C-Brace Dto - User Test Protocol (Template For Copying) - Otto Bock C-Brace Instructions For Use Manual

C-Brace DTO – user test protocol (template for copying)
Date:________________ Employee: _________________________
Last name: __________________________ First name:_____________________________
Age:___________ male
Diagnosis: ______________________________________________________________________________
Test side: right left
Key patient objectives: (what does the patient expect of the product)
1. _______________________________________________________________________________
2. _______________________________________________________________________________
Patient does not yet meet the
goal
Functional tests
Independent transfer
Torso stability, sitting (free upright sitting possible)
Torso stability, standing (standing upright possible)
Standing freely (without support)
Standing freely with upper body activity and arm movements
Standing on one leg, affected side
Standing on one leg, contralateral side
Swing phase
Initiating the swing phase in lunge position
Initiating the swing phase while walking
Stance phase
Sitting down with the use of stance phase flexion damping
Sliding into stance phase flexion while standing
Walking
Between parallel bars
With unilateral support around parallel bars
Walking with 2 forearm crutches
Walking with 2 forearm crutches turned around (2 canes)
Walking with 1 forearm crutch or 1 cane
Walking without device
Uniform step length
Walking on various surfaces
Walking at different walking speeds
17T1=* C-Brace DTO
female
Patient partly meets the goal
C-Brace DTO – user test protocol (template for copying)
Patient meets the goal
reliable
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