JAECO/Rancho MultiLink Mobile Arm Support (MAS) System Instructions for Setup and Functional Adjustments June 11, 2004 Funded by National Institute for Disability & Rehabilitation Research (NIDRR) Developed by Rehabilitation Engineering Research Center on Technology for Children with Orthopedic Disabilities Rancho Los Amigos National Rehabilitation Center Distributed by JAECO Orthopedic (501) 623-5944 info@jaeco-orthopedic.com
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How to Use this Manual This manual is divided into 3 major sections: o Basic Setup o Basic Adjustments o Special Circumstances and Alternatives Follow the step-by-step written instructions as you assemble and adjust the MultiLink Mobile Arm Support for the first time because useful notations and suggestions are included. The separate sheet showing Components, MAS Mount, and Offset Swivel with Adjustable Slide Attachment is a quick reference sheet for names of parts. It would be helpful to use it as you read the manual and begin setup and adjustments. The last section Special Circumstances and Alternatives shows alternative setups for common problems. o For those new to MAS setup, refer to this section only after attempting the standard setup in order to simplify instructions. o For persons experienced in MAS setup and adjustments, reviewing this section before attempting MultiLink setup and adjustments might provide problem solving ideas. Use the Table of Contents to find specific topics or problem areas. If problems are encountered, contact Jaeco Orthopedic: Email: info@jaeco-orthopedic.com; Fax: (501) 623-0159; Phone: (501) 623-5944
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Table of Contents Title Sheet..... 1 How to Use this Manual 3 Table of Contents.... 5-6 Basic Setup Instructions for the JAECO/Rancho MultiLink MAS System.... 7 Components........ 8 Assembled MultiLink MAS Photo (Right side)...... 9 JAECO/ Rancho Mount Setup.... 10 Important Information Identify Parts of the Mount (drawing) How to Attach the MAS Mount... 11 Prepare the Mount Attach the Mount Position the Mount Tighten the Clamp Screws Use of the Locking Set screws How to Level the MAS Mount........ Use of the Bubble Level How to Set Up the Forearm Support...... General Information Attach the Offset Swivel/ Adjustable Slide to the Forearm Support Drawings of the Offset Swivel and Adjustable Slide Balance the Forearm Support (Use the Adjustable Slide) How to Assemble the MultiLink MAS System (Left side).... 14 How to Assemble the MultiLink MAS System (Right side)..... 15 Basic Adjustments for the Functional Use of the MultiLink MAS..... Recommendation.... Note Horizontal Movements...... Medial-Lateral/ Side to Side Movements (Scroll Wheel A) Anterior/Posterior or Forward/Return Movements (Scroll Wheel B) Check for Clearance Use of the Horizontal Stop collar Document Functional Working Range Vertical Movements.... Check Alignment of the Offset Swivel Hand to Mouth Movements Use the Adjustable Slide to Assist Hand to Mouth Movements Use of the Down Stop Finalize the Settings Check Overall Setup Secure the Settings Mark the Settings How to Remove the MAS for Transport. Special Circumstances and Alternatives (see next page) 12 13 17 18 18-21 22-24 25 25 5
Special Circumstance and Alternatives......... 27 MAS Mount Attachment Problems.... 28-31 Alternative Mount Attachment If Proximal Shaft hits W/C armrest If the Mount is too Low If the Mount is too High If Cannot Align with W/C Armrest If W/C Upright is not Tubular or if Positional Problems Adapters/ JAECO Relocators Problems with Clearance of Offset Swivel Stem or Elbow Dial... 32 Problems with Doorway Clearance 33 Retracting Proximal Link Horizontal Stop (Disabling the Horizontal Stop) Mount at an Angle Problems Operating the Wheelchair Joystick Controls While Using the MAS 34 How to Attach the Offset Swivel with Adjustable Slide to the Forearm Support 35 Care and Maintenance (Instructions for the Therapists)... 36 Care and Maintenance (Instructions for the Families) 37 Components (Use as reference sheet while setting up the MultiLink.) Mount/Offset Swivel Assembly Diagrams (Use as reference sheet while reading manual) 6
Basic Setup Instructions for the JAECO/ Rancho MultiLink MAS System Identify Parts Attach the MAS Mount Level the Mount Balance the Forearm Support Assemble the MultiLink MAS System 7
1. 2. 3. 4. 5. 6. 7. 8. 9. Components of the JAECO/Rancho MultiLink MAS System (Make sure you have all these items in order to begin setup.) MAS Mount (attaches to the wheelchair) Proximal Shaft (2a) with a removable Bubble Level (2b) (Shaft secures the MultiLink; the Bubble Level is used to neutrally balance all JAECO mounts) MultiLink (comes in 2 lengths: standard 20 & longer 24 ) Horizontal Stop collar (controls lateral motion and adjusts height of the MultiLink) Offset Swivel with Adjustable Slide: Offset Swivel (5a), Down Stop (5b), Stem with Stem Collar (5c), and Slide Saddle (5d). (for pivotal and height adjustments) Rail for Adjustable Slide (comes attached to underside of Forearm Support) Forearm Support with Elbow Dial T-Wrenches: large (5/32 ) & small (3/32 ) Flat head screwdriver (not provided) JAECO Mount Adapter or Relocator is needed if the wheelchair upright is not tubular or ¾ to 1 in diameter (Must be ordered separately; not included in photo below. Refer to Special Circumstances and Alternatives section.) 2b 5d 7 5b 2a 6 5a 5c 3 4 1 8 9 8
Assembled JAECO/Rancho MultiLink MAS (Right side) This is how the right side JAECO/ Rancho MultiLink MAS will look when assembled. The MAS Mount (#1) will be attached to the wheelchair. Please follow the step by step written directions provided in order to assemble. This system can easily be converted to a Left side system. (Refer to instruction manual) 2 1 5b 7 4 3 5a 5c 5d 6 9
Important Information: JAECO/Rancho MOUNT SETUP The MAS Mount can be directly attached ONLY to a tubular wheelchair upright (back post) which is ¾ to 1 in diameter. If the wheelchair upright is not tubular or is a different diameter, an adapter or a JAECO Mount Re-Locator is needed. If the wheelchair upright is angled beyond 20 degrees (as for a person sitting semi-reclined), a recliner adapter is needed. The appropriate adapter or Mount Re-Locator is needed before setup is attempted. These must be ordered separately. See Special Circumstances and Alternatives section. Identify Parts of the Mount: The same Mount can be used for either the Right or Left side by simply inverting the mount; no re-assembly is necessary. Recommended setup: Clamp Screws should be facing toward the front of the wheelchair and Lock Knob A toward the back (as shown below). View from Above LEFT Side (Front of wheelchair) RIGHT Side (Front of wheelchair) 10
1. Prepare the Mount: Right Side (view from above) LOOSEN (but DO NOT REMOVE) Clamp Screws on the MAS Mount; use the large T-wrench. OPEN JAW CLAMPS just wide enough to slide the Mount onto the wheelchair upright. The jaw clamps can be opened to its widest position by pushing the movable jaw forward and outward (see diagram on right). Back of wheelchair Front of wheelchair 2. Attach the Mount to the tubular upright post on the back of the wheelchair (W/C), with Clamp Screws facing front and Lock Knob A facing rear. Right Side, view from above Right side, view from side 3. Position the Mount: Initially attach the Mount so the top of the Mount is at the patient s mid-humeral level. (see arrow position at right) Position Scroll Wheel B parallel to (in line with) the wheelchair armrest. (see photo above) Refer to the Special Circumstances & Alternatives section if problems are encountered 4. Tighten the Clamp Screws firmly to secure the Mount to the W/C (DO NOT tighten the small locking set screws yet..see below.) Adjustments will be needed to achieve optimal functional use of the MAS. Use of the Locking Set Screws: Tighten the locking set screws only after evaluating and making adjustments for all desired activities. This might take several sessions. When satisfied with the finalized position of the Mount, then tighten the locking screws. It will pierce through upholstery and metal surface to maintain the desired Mount position. 11
HOW TO LEVEL THE MAS MOUNT: 1. Insert the Proximal Shaft with the Bubble Level through both the upper and lower ball bearing housings of the Mount. (The Proximal Shaft must always extend through both housings.) 2. Center the Bubble on the Bubble Level by manipulating the scroll wheels. a. Slightly loosen the Lock Knobs A and B just enough to easily move the Scroll Wheels A and B. (If too loose, it is more difficult to control the adjustments.) b. Turn the Scroll Wheels A and B so the air bubble is approximately centered (in or close to the center ring) to achieve neutral balance. Scroll Wheel A tilts the Mount side to side. Scroll Wheel B tilts the Mount forward and back. The Scroll Wheels can be turned individually or simultaneously. Note: The Bubble Level is used only to level the Mount and to achieve a neutral starting point for functional adjustments. (The Bubble Level can be removed from the Proximal Shaft if so desired after setup and adjustments are competed. Unscrew to remove.) 3. Tighten Lock Knobs A and B (turn clock wise) to maintain the desired position. (Tightening the lock knobs may cause the bubble to move from the center; do not be concerned.) 4. Remove the Proximal Shaft with the Bubble Level from the Mount. 12
HOW TO SET UP THE FOREARM SUPPORT: General Information: The MultiLink MAS is shipped with the slide rail already attached to the Forearm Support. The Offset Swivel is shipped with the Down Stop set for the Right side unless specifically ordered for the Left. Directions for converting to the Left is included in the Basic Adjustments section. If the Offset Swivel Assembly was ordered separately and needs to be attached to a Forearm Support, refer to the Table of Contents for specific assembly instructions. Attach the Offset Swivel / Adjustable Slide to the Forearm Support: 1. Loosen (but do not remove) the flat head screw on the distal (wrist) end of the Forearm Support. This screw attaches the Forearm Support to the slide rail. It needs to be loosened so the Slide Saddle can slide on to the Slide Rail. 2. Determine if setup is for Right or Left side. Position the Offset Swivel so it will be on the outside edge of the Forearm Support. 3. Press in the Slide Pin on the Slide Saddle. While holding the pin in, slide the Saddle on to the Slide Rail (bottom of the Forearm Support) from wrist end to elbow end. (see photo on right) 4. Release pressure on the Slide Pin; move the Slide Saddle until it clicks into a notch. 5. Re-tighten the flat head screw on the distal end of the Forearm Support. This will serve as a safety stop so the adjustable slide will not slip off during adjustments or use. Left Side Setup Right Side Setup 6. Balance the Forearm Support by moving the Adjustable Slide forward or backward to approximate midpoint. (see photo on right.) 13
HOW TO ASSEMBLE THE MULTILINK MAS Left Side Note: The same MultiLink can be used for the Right or Left sides.left side setup is shown on these diagrams. Simply invert (turn over) if needed for the Right side. 1. Position the MultiLink so the shortest link with the larger hole is proximal (closest to the shoulder or mount). 2. Insert the Proximal Shaft with bubble level all the way down into the hole in the proximal link. (If the Proximal Shaft does not easily insert, loosen the set screw on the outside of the proximal link.) 3. Tighten the set screw on the outside of the proximal link; this will secure the MultiLink to the Proximal Shaft. Note: The Horizontal stop is used to limit the patient s lateral (horizontal abduction) movement. Setting the stop will be explained later. 4. Slide Horizontal Stop collar up the Proximal Shaft; align the Stop directly under the proximal Link. 5. Loosely tighten the set screw on the Horizontal Stop to prevent it from slipping off. 6. Insert Proximal Shaft into the MAS Mount which should already be attached to the wheelchair. Note: Be sure that the shaft extends through both upper and lower ball bearing housings. Note: The Forearm Support should already be attached to the Offset Swivel and Adjustable Slide. If not, refer to the Table of Contents for assembly instructions. 7. Insert the stem of the Offset Swivel into the small hole on the distal link. 8. The MultiLink System is now assembled. 14
How TO ASSEMBLE THE MULTILINK MAS Right Side Note: The same MultiLink can be used for the Right or Left sides. Right side setup is shown on these diagrams. Simply invert (turn over) if needed for the Left side. 1. Position the MultiLink so the shortest link with the larger hole is proximal (closest to the shoulder or mount). 2. Insert the Proximal Shaft with bubble level all the way down into the hole in the proximal link. (If the Proximal Shaft does not easily insert, loosen the set screw on the outside of the proximal link.) 3. Tighten the set screw on the outside of the proximal link; this will secure the MultiLink to the Proximal Shaft. Note: The Horizontal stop is used to limit the patient s lateral (horizontal abduction) movement. Setting the stop will be explained later. 4. Slide Horizontal Stop collar up the Proximal Shaft; align the Stop directly under the proximal Link. 5. Loosely tighten the set screw on the Horizontal Stop to prevent it from slipping off. 6. Insert Proximal Shaft into the MAS Mount which should already be attached to the wheelchair. Note: Be sure that the shaft extends through both upper and lower ball bearing housings. Note: The Forearm Support should already be attached to the Offset Swivel and Adjustable Slide. If not, refer to the Table of Contents for assembly instructions. 7. Insert the stem of the Offset Swivel into the small hole on the distal link. 8. The MultiLink System is now assembled. 15
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BASIC ADJUSTMENTS for Functional Use of the MULTILINK MAS 17
BASIC ADJUSTMENTS FOR FUNCTIONAL USE OF THE MULTILINK MAS Recommendation: Develop an initial comfort level making scroll wheel adjustments without an arm in the MAS. With the MultiLink MAS System attached to the wheelchair, loosen both Lock Knobs A and B just enough to easily turn Scroll Wheel A and Scroll Wheel B. Turn Scroll Wheels A and B separately and also simultaneously. Observe how the adjustments affect the movement of the MAS. Return the Mount to neutral balance by using the Bubble Level. (see setup section) Note: Turning the Scroll Wheels tilt the MAS to help the person move in the direction that he/she is weaker. The person must have enough strength to move against the assisted motion. HORIZONTAL MOVEMENTS: Medial/Lateral (or side to side) Movements (use Scroll Wheel A): 1. With the person s arm in the MAS, passively move his/her arm as far as possible across the body and then out to the side. (Note: This defines the maximum lateral-medial reach area.) 2. Ask the person to actively move his/her arm as far as possible from side to side. 3. Observe active movements. Is motion in one direction greater or easier than the other? Consider the work area needed for task performance as you evaluate his/her range of movement. 4. Adjust for side to side reach. Loosen Lock Knob A and turn Scroll Wheel A in small increments in the direction you want to increase movement. (see photos on the right) Note: The weight of the person s arm must be supported under the forearm support in order to turn the scroll wheels. MAS mount tilted to assist reach across the body. Exaggerated for effect. 5. After each adjustment, ask the person to move his/her arm from side to side and re-adjust until you have the optimum range of movement for his/her needs. Repeated adjustments may be needed during the fitting process. Tighten the Lock Knob to secure the Scroll Wheel after each adjustment. MAS mount tilted to assist reach to the side. Exaggerated for effect. 18
Anterior/Posterior or Forward Reach/Return Movements (Use Scroll Wheel B): Scroll wheel B tilted to aid forward reach (exaggerated for effect). Scroll wheel B tilted to aid return motion (exaggerated for effect). Repeat previous steps #1-5 but for forward reach and return motions, using Scroll Wheel B. Adjustments made for one movement may affect the other. Repeat as necessary with both Scroll Wheels A and B to obtain the best adjustment for the person s functional needs. The goal is to achieve overall optimal functional range. Readjustments may be needed. Check for clearance. Does the stem of the Offset Swivel hit the wheelchair armrest and/or tabletop? If this is a problem, the forearm support may need to be raised by lowering the stem collar. Do this by loosening the set screw on the stem collar and reattaching it in a lower position. (see photo on right) The alternative suspension setup may be necessary. (see photo on right) Refer to the "Special Circumstances and Alternatives section for setup instructions. It may be necessary to re-adjust the height of the Mount. Refer to the Special Circumstances and Alternatives section if problems are encountered. 19
Use of the Horizontal Stop collar: The purpose of the Horizontal Stop is to limit the horizontal arm motion, especially if the MultiLink swings out to the side and the person cannot bring it back to the midline work area. How to Set the Horizontal Stop: (read each step) 1. If not already done, tighten the set screw on the proximal link of the MultiLink so it is securely attached to the Proximal Shaft. 2. Loosen the small set screw on the Horizontal Stop collar to allow free movement of the collar on the Proximal Shaft 3. Ask the person to actively move his/her arm as far to the side as possible while still being able to bring it back to the center. (If the lateral movement needs to be restricted, the horizontal stop function is needed.) 4. To set the Horizontal Stop, hold the proximal link of the MultiLink at the end range of the desired lateral movement. 5. Move the Horizontal Stop collar so the Horizontal Stop rests against the back Horizontal Stop Pin on the Mount at this established end range. (see photo at right) 6. Tighten the set screw on the collar in this position to set the Horizontal Stop function. 7. Check the position of the Horizontal Stop by asking the person to move his/her arm to the side. The person should be able to return arm to the midline work area. Note: If the Horizontal Stop function is not needed: The collar is still needed whether the Horizontal Stop function is used or not used; the collar allows the proximal link to clear the mount stop pin. Tighten the collar set screw with the Horizontal Stop directly under the proximal link so it does not hit the stop pin on the mount and interfere with the horizontal motions. (see photo) The proximal link can now be fully retracted, and it is easier to move through doorways. (see photo) 20
Document the Functional Working Range: It may help to mark these horizontal tabletop ranges for future reference and comparisons. Different colored marking pens can be used to record differences in range with and without the MAS or with different settings of the MAS. Indicate body midline with an X and use a dotted line for orientation of the paper for reference and comparisons. This dotted line indicates Body Midline Note: Forearm support is shown in suspended setup. 21
VERTICAL MOVEMENTS: Check Alignment of the Offset Swivel Pin; (Change position only if needed. In most cases, the manufacturer s setting will be adequate.): Note the recommended position of the Offset Swivel Pivot Pin in the photo on the right. Movement is easier if the Pivot Pin is slightly lower rather than higher than this mid-position. This mid-position usually allows easy pivoting motions without excess shoulder hiking. If the position of the Pivot Pin needs to be changed: 1. Remove the Forearm Support assembly from the MultiLink. 2. Detach the offset swivel from the L-bar. (Firmly hold the L-bar and press out the pin with your thumb(s). If difficult, remove the forearm support from the L-bar (remember to loosen the distal screw to slide off). Stabilize the inside pivot pin against a flat stable surface and press down on the L-bar. (see photos below). 3. Reattach the pin in the desired hole by firmly pressing pin into the hole. The Down Stop should be on the front side of the L-bar for Right side setup and rear of the L-bar for Left side setup. The Pivot Pin must be inserted all the way in. Pressing out pivot pin with thumbs Pressing out pivot pin against table surface Reattaching L-bar with Down Stop in front 22
Hand to Mouth Movements: 1. With the person s arm in the Forearm Support, passively move the person s hand from tabletop to his/her mouth. Can hand reach the mouth? Does the elbow dial hit the laptop or tabletop? (review check for clearance ) Is the person s elbow centered on the elbow dial when hand is near the mouth? Bend the elbow dial as necessary to center the elbow 2. Ask the person to actively bring his/her hand to their mouth. If he/she has difficulty, instruct the person to push down with his/her shoulder or to move their elbow down and inward toward their body. This causes the elbow to push down on the elbow dial and brings the hand to the mouth. Ask the person to relax the shoulder to bring the hand down to the tabletop. 3. Determine which motion is more difficult. 4. Adjust the Slide to Assist Hand to Mouth Movements: Note: During functional adjustments, it is not necessary to remove the person s arm from the forearm support. Bend the person s elbow so full arm weight is not on the slide mechanism, but on the elbow dial. Support the weight of the person s forearm with one hand under the elbow dial; move the adjustable slide with the other hand. Assist hand to mouth motions by moving the Adjustable Slide. (see photos below). Moving the slide toward the wrist usually aids the up motion. Moving the slide toward the elbow usually aids the down motion. Slide positioned so forearm Slide moved forward Slide moved back toward elbow support is balanced to aid the up motion to aid the down motion (exaggerated for effect) (exaggerated for effect) 23
5. Set the Down Stop: The Down Stop limits the downward motion and makes it easier for the person to bring their hand back up to their mouth. Loosen (do not remove) the set screw on the Down Stop to allow pivotal movement of the offset swivel. Note: The Down Stop Pin should not hit against the L-bar during up motions. If the Down Stop function is needed to limit the down motion: 1. Position the forearm support in the maximum down position desired, 2. Move the Down Stop until the Pin rests against the L-bar and blocks further downward motion, see photos below. (The stop will hit L-bar on top/front for the Right side setup and bottom/rear for Left side setup.) 3. Tighten the Down Stop set screw in this position to set the stop" function. Offset Swivel Assembly, Right Side Right side (close up, inside): Down Stop Pin rests against the top/front of the L-bar to limit the down motion Offset Swivel Assembly, Left Side Left side (close up, inside): Down Stop Pin rests against the bottom/rear of the L-bar to limit the down motion 6. Raise the Forearm Support, as needed: It may be necessary to raise the forearm support by moving the stem collar to a lower position. (Use the small T-wrench to loosen and re-tighten the set screw.) 7. Re-adjust the height of the MAS mount if necessary. (Refer to the Special Considerations and Alternatives section, if problems are encountered.) 8. Use a strap to secure the arm in the Forearm Support. 24
CHECK OVERALL SETUP: Again, observe the person s shoulders to be sure they are at a comfortable, level, resting position. (If the person is uncomfortable, MAS wear time and use will be limited.) Make re-adjustments as necessary to achieve normal shoulder height. (It may be necessary to lower the mount placement.) Refer to the Special Circumstances and Alternatives section if mount placement is a problem. SECURE THE SETTINGS: After evaluating the MAS use with a variety of functional activities, and when you are satisfied with the adjustments, make sure to secure the settings. Tighten the small Locking Set Screws on the MAS Mount to secure it to the wheelchair upright. The pointed end of these lock screws will pierce fabric and/or metal. Tighten ALL knobs and screws. MARK THE SETTINGS: Mark the settings when you are satisfied with the adjustments. Mark scroll wheels, mount position, stem position, etc. See photos below. When marked, it is easy to match up the marks and return to your desired settings if parts get out of alignment or moved. Correction fluid works well on the black for initial adjustments because it can be removed with a damp cloth. Nail polish can be used for a more permanent marking. Different settings might be desired for varied activities such as keyboard activity or feeding; markings can be color coded. Marks on the W/C upright and also on the mount make it easy to realign the pieces, if moved. Line markings on the forearm support or stem make it easy to find the correct position for various activities HOW TO REMOVE THE MAS FOR TRANSPORT: Lift the Offset Swivel stem up and out of the distal link. Lift the Proximal Shaft up and out of the Mount. (leave MultiLink attached to the shaft) Place the MAS parts in a protective bag to protect the black anodized covering from scratches. Leave the Mount on the wheelchair. 25
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SPECIAL CIRCUMSTANCES and ALTERNATIVES 27
SPECIAL CIRCUMSTANCES AND ALTERNATIVES MAS Mount Attachment Problems: Alternative Mount Attachment: Invert the mount (turn it over). Clamp Screws face toward the back of wheelchair and Lock Knob A faces front. Clamp Screws are easier to reach for tightening and adjusting in this position. LEFT Side View from Above RIGHT Side (Front of wheelchair) (Front of wheelchair) (Back of wheelchair) (Back of wheelchair) Depending upon location of the mount attachment, Lock Knob A might cause pressure against the back of the person s upper arm when their forearm is resting on the wheelchair armrest and not in the MAS. (See photo on right). If this occurs, do not use this setup. Alternative Mount Setup If this happens, use the regular Mount setup with the Lock Knob A facing to the back and the clamp screws facing to the front. This should make it more comfortable for the person when not using the MAS. 28 Regular Mount Setup
If the mount still rests against the upper arm, it can be mounted at an angle. Scroll Wheel A will no longer be just for Side to Side adjustments, and Scroll Wheel B will no longer be just for Forward/Return adjustments. Combined Scroll Wheels A and B adjustments will be necessary. If the Proximal Shaft hits the W/C armrest and cannot be fully inserted: Attach the mount at an angle as described above If the mount is too low: The MultiLink Arm can be raised slightly and secured by lowering the Horizontal Stop collar on the Proximal Shaft and re-tightening the set screw. Make sure that the set screw on the proximal link is tightened to secure the MultiLink to the proximal shaft. (This modification is not recommended for those with heavy arms or increased tone because of the added stress on the shaft and mount.) The shaft must protrude through the bottom ball bearing housing on the mount. o The person s arm can be raised to compensate for a low placed mount by elevating the forearm support. Lower the collar on the stem as shown in the photo and tighten the set screw. 29
If the mount is too high and can only be mounted above the person s mid-humeral level, the Multi-Link Arm may need to be lowered by using a suspension mode. For distal suspension: Insert the stem of the Offset Swivel from the bottom up and secure with the stem collar on top. If this setup is used, do not constantly remove the stem collar. It is recommended that the MAS system be kept as one unit if removed from the mount for storage or transport. As one unit, the MAS is less compact for fitting in a wheelchair backpack for transport but easier for setup. 30
If the mount cannot be attached with the Scroll Wheel A in line with the W/C armrest: It is possible to attach the Mount at an angle. Combined adjustments of the Scroll Wheels A and B will allow for Side to Side and Forward Reach movements. Scroll Wheel A in line with the WC armrest Mount attached at an angle Mount attached at an angle (top view) (top view) (front view) If the wheelchair uprights are not tubular or are set back too far or to compensate for MultiLink length or positional problems: Adapters and Mount Relocators are available through JAECO Orthopedic. MR-10 For tubular back posts MR-8 For Keyed back posts MR-10 For molded plastic or metal back rests View of keyed back post 31
Problems with Clearance of Swivel Stem or Elbow Dial: Suggestions if the elbow dial or stem hits the tabletop or MAS links: Raise the forearm support by lowering the stem collar on the offset swivel insert stem and tightening the set screw. Move the adjustable slide under the forearm support back 1 to 2 notches toward the elbow. This will only work if the person can still easily move their hand up and down after the adjustment. Try the alternative Suspension Set-up: 1. Remove the stem collar on the offset swivel. 2. Insert the offset swivel stem from bottom up. 3. Secure with the stem collar on the top. 4. Raise the Mount or MAS. 5. Readjust MAS as needed for optimum patient functioning 32
Problems with Doorway Clearance: (Suggestions to Decrease Lateral Protrusion of MAS) Passively retract the proximal link. This is only possible if the horizontal stop is not being used to restrict the motion. See below for disabling the Horizontal Stop. Proximal link retracted (top view) (full view) (front view) Disabling the Horizontal Stop: Make sure that the Horizontal Stop is positioned and secured where it will not interfere with motions (positioning the Stop directly under the proximal link usually works). Do not remove the collar. It is needed to allow the MultiLink to move over the stop pins on the mount. (see below). Without the Horizontal Stop function, the Proximal Link can be fully retracted, producing a more narrow profile as pictured above. Position the Stop directly under Without the collar, the proximal link Collar is needed for the MAS the distal link hits the mount stop pins, restricting motion. to clear the mount stop pins. Secure the MAS mount at an angle (slightly to the back); this may help reduce lateral protrusion. Leveling the Mount is slightly more difficult, requiring combined movements of Scroll Wheels A & B. Mount aligned with W/C armrest Mount attached at an angle (top view) Mount at an angle (front view) 33
PROBLEMS OPERATING WHEELCHAIR JOYSTICK CONTROLS WHILE USING THE MAS: Those with functional strength in their proximal muscles can usually operate the wheelchair joystick controls using the MultiLink MAS (i.e. those with Spinal Cord Injury, C5 muscle sparing). However, for those with weak proximal muscles (i.e. those with Muscle Disease), the MAS moves too freely for controlled wheelchair joystick operation. By using the following setup, many have demonstrated comfortable, controlled ability to drive their wheelchair and thus increase MAS wear and functional use time. 1. Maintain the proximal link in retracted position and 2. Stabilize the proximal link to the middle link (A velcro strap can be used to stabilize the MultiLink MAS in a retracted position. Assistance will be needed to stabilize the MAS for driving and to release it for activities.) 3. Lower the forearm to wheelchair armrest level (Use the distal suspension setup. See photos below.) 4. Elevate the MAS for tabletop and/or hand to mouth activities; this can be achieved by raising the Proximal Shaft and re-securing the Horizontal Stop Collar. Images not available The suspended setup is used to lower the hand for W/C joystick control. The Proximal Link Is retracted for less protrusion and more stability, especially for those with weak shoulder muscles. MultiLink is raised by lowering the stop collar on the Proximal Shaft. This allows easier hand to mouth motions. The MultiLink is mid-height level to allow MAS clearance for tabletop activities. 34
HOW TO ATTACH the OFFSET SWIVEL with ADJUSTABLE SLIDE to the FOREARM SUPPORT These instructions are included for use when the Slide and Offset Swivel do not come already attached to the forearm support, or if the therapist wishes to change the forearm support. Items needed: 1. Forearm Support 2. Offset Swivel with Adjustable Slide attachment 3. Adjustable Slide Rail 4. Flat head screwdriver (not included) Holes for Wrist/Hand Support on Forearm Support Offset Swivel with Adjustable Slide attachment Attach the rail to the bottom of the Forearm Support: Note: Rails come in two lengths for standard Forearm Support sizes. Large-10 inch & Extra Large-11 inch require the long slide rail. Small-8 inch & Medium-9inch require the short slide rail. For Forearm Supports shorter than 8 inches, custom sized slide rails may be needed. (The proper length will be sent along with the ordered forearm support.) 1. Remove the screws from the slide rail. 2. Place the rail (flat narrow side) against the forearm support. 3. Align the hole on the proximal (elbow end) of the forearm support with an end hole on the slide rail. Line up two holes on the forearm support and rail. 4. Tighten the proximal screw first. 5. Loosely secure, but do not tighten the distal screw yet. Attach the Offset Swivel attachment: 1. Hold the Offset Swivel attachment with the swivel on the lateral side (outside) of the Forearm Support. 2. Press in the slide pin. 3. Align the Slide attachment with the wrist end of the rail. 4. Slide attachment on to the rail from the front to the back (wrist to elbow end). 5. Release the slide pin and move until it clicks into a notch. 6. Tighten the distal screw to securely attach the rail to the forearm support. 7. Balance the Forearm Support: Hold the stem of the Offset Swivel with one hand; move the slide forward or back with your other hand to achieve balance. This will serve as the starting point for functional adjustments. 35
CARE AND MAINTENANCE OF THE JAECO/RANCHO MULTILINK MAS Instructions for the Therapists Maintaining the MAS Adjustments: Be sure the Mount is very firmly clamped to the wheelchair so it is not knocked out of position when the wheelchair is transported. Mark the position of the Mount on the wheelchair (correction fluid, nail polish, etc.) so the Mount may be returned to the proper position if it is moved. Be sure the Lock Knobs for the Scroll Wheels are tight. Mark the Scroll Wheel so you can return the adjustment to the desired position if it is moved by someone inadvertently. Caution caregivers to leave all adjustments as you set them and to return them to the marked positions if moved. You may want to instruct them in the adjustments or you may prefer to have the caregiver call you if adjustments are lost. Transporting the MAS: Leave the Mount attached to the wheelchair. Lift the forearm support from the MultiLink Arm and remove the MultiLink Arm from the Mount. Be sure to instruct caregivers to place the shaft of the MultiLink system completely through the Mount when replacing the MAS. They should also retain the position of the collar. The anodized surface of the MultiLink Arm will be scratched if it is placed near sharp objects. Suggest using a soft bag or wrapper for the MultiLink Arm during transport or when the MAS is not in use. Cleaning and Repairs: The MAS parts may be cleaned with a damp cloth, if needed. Do not immerse in water or other cleaning solvents. Do not oil bearings or other parts. Please do not attempt to disassemble or modify the Mount or MAS parts. Instruct Patient, Caretakers, and Family Members in the following (include observed practice sessions): MultiLink MAS: How to setup for various activities How to remove MAS How to protect for transporting Basic adjustments and what to do if it the MAS becomes out of alignment Care and Maintenance Instructions (Provide and Review Care & Maintenance Instructions for Families ; suggested form is provided.) Who to Contact for problems and feedback 36
CARE AND MAINTENANCE OF THE JAECO/RANCHO MULTILINK MAS Instructions for Families Setting Up and Removing the MAS: Practice setting up and removing the MAS while you are with the therapist. If the therapist marked the settings, be sure you understand the markings. Be sure the shaft of the MAS goes completely through the Mount before the MAS is used. Leave the Mount on the wheelchair at all times. When the MAS is not in use, you may remove the MultiLink and forearm support. Saving the MAS Adjustments: The therapist adjusted the MAS for function. Be very careful to keep these adjustments. Do not unlock or move the scrolls unless instructed by the therapist. If the Mount is knocked out of adjustment when the wheelchair is transported, try to return it to its former position, or call the therapist. If anything else changes the adjustment, report it to the therapist. Maintenance: The anodized surface of the MultiLink Arm can be easily scratched. Use a soft bag or wrapper for the MultiLink during transport or when it is stored. The MAS may be cleaned with a damp cloth. Do not immerse it in water; do not use abrasives, or chemical solvents on the MAS. Comfort: Be sure to tell the therapist if the shoulders become tired or sore because they are raised too much or if the forearm support becomes uncomfortable. The therapist may be able to make changes to improve comfort. Function: Tell the therapist about any problems using the MAS for activities. Try to remember what activities you tried to do and the height of the work surface. Problems: Report to the therapist immediately if the MAS isn t working well, is broken, or damaged. Try to remember what you were doing just before the MAS stopped working well. This may give important information to the manufacturer. Please return all parts to the therapist promptly. DO NOT oil or take apart any of the MAS components. Mobile Arm Support Use: You have received the newly designed Jaeco/Rancho MultiLink Mobile Arm Support. Your experiences and comments are important; please share them with your therapist and manufacturer. Occupational Therapist Phone I understand the care and maintenance instructions and procedures for the evaluation. Phone: Date: Family member/caregiver s signature 37
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Components of the JAECO/Rancho MultiLink MAS System (Make sure you have all these items in order to begin setup.) 1. MAS Mount (attaches to the wheelchair) 2. Proximal Shaft (2a) with a removable Bubble Level (2b) (shaft secures the MultiLink; the Bubble Level is used to neutrally balance all Jaeco mounts) 3. MultiLink (comes in 2 lengths: standard 20 & longer 24 ) 4. Horizontal Stop collar (controls lateral motion and adjusts height of the MultiLink) 5. Offset Swivel with Adjustable Slide: Offset Swivel (5a), Down Stop (5b), Stem with Stem Collar (5c), and Slide Saddle (5d). (Used for pivotal and height adjustments) 6. Rail for Adjustable Slide (comes attached to underside of Forearm Support) 7. Forearm Support with Elbow Dial 8. T-Wrenches: large (5/32 ) & small (3/32 ) 9. Flat head screwdriver (not provided) 2b 5d 7 5b 2a 6 5a 5c 3 4 1 8 9 39
JAECO/Rancho Mobile Arm Support (MAS) System MAS Mount (Right Side): (Front of Wheelchair) Offset Swivel with Adjustable Slide Attachment: 40