to the vertical mounting bar. f) Adjust the depth of the shoulder pads: 1) Loosen the front retainer ring (D) to allow adjustment. E 2) Loosen the rear index clamp (E) and move the shoulder pads in place to provide the appropriate D amount of anterior support. 3) Tighten the index clamp (E), making sure that it is aligned so that the shoulder pad will lock in two positions: set and B out-of-the-way. 4) Tighten the inner retainer ring (D) to provide enough tension to allow the pivot to lock into place. C A 17 Outriggers: Attach the two Outriggers on the base with the push pins above the base. Place them approximately in line with where the child s center of gravity will be. Tighten the two allen screws on each to secure into place. Note: The Outriggers can be flipped upright to keep them out of the way when not in use. 18 PLACING CHILD IN THE STANDER: 1. Always lock all four casters before putting the child in the stander. This is done by stepping on the lock levers. 2. The child's therapist should identify whether or not one or two people should be required for the standing transfer. 3. Placing the child's feet on the foot supports, slowly lift him/her into the stander, fastening the hip straps first, then the trunk straps. After checking for proper alignment and weight bearing, fasten the buckle straps on the hip and trunk supports, the foot supports, and the knee straps. 4. The child should be directly supervised at all times. 5. Provide a table or socialization activity while the child is standing. 6. Observe closely for signs of fatigue, distress or discomfort and remove the child within the prescribed period. MAINTENANCE: 1. Keep the stander clean. The metal and plastic parts can be washed with a mild concentration of dish soap (the same as you use on your dishes). Rinse with water and dry. Wipe down all of the upholstered parts with a damp cloth. 2. Check weekly for frayed straps and Velcro. For the child's safety, discontinue use of the stander until worn Velcro and straps are replaced. 3. Periodically check for loose screws and tighten them as needed. 19 839 Albion Ave P.O. Box 70 Burley, ID 83318 Phone: (208) 878-3840 (800) 543-4769 Fax: (208) 878-3841 20 info@mulhollandinc.com www.mulhollandinc.com ...