Otto Bock C-Leg 4 Certification Course Complete

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C-Leg 4 3C98-3/3C88-3

Certification course complete – V 1.6

Academy

| © Ottobock

Table of Contents

Summary of Contents for Otto Bock C-Leg 4

Page 2 Agenda 1. Introduction 2. Gait cycle 3. Component selection 4. Alignment and adjustment 5. Cockpit App 6. User instructions 7. Service and warranty concept 8. User training Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 3 • Furthermore, stance release and standing with a flexed knee are now a lot easier and therefore noticeably improve the user’s flexibility and freedom of movement Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 4 Enhanced safety • Easier use for user and CPO • Improved outcomes for user and CPO • Broader group of users • Maintain and improve proven C-Leg stability Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 5 Introduction Bluetooth Technology Battery / knee angle sensor Inertial Motion Unit (acceleration sensors and gyroscope) Main electronics Hydraulics Servo electronics Charging plug Tube clamp Tube stop Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 6 Inertial Motion Unit (IMU)  Linear accelerations  + velocities & distances  Orientation of shank in space  + angular velocities • No ankle sensor needed due to IMU Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 7: Technical Overview
Prox. 3C98-3: 5 mm time: (recommended to Prox. 3C88-3: 26 mm charge every night) IP67 Maximum user Water 136 kg / 300 lbs (weatherproof but not weight: protection: corrosion resistant) Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 8 Use fresh water and lint-free cloth and allow the components to fully air dry If the knee joint shows a malfunction after drying it must be inspected by an authorized Ottobock Service Center! Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 9 Introduction Technical overview Knee- extender Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 10 If an additional Protector or Guard are used at least 10 mm additional safety distance are needed! • When using a 4R57 rotation adapter take care that the push-button is positioned medially! Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 11 Technical overview – Comparison of build heights C-Leg 4: C-Leg: Min. distal Min. distal system height system height ≥ 289 mm ≥ 338 mm ∆ 49 mm Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 12 Very good support for slow and fast walking speeds  Adapts flexion resistances to different walking speeds  Adapts to changed parameters (e.g. shoe weight) Regulation of maximum flexion with a high accuracy! Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 13 Adapts extension resistances to different situations and walking speeds  Adjustable basic resistance for extension during slow walking  Minimal resistance when walking stairs and ramps (reliable foot positioning) Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 14 Flexion Locked  E.g. useful for standing possible joint in → no on ramps flexion stable • Manual Stance Function standing  Via motion pattern Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 15 Characteristics – Broader range of ADL’s • Sitting Function (low flexion and extension resistance) • Weatherproof (IP67, not corrosion resistant) • 2 additional MyModes for specific activities Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 16 Android compatible knee joints are marked by a “DUAL” logo right on the main electronics and a small line on the front of the main electronic housing Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 17 (by default always activated) • Posterior position for charging receptacle  Additionally protected by a cover • Normal tube adapter (34 mm diameter) without electronics (with / without torsion unit) Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 18 Characteristics – Improved outcome for user and CPO • Safety  Safe backwards walking  Enhanced stumble recovery  Easier stance release → smaller steps, sand… (real time control)  Adjustable safety mode Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 19 (→ response time = 0 ms!)  This results in enhanced stability on the prosthetic side  More time to shift body weight to contralateral side Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 20 Up to 136 kg (300 lbs) of body weight • Minimal installation height = 307 mm (using LoRider foot)  Shorter users possible  More functional feet possible Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 21 Introduction Combination with osseointegration implant systems • The C-Leg 4 can be connected to an osseointegrated percutaneous implant system • Take care that this combination has been approved by the manufacturer of the implant system and by the manufacturer of all the additional exoprosthetic components •...
Page 22 Agenda 1. Introduction 2. Gait cycle 3. Component selection 4. Alignment and adjustment 5. Cockpit App 6. User instructions 7. Service and warranty concept 8. User training Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 23 Stance phase Swing phase First double support Single limb stance Second double support Initial contact Mid stance Preswing Midswing Loading response Terminal stance Initial swing Terminal swing Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 24 Gait cycle Initial contact → Default Stance Double support • High safety at heel strike flexed Knee extended Ankle neutral GOAL begin stance Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 25 Knee flexing resistance Ankle slightly PF • Movement has to be controlled by the user GOALS weight acceptance, shock absorption, advance body over heel Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 26 → µP controlled extension Single support resistance extending • Automatically controlled Knee extending Ankle slightly DF resistance in real-time • Smooth extension stop advance body over stationary foot GOAL Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 27 → Switching from stance to Single support swing extending • Continuous monitoring of the gait Knee extended cycle Ankle dorsi flexed • Preparation for swing initiation GOAL advance body over forefoot Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 28 Finding the correct situation for switching is a safety issue and essential for a harmonic gait pattern. Too early Too late Knee may collapse Knee stays extended  user may fall  difficult hip flexion Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 29 Gait cycle Stance release • The C-Leg 4 monitors the gait cycle in real time • Stance release is independent of body weight changes and ground condition • Main criteria for stance release: Extended (hyperextended) knee joint Knee Forward inclination of the shank...
Page 30 There is the possibility that certain movements (e.g. during sports) can fulfill the necessary criteria for stance release • In such a case, C-Leg 4 will trigger stance release in basic mode If special movements lead to stance release (e.g.
Page 31 Gait cycle Preswing → Swing phase behavior Double support • Minimal swing flexion resistance flexing during swing initiation Knee flexing Ankle in PF prepare for swing GOAL Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 32 • Adaptively controlled swing Knee flexing flexion resistance Ankle in DF • Joint reaches the desired maximum flexion angle GOAL clear foot and advance limb Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 33 • The controls give comfortable damping characteristics • Adaptive compensation for different shoe weights Swing phase control C-Leg 4 Swing phase control of other knee joints Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 34 • Adjustable for slow walking speeds Knee extending (~ up to 2 km/h) Ankle in DF • Increased stance flexion resistance (stumble recovery) GOAL advance limb Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 35 • A increased flexion resistance is flexing Knee extending present (compared to the Ankle in DF adjusted flexion resistance) • Increased safety for the user (joint can be loaded!) GOAL advance limb Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 36 → Progressive µP controlled Single support knee extension flexed • Automatically controlled Knee extending Ankle neutral resistance in real-time • Smooth extension stop GOAL advance limb, initiate next step Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 37 Gait cycle Gait pattern on level ground Stance Release Stance flexion Adaptive swing (Consider the Joint extended possible phase control criteria!) 65° 0° Knee angle ° Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 38 Shoe construction (heel height and heel profile) • Fit of the socket • Previously used components (e.g. polycentric knee) • Individual skills An inappropriate static alignment can‘t be compensated for by the joint! Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 39 Agenda 1. Introduction 2. Gait cycle 3. Component selection 4. Alignment and adjustment 5. Cockpit App 6. User instructions 7. Service and warranty concept 8. User training Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 40 Long residual limb version  Knee joint 3C88-3 with screw top connector  Changes to prosthetic alignment are more difficult but shorter built-in length than regular version Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 41: Optional Components
646C107 Bluetooth PIN Card 647G1375-* Instructions for use (qualified personnel) 647H569* Instructions for use (user) 4X441-Andr=V* Cockpit App for download (Android) 4X441-IOS=V* Cockpit App for download (Apple) Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 42 System height of torsion unit = 40 mm • Caution: For adjusting the torque resistance of the 2R67 the mark on the adjustment screw must never be turned into the red zone 2R57 2R67 Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 43 Component selection Overview system height Distal system height ≥ 289 mm (without torsion) Distance knee ≥ 329 mm (with torsion) axis to ground System height foot Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 44 • E.g.: Triton Low Profile (size 24) → necessary distance = 331 mm • E.g.: Triton Vertical Shock (size 30) → necessary distance = 480 mm Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 45 4R119 4R170=1/2 4R84 manual The fitting instruction of each adapter has to be considered regarding fitting position that absolutely no collision with the knee or hydraulics occurs! Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 46 Allows the use of different prosthetic feet regarding the everyday situation • No tools necessary • Waterproof and corrosion resistant • Max. user weight 125kg / 275lbs manual Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 47 1C30 Trias 1D35 Dynamic Motion A complete list of all approved feet can be found in the IFU. manual Consider current restrictions regarding foot size and weight! Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 48 Component selection Suitable microprocessor controlled prosthetic feet 1B1-2 Meridium 1A1-1 Empower The C-Leg 4 can be combined with these µP-controlled prosthetic feet: Meridium and Empower. The current restrictions regarding foot size and user weight have to be considered! manual Certification course | C-Leg 4 | Global Academy | 25.09.2019...
Page 49 (64 Bit) and Windows 10 (32 / 64 Bit) 4X440=* • Automatic configuration of Bluetooth connection New: Automatic update 60X5 check (connect your PC regularly to the internet)! Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 50 Component selection Compulsory components Knee-Extender 4H105 for bench Siehe Gebrauchs- alignment (basic alignment) anweisung 4H105 Fitting of knee-extender on YouTube Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 51 Flexion stop 4H106 / 16° → restricts the max. flexion angle from 130°to 114° • The remote 4X350 is not compatible with the DUAL version of C-Leg 4 and thus the 4H95 remote is not available anymore manual 4X350 Certification course | C-Leg 4 | Global Academy | 25.09.2019...
Page 52 Dark Vulcano • Guard 4P862 • Exchangeable cover 4P863=* for Protective cover and Guard 4X860-* manual 4P863-* Video on YouTube about fitting the Protective cover 4P862 Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 53 Available in 3 colors • Not in scope of delivery Functional shank Functional Knee Part Please note the safety manual instructions as well as the assembly instructions in the manual Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 54 Guard or 4X156 & 4X158 the Protective cover • One-piece cosmesis (3S26) manual Video on YouTube about the adaptation of the extension cable 4X157 3S26 Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 55 Agenda 1. Introduction 2. Gait cycle 3. Component selection 4. Alignment and adjustment 5. Cockpit App 6. User instructions 7. Service and warranty concept 8. User training Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 56 Select a user or enter new user name • Choose a „New job“ • Click the „C-Soft Plus“ button • Enter username and Unlock-PIN • Start screen of C-Soft Plus appears Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 57 • Select foot type and foot size • System height of the foot is preselected • Select tube adapter type (with / without torsion) Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 58 (= MTP + 20 mm) • Note both cutting length and insertion length without shoe! Use estimate of possible distance for knee disarticulation! Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 59 (measure from distal end) • Don‘t clamp the tube adapter into a bench vise without protection Tip: Mark the minimum and maximum insertion range on the tube! Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 60 Always smooth out the cut edge:  Sandpaper  Grinding machine  File  Deburrer (e.g. 718S2)  etc. Smooth the inner and outer cut edges thoroughly! Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 61 Pre-fasten both screws lightly at the clamp (only valid for the basic alignment, not for the static or dynamic alignment!) For safety reasons, always insert the tube at least to 40 mm! Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 62 Alignment and adjustment Switch on the knee joint • Connect the charger with the C-Leg 4 (mind plug polarity and that charger is completely plugged in!) • Verify the charging status via the feedback signals • After removing the charger the knee joint performs a self test (keep knee joint at rest)) •...
Page 63 When established, the connection icon is displayed in green (mouseover effect: showing serial number) • Confirmed by a flashing LED on the knee joint and a feedback signal Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 64 If several units are within range, they will all be displayed in a pop-up window • The serial number is provided on the inside of the frame Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 65 Entering the basic data in C-Soft Plus • This data is the basis for the prosthetic control and the alignment recommendation • Stance release only possible after data entry! Be precise! Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 66 • Body weight • Knee center to ground distance The described behavior isn’t a • Calibration CPO Video! malfunction of the C-Leg 4! Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 67 (IMPORTANT: choose the correct unit: kg or lbs) • Knee center to ground • Amputation level • Bilateral (check box) • Foot type • Foot size Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 68 Alignment and adjustment Entering the user data in C-Soft Plus • Limb/hip flexion contracture (determined via Thomas-test) • Effective heel height of shoe Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 69 Bring the amputated leg into hip flexion until the hollow of the back vanishes • Bring the residual limb carefully down until the lumbar spine lifts-off • Measure contracture in degrees Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 70 Draw a line through both points to the top of the socket • Find IT level and mark it on the line • Socket reference point = IT level + 30 mm Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 71 Plumb line / LaserLine • Also see alignment poster 646F219 For the bench alignment the knee-extender 4H105 has to be inserted to reach an overextended knee joint! Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 72 Higher knee extension moment More hip muscle effort needed to initiate swing phase A utilized knee-extender during alignment is essential for an optimal C-Leg 4 functionality! Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 73 Torque screw with 70 Ncm (0,7 Nm) → alternatively turn the screw with an allen CPO Video! key (size 4 mm) 10 full turns further Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 74 Alignment and adjustment Bench alignment: Knee-extender Before the user dons the prosthesis the knee-extender CPO Video! has to be removed! Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 75 Bench alignment with C-Soft Plus and assembly tool • Link to CPO videos • PRO.S.A / L.A.S.A.R Assembly • Alignment recommendation • Assembly without shoe Maintain the recommendations (via pyramid or additional adapters)! Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 76 Bench alignment with C-Soft Plus and plumb line • Plumb line / LaserLine • Alignment recommendation • Assembly with shoe + heel height (block height) Foot middle, not shoe middle is essential! Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 77 Necessary alignment optimizations (e.g. in case of a hip flexion contracture) have to be made in order to bring the alignment in to an acceptable range by using an adapter authorized by the implant manufacturer! Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 78 Tube adapter Screws of tube clamp Knee head with pyramide adapter Screws above torsion adapter Screws for flexion stops Tighten the screws before the user loads the prosthesis! Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 79 Alignment and adjustment Flexion stops • When delivered the C-Leg 4 is equipped with the 4H95 flexion stops (= 8° less flexion angle) → optional 4H106 flexion stops with 16° are available • With the stops installed, the maximum flexion angle is: 122°...
Page 80 If there is contact even with mounted flexion stops a cushion has to be placed on the socket to generate enough distance between socket and hydraulics CPO Video! Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 81 (even when overextended) • If a Protector or Guard should be used at least 10 mm distance have to be present! CPO Video! Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 82 2 cm lateral of middle of knee joint • The prosthetic side should be loaded with at least 35% of body weight Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 83 Determine deviation of weight line (→ both feet) and load line (→ only prosthetic foot) measurement • If variation is less then 15 mm it’s OK (only slight compensation present) Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 84 • After finishing adjustments of MyModes, always switch back to basic mode • The user can use the app to make small changes to the adjustments Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 85 Calibration of C-Leg 4 using C-Soft Plus CPO Video! During calibration the user has to stand on a hard level surface in an upright position. Recalibrate after every alignment change! Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 86 (including error description) • Calibration successful It is grossly negligent to manipulate or ignore the calibration instructions. An incorrectly calibrated knee joint leads to safety risks! Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 87 Basic mode – Stance phase control Adjustment of: • Stance phase flexion resistance In stance phase the extension resistance is controlled automatically in real-time! Adjustment range with app CPO Video! Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 88 • Check the adjusted value on ramp and stairs A compromise value for sitting down – stairs – ramps has to be found! Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 89 Basic mode – Swing phase control Adjustment of: • Swing phase flexion angle The swing phase flexion angle determines the maximum knee flexion in swing phase! CPO Video! Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 90 Alignment and adjustment Functions in basic mode Activation of: • Stance Function (intuitive activation of standing or manual activation) • Sitting Function These functions only work in basic mode! Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 91 When rolling forwards or backwards, the resistance is reduced smoothly • The joint is not locked in a seated position The knee joint activates/deactivates the Stance Function automatically! CPO Video Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 92 (→ now it can be fully loaded) • Exit Manual Stance Function via knee extension or a large backward rotation of the thigh CPO Video Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 93: Sitting Function
• Sitting position = thigh is close to horizontal When in a seated position, the knee joint switches to an energy-saving mode! CPO Video Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 94 • Component compatibility is displayed CPO Video The user always has to distinguish exactly between 3 or 4 times bouncing on the forefoot! Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 95 Press the “Transfer configuration” button to save the configuration data for the Cockpit App on the prosthesis • Connections to both aren't possible at the same time! Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 96 The desired mode can be renamed • Adjust the flexion locking angle by modifying the values „Basic Flexion Resistance“and „Flexion resistance increase“ • Display of the flexion locking angle (here: 11°) Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 97 Alignment and adjustment Adjusting the acoustic signals • Adjustment of:  Volume Error signals always have the highest volume setting and can’t be changed! Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 98 • For high safety, set a high value • If a low value is preferred, point out the possible dangers! Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 99: Bluetooth Function
Bluetooth is by default always activated • Bluetooth can be deactivated by switching off the check box • The user can activate Bluetooth again permanently with the Cockpit App Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 100: Data Overview
(even calibration!) • Overview of parameters in database • Overview of parameters in knee joint • Exchange of values between database and knee joint Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 101 • A calibration can also be performed directly in the data overview tab CPO Video Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 102 The pendulum characteristics of the shank on knee should be ramps and stairs is not altered by the adjustment! extended again Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 103: Maintenance
Information about firmware version, date of first use and date of most recent maintenance Information that the knee joint requires maintenance and has to be sent in for service! Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 104 Activities – Measured activities The CPO / technician first has to activate the data storage (mind privacy protection)! The activity measurement can be reset and also deactivated at any time! Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 105 (e.g. amount of steps, average walking speed...) • The data is displayed in a numerical or graphical way in C-Soft Plus Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 106 Connect the second knee joint to the second instance of C-Soft Plus • Make the further adjustments using the same procedure • Save both jobs when completed Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 107 Agenda 1. Introduction 2. Gait cycle 3. Component selection 4. Alignment and adjustment 5. Cockpit App 6. User instructions 7. Service and warranty concept 8. User training Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 108: General Information
App or with the toe-tapping movement pattern • Certain parameters can be adapted with the Cockpit 2.2 Cockpit app • Mind brochure with user information and safety instructions (646D790) Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 109 DUAL C-Leg 4 and has to be updated • This Cockpit App can be downloaded free of charge from the Google Play Store or the Apple App Store Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 110 • The Cockpit App also enables the user to query information about the product (step counter, battery charge level, service information…) Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 111 • The knee joint should consciously be kept still during the switching process • Test carefully whether the desired function was successfully set by the knee joint Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 112 PIN becomes visible • → For a saved job this procedure also works offline! • The shown Bluetooth PIN is only valid for the currently connected component! Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 113 Stance flexion resistance (± 10 points)  Stance function (On/Off, if activated in C- Soft Plus)  Sitting function (On/Off, if activated in C- Soft Plus)  Volume (total range) Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 114 Cockpit App Adjustment of functions and settings in basic mode User view CPO view Certification course | C-Leg 4 | Global Academy | 9/25/2019 | © Ottobock...
Page 115 MyModes plus in a limited range Choose a MyMode Switch to “Settings” • The following parameters can be adjusted: • Gain (Flexion resistance increase) (± 10 points) • Volume (total range) Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 116: Control Elements
Cockpit App Control elements Product name Open Menu Currently selected mode and MyModes Charge level Bluetooth Status of the component (here: exceeded service interval) Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 117 Cockpit App Cockpit App – New with version 2.2 Cockpit Connect Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 118 • Better connection of user with CPO • Availability of the new functions is country and product dependent → use of basic app functions is always possible Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 119 Walking • MyModes Recovery of data via cloud • Ideal synchronization by using the app in the morning and in the evening! Average steps on level surfaces Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 120 • The CPO can invite his/her users via his myOttobock account (prerequisites: the user has an own myOttobock account → email address has to be identical!) Certification course | C-Leg 4 | Global Academy | 9/25/2019 | © Ottobock...
Page 121 • Set daily goals in accordance with the user • Establishment and evaluation of a detailed usage analysis including questionnaires (has to be started by the user) Certification course | C-Leg 4 | Global Academy | 9/25/2019 | © Ottobock...
Page 122 New functions of the Cockpit App 2.2 for users → online help inside the Cockpit App • New functions of the „Cockpit Connect“ for CPOs → online help at cc.ottobock.com Certification course | C-Leg 4 | Global Academy | 9/25/2019 | © Ottobock...
Page 124 Agenda 1. Introduction 2. Gait cycle 3. Component selection 4. Alignment and adjustment 5. Cockpit App 6. User instructions 7. Service and warranty concept 8. User training Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 125 Non-compliance with safety instructions can lead to malfunctions of the knee joint and possible risks to the end-user • Changes or modifications of system components are not permitted Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 126 When walking down a small step a (maybe surprising) stance release can be triggered! • The user has two possibilities: • Using the yielding functionality • Using the stance release Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 127 • Feedback signals:  Vibration signals  Acoustic signals • Do not ignore unexpected feedback signals (check prosthetic function) • Volume can be adjusted with C-Soft Plus Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 128 Beep signals indicate correct switching (1, 2 or 3 beeps) • Switching back into basic mode via bouncing is always possible Audio signals indicate the 3x / 4x chosen in 1 sec MyMode CPO Video Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 129 User Instructions Charging • Fully engage the charging plug with the C-Leg 4 (mind plug polarity!) • Verify the charging status via the feedback signals • After removing the charger the knee joint performs a self test (don’t move the knee joint) •...
Page 130 50% is above 50% procedure over If the battery is completely drained, it needs nearly 8 hours to charge the battery completely! Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 131 User Instructions Charging status 100% Charging is only possible at temperatures between +10°C (+50°F) to + 45°C (113°F). Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 132 The charging status  indication doesn’t work if 3x = > 50%  the charger is still attached 2x = > 35%  1x = < 35% Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 133 Cockpit App Remaining Charging Feedback signal operating time status approx. 10 h 25 % vibrating 3x approx. 5 h 10 % vibrating 5x vibrating 10x and beeping Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 134 • An error is signified by a defined sequence of beeps and slow pulsing vibration signals • No stance release possible! manual Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 135 With a low resistance, the joint has to be actively secured upon heel impact In the case of a drained battery, the prosthesis switches back to basic mode after the battery is charged! Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 136 (within max. 10 seconds) or the knee joint goes into an undefined state • Potentially the joint has to be actively secured upon heel impact See your CPO immediately! Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 137 Reaction of the C-Leg 4:  Stance flexion resistance increases gradually • Consequence → User has to walk slowly • Reduce activity until the hydraulics have cooled down Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 138 Ideal storage position: vertical with extended knee head • This is noticeable through sounds and irregular damping behavior Automatic air bleeding mechanism after 10 – 20 steps! Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 139 When connecting with C-Soft Plus, the “Maintenance” tab opens automatically and displays a service message The knee joint has to be sent to an authorized Ottobock service by the CPO! Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 140 Switching the joint on is only possible via applying the charger • The flexion resistance in a switched off case is set by the safety mode flexion resistance CPO Video Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 141 After the initial connection (pairing) with the app, this procedure is no longer necessary • If desired, Bluetooth can be deactivated in the app by the user (e.g. in airplanes) Certification course | C-Leg 4 | Global Academy | 9/25/2019 | © Ottobock...
Page 142 Agenda 1. Introduction 2. Gait cycle 3. Component selection 4. Alignment and adjustment 5. Cockpit App 6. User instructions 7. Service and warranty concept 8. User training Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 143 • Warranty enables flexibility for the user (free loaner unit during warranty period) • An upgrade from 3-year to the 6-year warranty package is possible Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 144 Service And Warranty Concept Three year warranty package (SP-3C*8-3=3)  Remark North America and Russia have a condition-based maintenance instead of fixed service intervals (2.0 Mio. steps or 36 months) Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 145 Service And Warranty Concept Six year warranty package (SP-3C*8-3=6) Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 146: Warranty Conditions
(every two years -> depending on warranty package) • Service inspections can be performed one month before or maximum two months after the due date Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 147  Gross negligence and intention  Missing service inspection • After the warranty package  Optional service inspections  Repair costs depend on required time and material Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 148 The service procedure is described in detail in the Service Pass and the user’s instructions for use • The completed Service Pass has to be attached for each inspection Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 149 Customer receives a loaner unit from the service center • Components to be sent in:  Knee joint (knee head fully extended)  AC adapter  Charger Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 150 A blue label signifies that the data has been preserved In both cases the adjustments have to be checked and the values have to be changed if necessary. Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 151 3-year warranty package -> in 2 year  6-year warranty package -> in 2 & 4 year • The customer is provided with a free loaner unit during the service Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 152 Consider and identify error or feedback signals emitted by the knee joint (see signal overview in the module “user instructions”) • Contact OB Helpline (note the error signals of the knee joint) Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 153 Video of the error behavior if possible • Photographs of the error • Request a loaner knee joint “The joint has a malfunction” is not an error description! Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 154 • Extend the knee head completely • Remove the tube adapter • Send these components to Ottobock • Charger • Power supply Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 155 The knee joint does not necessarily have to be sent to an authorized service center if an axis cap is missing • To replace the axis caps a C-Leg 4 certificate is compulsory • The repair kit can be ordered and comes with instructions (4Y491) →...
Page 156 / clicks into place. Switch on the knee joint and let it perform a self-test. Follow the procedure described in the manual when installing axis caps! manual Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 157 Agenda 1. Introduction 2. Gait cycle 3. Component selection 4. Alignment and adjustment 5. Cockpit App 6. User instructions 7. Service and warranty concept 8. User training Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 158 User training OB Clinical research - Homepage Recent studies about Ottobock products http://www.ottobock.com/en/ company/clinical-research/ Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 159 C-Leg 4: • For functions which has to be trained differently with Genium / X3, separate video's are available in this playlist either https://www.youtube.com/playlist?list=PLHyzPKz 93e7 Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 160: Training Support
User training Training support - Ottobock Fitness APP Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 161: Sitting Down
Load both legs equally when sitting down – Bend forward at the waist, buttocks to the back – “Nose towards the toes“ – Hands towards armrests – Sit down fluidly Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 162 • The function is also active when sitting on the floor with straight legs When in a seated position, the knee joint switches to an energy-saving mode! Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 163 User training Walking on level ground  Stance release  Stance phase flexion Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 164 (in motion) • It is independent of body weight changes Forward movement and the surface Knee extension in TSt • It is safe to walk backwards Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 165 E.g.: When you have the end user perform stance extension exercises, please make sure that the stance resistance is not involuntarily released  Inform the user and simulate within the parallel bars Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 166 The contralateral leg takes a step forward and becomes the “new” supporting leg  At the same time stance release on the prosthetic side is happening × Avoid lateral hip hiking Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 167 Keep lateral trunk muscles relaxed – Spend as little effort as possible during “kicking” × Avoid lateral hip hiking A good stance phase is a prerequisite for a good swing phase! Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 168 – The contralateral leg takes a step forward – Stance release in Terminal Stance To allow stance flexion during walking the user needs time, trust and training. Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 169 Walking with different gait speed / step frequency • Walking with small steps • Walking on a figure of eight, circles, etc. • Walking on different terrain • „Outdoor-Training“ Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 170 User training Stairs / walking on inclines  Use stance phase flexion resistance  Choose the right technique for walking on shallow / steep inclinations Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 171 Let the user push in as far as he is able to stabilize himself – Check if the user is able to get back to hip extension independently Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 172 Step on the obstacle with the heel: knee flexion is provoked – Walk over the obstacle with the flexed knee joint  This exercises improves trust in the prosthesis and the hydraulic resistance Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 173 – Knee remains straight and load prosthesis – Step down with sound side and allow knee flexion on the prosthetic side × Avoid residual limb extension! Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 174 Step by step, focus on: – Foot placement – Sufficient load on prosthesis – Allowing knee flexion on prosthetic side • Alternating steps – Actively support foot placement if necessary Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 175 When walking down a small step a (maybe surprising) stance release can be triggered! • The user has two possibilities: • Using the yielding functionality • Using the stance release Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 176 User training Walking uphill Walking uphill • Alternating step sequence • Stance release is possible × Avoid circumduction / hip hiking Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 177 If the slope gets steeper this is not possible any longer  The user walks downhill over the flexed knee joint by using the stance flexion resistance Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 178 Load prosthesis, allow knee flexion & roll over the entire foot  Small steps are easier at the beginning × Avoid residual limb extension! • Test various inclinations • Reduce support if possible Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 179: Stance Function
User training Stance function  Intuitive stance function (= default setting)  Manual stance function (Change via software) Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 180 If a forward or backward movement occurs, resistance is reduced smoothly to the Stance Flexion Resistance level • This function will not be activated while seated The knee joint activates/deactivates Stance Function automatically! Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 181 Move knee forward or backward or straighten the knee (e.g.: take a step) Use in daily life • Standing on a slight decline • Standing on level and uneven ground Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 182 Exercise: • Out of stance function: take a step down – If necessary facilitate knee flexion on prosthetic side (therapist) × Avoid residual limb extension! Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 183  Keep still for one second  Joint vibrates (knee flexion is locked) Deactivation • Knee extension • Or : more than 50°backward tilt of the thigh Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 184: Switching Modes
User training Switching modes  Change between 1. and 2. MyMode Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 185 Beep signals indicate correct switching (2 beeps for 1. MyMode, 1 beep for basic mode)  Switching back to basic mode by using the same pattern Audio signals 3x / 4x in indicate the 1 sec chosen MyMode Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...
Page 186 User training Ottobock therapists HQ + Vienna Further therapeutic related information / questions? Please contact: rehabilitation@ottobock.com We will forward your request to our specific experts! Certification course | C-Leg 4 | Global Academy | 25.09.2019 | © Ottobock...

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