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Product	Set-Up	Construction	Video Clip
Rehabilitation	Exercises	Background	Customers

The following exercises can be performed on the PowerWristor®

Extension Stretching Extension Strengthening Flexion Stretching Flexion Strengthening	Radial Deviation Stretching Radial Deviation Strengthening Ulnar Deviation Stretching Ulnar Deviation Strengthening	Hold-Relax Technique Finger Stretching Finger Strengthening

General Features (Refer to the Set-Up page for component description of the PowerWristor)

For most wrist flexion and extension functions (stretching or strengthening), it is best to arrange the patient's seat height so the
brachium is nearly vertical. The Wristor platform should be closely positioned at the patient's side. The forearm will then rest on the
platform, surrounded by the side supports and elbow stop. The wrist joint should be aligned over the mobile tray axis. The hand then
rests with the hypothenar eminence on the mobile tray. With the locking knobs loosened, the elbow stop and side supports can be
moved next to the forearm for adjustment to any size patient.

For radial and ulnar deviation functions or for patients with restricted supination range, it may be more advantageous to position the
patient so the brachium rests at a 45-60 degree angle with respect to the platform. This may require removal of the proximal side
support nearest the patient to avoid uncomfortable pressure on the medial distal brachium. This removal is accomplished by loosening
and removing the locking knob, lifting the side support off the bolt, and removal of the bolt through the bottom of the base.

Hygiene considerations are increasingly important in all aspects of patient care. Each contact component (side support, elbow stop,
and hand grip) should be covered with a hygiene towel. Therapists should, after each patient's use, wash the surface with a general
purpose cleaner, just as a treatment table is washed between patient uses. Should a patient have drainage, use a disinfectant solution
(avoiding corrosive agents such as chlorine, which damages metals), to provide bacteriocidal action.

The following detailed description encompasses more specific directions for various functions of the Wristor System and
are wrote with the Medical Professional in mind. Use them as a foundation for employing this device in your patient care. As you
become more familiar with the features of this device, you may find yourself making your own modifications to best suit you and your
patient's needs.

Set-Up for Extension Stretch & Flexion Resistance

1. Arrange your seat height to allow upper arm (brachium) to be nearly vertical when the forearm rests on the Wristor system.
2. Rest the forearm on the base so the wrist joint is over the mobile tray axis.
3. Slide the elbow stop toward the elbow until it touches the elbow. Once the stop is tightened, it will prevent the elbow from sliding
back and altering the wrist joint alignment over the mobile tray axis.
4. Loosen hand grip (by turning it counterclockwise) in middle slide and position the grip for patient to grasp. Tighten post by turning
it clockwise. Once tightened, this will prevent the forearm from sliding forward and insure proper alignment of the wrist.
5. Bring slide support for proximal and distal forearm to bear on forearm surface, to keep forearm from shifting from side to side as
the elastic force is applied.
6. Hook elastic band over the tray anchor pin or cord through the tray anchor pin, of mobile tray, and then follow directions for either
(a) Extension Stretch or (b) Flexion Strengthening.

Extension Stretching

7. Depending on the objectives and needs of the user, you may wish to begin with a thin tension band or cord initially, and then
gradually increase the band's or cord's thickness as the patient tolerates it. Carefully and slowly stretch the resistance band or cord
until the patient begins to feel a stretch sensation.
8. Insert the peg at this point because this is where you will want to hook the tension band. Use extra pegs to insert in nearby
holes. If you are using a resistance cord then adjust the cord tension through the cam cleat to achieve the same result.
9. As the user becomes accustomed to the initial level of stretch, the tension band or cord may be stretched to more distant peg or
through the cam cleat to re-start the slow sustained stretch process again.
10. Another option that allows more discrete adjustments is to stretch the tension band around the body of a peg and hook the end
of the band over a second peg that is at least two holes away. The angled elastic should be at a 90-120 degree angle to work
effectively. The first peg, around which the elastic bends, can be turned to either slowly increase or decrease the elastic force of
the stretch. (The friction of the peg on the elastic causes the elastic to shorten or lengthen and thus apply a changed force to the
patient). This is an ideal way to encourage patient participation. The use can adjust their own elastic force in either of the two manners
noted.

Flexion Strengthening

7. After hooking the elastic band over the tray anchor pin of the mobile tray, stretch the band in the direction that will cause the
wrist to extend. Stretch band slowly to desired resistance level. If you are using a resistance cord then adjust the cord tension
through the cam cleat to achieve the same result. The user should start to feel a pulling sensation.
8. Insert peg at this point and several more nearby to provide various tension level options. If using the resistance cord then it is
just a matter of securing the cord in the cam cleat at the desired point of stretch.
9. The user should contract against band or cord resistance. If the patient does not have an effective grasp, strengthening can still
proceed. The hand grip located in the palm can be pushed while the fingers are extended. Any users, effective grasp or not, can
thus promote the normal synergy of wrist flexion with finger extension.
10. Stretch band or cord tension further or add more (or thicker) bands or cords, if more resistance is desired.
11. Use the usual parameters of comfort, achieving desired or full excursion through ROM, and fatigue, to decide if resistance
should be increased or decreased.
12. Use common methods of repetitions and sets, or timed durations of continuous exercise (depending on what your goals are for
that particular customer), to measure and record work level.
13. This device is also designed to provide a means for heavy sensitive strengthening. Aggressive strengthening can be provided
by the Red Resistance Cord. This device is meant to promote and provide early mobilization and early strengthening when a
hand/wrist needs it, with or without an effective grasp capability

Set-Up for Extension Strengthening Flexion Stretch

1. Arrange the seat height to allow upper arm (brachium) to be nearly vertical to the table.
2. Align the wrist joint over mobile tray axis
3. Position elbow stop to keep wrist joint properly aligned.
4 Bring side supports for proximal and distal forearm to bear on forearm surface to prevent forearm from shifting side to side as
resistance force is applied.
5. Step 5 has two options:

Option 1: To promote synergistic finger flexion with wrist extension, the user may grasp the post as part of the wrist extensor strengthening. In this case, loosen the hand grip in the middle slide and position the grip for the user to grasp. Tighten post and proceed with exercise.
Option 2: If the user has inadequate grasp strength, or relaxing of the finger flexors is desired, position the adjustable hand grip to apply pressure on the dorsum of the hand, just proximal to the metacarpalphalangeal joints. Again, loosen the hand grip in the middle slide and position the grip proximal to the MCP joints then re-tighten the hand grip to prepare for use.

6. Hook tension band over the tray anchor pin of the mobile tray and follow directions for either (c) Extension Strengthening or (d)
Flexion Stretching.

Extension Strengthening

7. After hooking resistance band over the tray anchor pin of the mobile tray or thread the cord through the pin opening, and stretch
the band or cord in the direction that will cause the wrist to flex.
8. Follow the directions numbered 8-10 previously listed under EXTENSION STRETCHING exercise.
9. The user should contract against band or cord resistance using Option 1 or Option 2 in Step #5 above.11. Use the usual parameters of comfort, achieving desired or full excursion through ROM, and fatigue, to decide if resistance
should be increased or decreased.
12. Use common methods of repetitions and sets, or timed durations of continuous exercise (depending on what your goals are for
that particular patient), to measure and record work level.
13. This device is also designed to provide a means for heavy sensitive resistance. Aggressive resistance can be provided by the
Red resistance Cord. This device is meant to promote and provide early effect when a hand/wrist may need it, with or without an
effective grasp capability.
Strengthening or Stretching
Using the 3 Different "Slides" on the Mobile Tray

Flexion Stretching

7. Flexion Stretching should precede using Option 2 under Step #5 above, where the hand grip is placed against the dorsum of the
hand. After hooking the tension band over the tray anchor pin of the mobile tray or cord through the cam cleat, stretch either form
of resistance in the direction that will cause the wrist to flex.
8. Insert peg at this point and several more nearby to provide various tension level options. If using the resistance cord then it is
just a matter of securing the cord in the cam cleat at the desired point of stretch.
9. Contract against band or cord resistance using Option 1 or Option 2 in Step #5 above.
10 Stretch band or cord tension further or add more (or thicker) bands or cords, if more resistance is desired.
11. Use the usual parameters of comfort, achieving desired or full excursion through ROM, and fatigue, to decide if resistance
should be increased or decreased.
12. Use common methods of repetitions and sets, or timed durations of continuous exercise (depending on what your goals are for
that particular patient), to measure and record work level.
13 This device is also designed to provide a means for heavy sensitive resistance. Aggressive resistance can be provided by the
Red resistance Cord. This device is meant to promote and provide an early effect when a hand/wrist may need it, with or without
an effective grasp capability.

Set-Up for Radial Deviation and Ulnar Deviation Strengthening or Stretching

As previously noted, positioning for these activities may be better when the brachium is angled with respect to the wristor platform,
and not in the vertical position used for flexion and extension functions. The ball knob may be utilized at this point as pictured in
the set-up page with the palm rest facing down on the grip on the mobile tray. The original hand grip may be unscrewed and
replaced with the ball knob at the therapist's choice.

In some cases, the original hang grip may provide optimal positioning. It may be used as follows: Once the forearm is positioned
and stabilized and the wrist is volar side down over the mobile tray axis, position the hand grip in the thumb web space at or proximal
to the second MCP. This point serves as the contact if the choices are stretching into ulnar deviation or strengthening for radial
deviation. Alternately, position the hand grip against the hypothenar eminence, close to the fifth MCP. This point serves as the contract
if the choices are stretching into radial deviation or strengthening for ulnar deviation.

Strengthening or stretching functions can proceed as indicated using the same basic procedures as outlined in detail for the flexion
and extension functions.

Using Proprioceptive Neuromuscular Facilitation Techniques - Hold-Relax Technique

The HOLD-RELAX technique can be employed by placement of a peg to prevent movement of the mobile tray in one direction,
while allowing free movement in the opposite directions. For example; a peg placement could prevent wrist flexion. The patient
would actively contract against the peg, thus firing the flexors. Upon relaxation, a resistance band or cord that pulls the wrist into
extension would then work while the flexors go into a phase of reflex inhibition following contraction. This technique is an option if
the condition allows its use. As the extension ROM is increased, the blocking peg can be moved to a different hole to allow continued
effective use of this technique. (Use the same principles for other directions of movement).

Simultaneous Use of Heat or Cold

Heat or cold can be applied before or after a patient actually uses the Wristor SYSTEM but the option exists for simultaneous use
during stretch. This beneficial treatment combination of heat during a stretch position and cold concluding a stretch, promotes the
plastic-elastic concept to gain ROM. Actual application is directly over the arm with appropriate levels of insulation. If one of the
side supports is not necessary to stabilize the forearm, it may be slid away from the arm so cold or heat application is more directly
applied to the tissue.

Release from the stretch position should always be performed slowly. Abrupt release of the tension can be painful and thus counterproductive.

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