Bioness Neuromodulation A Bioness L3P-T-RFS-V10 Thigh RF Stimulation Unit User Manual manual1
Bioness Neuromodulation ltd. A Bioness Inc Company Thigh RF Stimulation Unit manual1
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manual1
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NESS L300 Plus System User’s Guide Rx Only NESS L300 Plus User’s Guide Copyright © 2010, Bioness Inc All Rights Reserved No part of this publication may be reproduced, transmitted, transcribed, stored in a retrieval system, or translated into any language or any computer language, in any form or by any third party, without the prior written permission of Bioness Inc. Trademarks NESS®, NESS L300™, NESS L300 Plus™ Intelli-Gait™, Intelli-Sense Gait Sensor™, Bioness®, the Bioness Logo and LiveOn™ are trademarks of Bioness Inc. | www.bioness.com | Rx Only Use of the symbols ® and ™ herein refers to the registration status of trademarks in the U.S. only. These trademarks may also be registered in other countries. Patents Pending Aspects of this device are covered by several patents and patent applications. Disclaimer Bioness Inc and its affiliates shall not be liable for any injury or damage suffered by any person, either directly or indirectly, as a result of the unauthorized use or repair of Bioness Inc products. Bioness Inc does not accept any responsibility for any damage caused to its products, either directly or indirectly, as a result of use and/or repair by unauthorized personnel. Environmental Policy Service personnel are advised that when changing any part of the NESS L300 Plus, care should be taken to dispose of those parts in the correct manner; where applicable, parts should be recycled. For more detailed information regarding these recommended procedures, please contact Bioness Inc. Bioness Inc is committed to continuously seeking and implementing the best possible manufacturing procedures and servicing routines. Bioness Customer Support: Telephone: (800) 211-9136, Option 2; or (661) 362-4850, Option 2. Manufactured by Bioness Neuromodulation Ltd. A Bioness Inc Company 19 Ha’Haroshet Street PO Box 2500 Industrial Zone Ra’Anana 43654, Israel II Worldwide Corporate Office Bioness Inc 25103 Rye Canyon Loop Valencia, CA 91355 USA Telephone: 800-211-9136 Email: info@bioness.com Website: www.bioness.com Contents Chapter 1: Introduction......................................................................... Chapter 2: For Your Health and Safety................................................ Indications for Use............................................................................................. Contraindications............................................................................................... Warnings........................................................................................................... Precautions........................................................................................................ Adverse Reactions............................................................................................ Skin Care Guidelines......................................................................................... Chapter 3: Environmental Conditions that Affect Use....................... 11 Radio Frequency (RF) Communication............................................................. 11 Conformity Certification............................................................................... 12 Travel................................................................................................................. 12 Chapter 4: Your NESS L300 Plus System Kit...................................... 13 Contents............................................................................................................ System Components................................................................................... L300 Accessories........................................................................................ L300 Plus Accessories................................................................................ L300 Plus Upgrade Kit....................................................................................... Contents...................................................................................................... 13 13 14 16 17 17 Chapter 5: System Components and Accessories............................ 19 L300 Functional Stimulation (FS) Cuff ............................................................. Locator......................................................................................................... RF Stim Unit Cradle..................................................................................... Strap............................................................................................................ Electrode Bases and Surface Electrodes ................................................... L300 RF Stim Unit............................................................................................. 19 20 20 20 20 21 III NESS L300 Plus Thigh FS Cuff ................................................................................................... Distal and Proximal Panels.......................................................................... Elongation Bar............................................................................................. Straps.......................................................................................................... Surface Electrodes...................................................................................... Thigh RF Stim Unit............................................................................................ Gait Sensor........................................................................................................ L300 Plus Control Unit....................................................................................... Control Unit Operating Buttons.................................................................... Control Unit Operating Modes..................................................................... Control Unit Digital Display and Indicator Lights......................................... Control Unit Audio Indicators....................................................................... L300 Accessories.............................................................................................. L300 Hydrogel Electrodes........................................................................... L300 Hydrogel Electrode Bases.................................................................. L300 Cloth Electrodes................................................................................. L300 Cloth Electrode Bases........................................................................ Wrist Strap, Neck Strap, and Belt Pouch..................................................... Replacement Battery, Gait Sensor.............................................................. Gait Sensor Pads........................................................................................ Shoe Spacers.............................................................................................. Phillips Screwdriver..................................................................................... L300 Plus Accessories...................................................................................... L300 Plus System Charger Set................................................................... Thigh FS Cuff Distal Panel Subassembly, Large......................................... Thigh FS Cuff Elongation Bar Lock Set....................................................... Thigh FS Cuff Electrode Marking Ring Set.................................................. Thigh FS Cuff Cloth Electrodes................................................................... 23 24 24 24 24 25 27 29 30 30 32 34 35 35 36 37 38 39 40 41 42 42 43 43 44 45 46 47 Chapter 6: Putting On and Taking Off the FS Cuffs........................... 49 IV Preparing the Skin............................................................................................. Checking and Wetting the Electrodes............................................................... Positioning the L300 FS Cuff............................................................................. Removing the L300 FS Cuff.............................................................................. Positioning the Thigh FS Cuff on the Quadriceps............................................. Positioning the Thigh FS Cuff on the Hamstrings.............................................. Removing the Thigh FS Cuff............................................................................. 49 49 50 54 55 60 65 Chapter 7: Placing the Gait Sensor in the Shoe................................. 67 Switching Shoes/Gait Sensors.......................................................................... 70 Chapter 8: Operating the L300 Plus Control Unit............................... 71 RF Communication Safety Features................................................................. Turning On/Off the Control Unit......................................................................... Selecting an Operating Mode............................................................................ Selecting Gait Mode.................................................................................... Selecting Training Mode.............................................................................. Returning to Standby Mode......................................................................... Adjusting Stimulation Intensity........................................................................... Adjusting the L300 RF Stim Unit................................................................. Adjusting the Thigh RF Stim Unit................................................................. Testing Stimulation............................................................................................ Testing the L300 FS Cuff............................................................................. Testing the Thigh FS Cuff............................................................................ Turning on Audio Feedback During Stimulation................................................ Turning on Audio Feedback for the L300 FS Cuff....................................... Turning on Audio Feedback for the Thigh FS Cuff...................................... Muting the Audio Alerts...................................................................................... Muting the Thigh RF Stim Unit Alerts................................................................ 71 73 73 73 73 73 74 74 76 78 78 78 79 79 79 80 80 NESS L300 Plus Chapter 9: Component Maintenance and Cleaning........................... 81 Charging the Batteries....................................................................................... 81 Replacing the Batteries..................................................................................... 86 Replacing the RF Stim Unit Batteries.......................................................... 86 Replacing the Gait Sensor Battery.............................................................. 86 Replacing the L300 Plus Control Unit Battery............................................. 87 Replacing the L300 Hydrogel Electrodes.......................................................... 89 Replacing the L300 Cloth Electrodes................................................................ 92 Replacing the L300 Electrode Bases................................................................ 95 Replacing the Thigh FS Cuff Cloth Electrodes.................................................. 98 Removing the RF Stim Units............................................................................. 101 Inserting the RF Stim Units................................................................................ 101 Cleaning the System Components.................................................................... 102 Chapter 10: Electronically Registering New Components................ 103 Registering a New L300 Plus Control Unit........................................................ 103 Registering a New RF Stim Unit........................................................................ 106 Registering a New Gait Sensor......................................................................... 108 Chapter 11: Troubleshooting................................................................ 111 Chapter 12: Component Technical Specifications............................. 117 VI User’s Guide List of Symbols Caution Double Insulated (Equivalent to Class II of IEC 536) Type BF Applied Part(s) Non-Ionizing Radiation Date of Manufacture Manufacturer This Product Must not be Disposed of with Other Household Waste Consult Instructions for Use Re-Order Number Lot Number VII 1 Introduction Central nervous system injuries often cause a gait disorder called foot drop and related muscle weakness in the thigh. People who have foot drop are unable to raise their foot while walking. They often drag their foot, resulting in instability and increased effort during gait. In addition, they may experience difficulty flexing or extending their knee. The NESS L300 Plus System is intended to provide ankle dorsiflexion and knee flexion or extension in people suffering from foot drop and thigh muscle weakness following an upper motor neuron injury or disease. The NESS L300 Plus System incorporates cutting-edge technology and sophisticated design features to improve gait and quality of life. The NESS L300 Plus System consists of four main components: •• The NESS L300 Functional Stimulation (FS) Cuff with Radio Frequency (RF) Stimulation Unit for the lower leg •• A Thigh FS Cuff with RF Stim Unit for the quadriceps or hamstrings •• A Gait Sensor •• An L300 Plus Control Unit These components communicate wirelessly to send electrical pulses to the nerves that control the muscles of the lower leg and thigh. When stimulated at the appropriate phase of walking, the muscles raise the foot and extend or flex the knee, and may improve gait. Chapter 1 - Introduction NESS L300 Plus Features of the NESS L300 Plus System include the following: •• Each FS Cuff includes a cradle for the RF Stim Unit. •• The FS Cuffs have an advanced ergonomic locator to ensure constant, snug contact with the leg. •• The FS Cuffs can be put on with one hand and will easily fit under a loose pant leg. •• The Gait Sensor detects when the foot is in the air and on the ground, and wirelessly regulates stimulation in both FS Cuffs accordingly. •• The wireless handheld Control Unit monitors system status and manages system performance. This User’s Guide describes the NESS L300 Plus System and how to operate the system to achieve maximum benefits. It also describes important safety information, and maintenance and cleaning instructions. Be sure to review each section of this guide with your clinician before using your NESS L300 Plus System. If you have any questions, consult your clinician or Bioness Inc immediately. User’s Guide 2 For Your Health and Safety Indications for Use The NESS L300 Plus System is intended to provide ankle dorsiflexion and knee flexion or extension in individuals who have foot drop and thigh muscle weakness following an upper motor neuron injury or disease (such as a stroke, traumatic brain injury, multiple sclerosis, cerebral palsy, or incomplete spinal cord injuries). During gait, the NESS L300 Plus System electrically stimulates muscles in the affected leg to provide dorsiflexion of the foot and knee flexion or extension; thus, it may improve the individual’s gait. The NESS L300 Plus System may also: •• Facilitate muscle re-education. •• Prevent or retard disuse atrophy. •• Maintain or increase joint range of motion. •• Increase local blood flow. Contraindications •• Patients with a demand-type cardiac pacemaker, defibrillator, or any electrical or metallic implant should not use the NESS L300 Plus System. •• The NESS L300 Plus System should not be used where a cancerous lesion is present or suspected. Chapter 2 - For Your Health and Safety NESS L300 Plus •• The NESS L300 Plus System should not be used on a leg where a regional disorder, such as a fracture or dislocation, could be adversely affected by motion from the stimulation. Warnings •• The long-term effects of chronic electrical stimulation are unknown. •• The NESS L300 Plus FS Cuffs should not be worn over swollen, infected, or inflamed areas or skin eruptions, such as phlebitis, thrombophlebitis, and varicose veins. •• Simultaneous connection of the NESS L300 Plus to the patient and highfrequency surgical equipment may result in skin burns where the stimulator electrodes adhere and damage to the RF Stim Units. •• Do not use the NESS L300 Plus within three feet of shortwave or microwave therapy equipment. Such equipment may produce instability in the output of the RF Stim Units. •• The NESS L300 Plus should only be configured by an authorized clinician. Precautions •• Inflammation in the region of the NESS L300 Plus FS Cuffs may be aggravated by motion, muscle activity, or pressure from the FS Cuffs. Stop using the NESS L300 Plus until the inflammation is gone. •• Use caution if you have a suspected or diagnosed heart problem. •• Use the FS Cuffs with caution: •• If you have a tendency to hemorrhage following acute trauma or fracture. •• Following recent surgical procedures when muscle contraction may disrupt the healing process. User’s Guide •• •• •• •• •• •• •• •• •• •• •• •• Over areas of the skin that lack normal sensation. •• If you have suspected or diagnosed epilepsy. Some patients may experience a skin irritation, an allergic reaction, or hypersensitivity to the electrical stimulation or the electrical conductive medium. Irritation may be avoided by having your clinician change the stimulation parameters, type of electrodes, or electrode placement. Do not use the NESS L300 Plus without electrodes. After removing the FS Cuffs, it is normal for the areas under the electrodes to be red and indented. The redness should disappear in approximately one hour. Persistent redness, lesions, or blisters are signs of irritation. Stop using the NESS L300 Plus until any irritation is gone. Stop using the NESS L300 Plus and consult your clinician if stimulation does not start at the correct time during gait. Do not wear the NESS L300 Plus during x-ray examinations. Turn off the NESS L300 Plus when at a refueling place. Do not use the NESS L300 Plus near flammable fuel, fumes, or chemicals. Only your treating clinician should determine electrode placement and stimulation settings. Use only NESS L300 Plus electrodes supplied by Bioness Inc. Obtain physician clearance prior to use if you have an alteration in normal arterial or venous flow in the region of the FS Cuffs because of local insufficiency, occlusion, arteriovenous fistula for hemodialysis, or a primary disorder of the vasculature. Obtain physician clearance before stimulating an area with a structural deformity. The safe use of the NESS L300 Plus during pregnancy has not been established. Chapter 2 - For Your Health and Safety NESS L300 Plus •• Skin problems where the FS Cuffs are worn may be aggravated by the NESS L300 Plus. •• Turn off the NESS L300 Plus before removing or replacing the electrodes. •• Keep the NESS L300 Plus out of the reach of children. •• The NESS L300 Plus Control Unit is splash proof. However, protect all electronic components from contact with water, such as from sinks, bathtubs, shower stalls, rain, snow, etc. •• Do not leave the NESS L300 Plus stored where temperatures may exceed the acceptable environmental range: -20°C to +60°C (-4°F to +140°F). Temperature extremes can damage the components. •• Do not attempt to repair your NESS L300 Plus. Contact Bioness if you experience a technical problem not covered in this guide. •• The FS Cuffs are to be worn only on the leg of the patient for whom they are fitted. They should not be worn by anyone else or on any other part of the body. •• Turn off the NESS L300 Plus before putting on the FS Cuffs. Do not turn on the NESS L300 Plus until the FS Cuffs are fastened in place. •• Shut off the NESS L300 Plus before driving, operating machinery, or performing any activity in which involuntary muscle contractions could injure you. •• Protect the NESS L300 Plus electronic components from condensation. When moving the components between hot and cold temperatures, place them in an airtight plastic bag, and let them slowly (for at least two hours) adjust to the temperature change before use. •• Medical electrical equipment needs special precautions for electromagnetic compatibility. User’s Guide Adverse Reactions In the unlikely event that any of the following occurs, stop using your NESS L300 Plus immediately and consult your physician. •• Signs of significant irritation or pressure sores where the FS Cuffs contact the skin. •• A significant increase in muscle spasticity. •• A feeling of heart-related stress during stimulation. •• Swelling of the leg, knee, ankle, or foot. •• Any other unanticipated reaction. Skin irritations and burns have been reported with the use of powered muscle stimulators. If you have any questions or concerns, please telephone the NESS L300 Plus Technical and Clinical Support Department at (800) 211-9136, Option 3. Chapter 2 - For Your Health and Safety NESS L300 Plus Skin Care Guidelines In the absence of proper skin care, extended use of electrical stimulation may cause skin irritation or a skin reaction to the electrodes or the FS Cuffs. Skin irritation tends to occur after approximately three months of use. To promote healthy skin with long-term use of the NESS L300 Plus, it is important to follow a daily skin-care routine. •• Clean the skin where the electrodes adhere with a wet washcloth. If any oils or lotions are on the skin, then clean with soap and water. Rinse well. •• Always check the skin for redness or a rash when putting on and taking off the FS Cuffs. •• Replace the electrodes at least every two weeks, even if they appear to be in good condition. •• After taking off the L300 FS Cuff, always re-cover hydrogel electrodes with the protective plastic covers. •• Excess body hair where the electrodes adhere may reduce electrode contact with the skin. If necessary, remove excess body hair with an electric shaver or scissors. Do not use a razor. A razor can irritate the skin. •• When positioning the FS Cuffs, make sure the electrodes uniformly contact the skin. •• Ventilate the skin by removing the FS Cuffs for at least 15 minutes every three to four hours. If skin irritation or a skin reaction occurs, stop using your NESS L300 Plus System immediately. Contact your clinician, dermatologist, or Bioness Clinical Specialist. Resume use only when the skin is completely healed. Then follow a skin conditioning protocol per the recommendation of your health-care specialist. User’s Guide Caution: Do not put on or operate the NESS L300 Plus System before being properly fitted and trained by a certified clinician. Caution: The Gait Sensor has not been validated for use by individuals weighing more than 300 pounds (136 kilograms). Caution: Do not use the Gait Sensor with a rigid insole, such as a custom rigid orthosis or an ankle foot orthosis. Caution: Use only NESS L300 Plus electrodes supplied by Bioness Inc. Do not use the NESS L300 Plus System without electrodes. Caution: Change the electrodes every two weeks. Caution: Changes or modifications to the NESS L300 Plus System components not expressly approved by Bioness Inc could void the user's authority to operate the equipment. If you have any questions or concerns, please telephone the NESS L300 Plus Technical and Clinical Support Department at (800) 211-9136, Option 3. Chapter 2 - For Your Health and Safety NESS L300 Plus 10 User’s Guide Environmental Conditions that Affect Use Radio Frequency (RF) Communication Several components of the NESS L300 Plus System communicate via radio communication and have been tested and found to comply with the limits for a Class B digital device, pursuant to Part 15 (RF Devices) of the FCC (Federal Communications Commission) Rules. These limits are designed to provide reasonable protection against harmful interference in a residential installation. This equipment generates, uses, and can radiate RF energy and, if not installed and used in accordance with the instructions, may cause harmful interference to radio communications. However, there is no guarantee that interference will not occur in a particular installation. If this equipment does cause harmful interference to radio or television reception, which can be determined by turning the equipment off and on, the user is encouraged to try to correct the interference by one or more of the following measures: •• Reorient or relocate the receiving antenna. •• Increase the separation between the equipment and receiver. Consult the dealer or an experienced radio/TV technician for assistance. The antenna for each transmitter must not be co-located or operating in conjunction with any other antenna or transmitter. Portable and mobile RF communications equipment can affect medical electrical equipment. Chapter 3 - Environmental Conditions that Affect Use 11 NESS L300 Plus Conformity Certification The L300 Plus complies with Part 15 of the FCC rules. Operation is subject to the following two conditions: 1. This device may not cause harmful interference, and 2. This device must accept any interference received, including interference that may cause undesired operation. Travel The NESS L300 Plus System charger set is compatible with both European and U.S. voltage: 110/220 V, 50/60 Hz. A voltage converter is not needed. A simple outlet adaptor should work. Outlet adaptors can be purchased at small electronic equipment stores. Turn off your NESS L300 Plus System before going through airport security. Wear loose clothing so that you can easily show the security person your NESS L300 Plus. The NESS L300 Plus System will likely set off the security alarm. Either ask for a “hand scan” or be prepared to remove your NESS L300 Plus so that security can scan it. You may want to carry a copy of your NESS L300 Plus prescription. A prescription can be useful when passing through customs as well. To request a copy of your prescription, call Bioness Customer Support: Telephone: (800) 211-9136, Option 2; or (661) 362-4850, Option 2. A Bioness representative can fax or mail you a copy. Note: The NESS L300 Plus System contains radio transmitters. The Federal Aviation Administration (FAA) rules require that all radio-transmitting devices be turned off during flight. 12 User’s Guide 4 Your NESS L300 Plus System Kit Your NESS L300 Plus System includes components and accessories of the NESS L300 Foot Drop System plus a Thigh FS Cuff, Thigh RF Stim Unit, accessories for the Thigh FS Cuff, and a Control Unit. For individuals who already have a NESS L300 Foot Drop System, an L300 Plus System upgrade kit is provided. Contents System Components •• •• •• •• •• •• L300 FS Cuff with Strap, Right or Left L300 RF Stim Unit Thigh FS Cuff with Straps, Right or Left Thigh RF Stim Unit Gait Sensor L300 Plus Control Unit L300 FS Cuff with Strap and RF Stim Unit Thigh FS Cuff with Straps and RF Stim Unit L300 Plus Control Unit Gait Sensor Chapter 4 - Your NESS L300 Plus System Kit 13 NESS L300 Plus L300 Accessories •• •• •• •• •• •• •• •• •• •• •• L300 Hydrogel Electrodes L300 Hydrogel Electrode Bases L300 Cloth Electrodes L300 Cloth Electrode Bases Control Unit Neck Strap Control Unit Wrist Strap Control Unit Belt Pouch Replacement Battery, Gait Sensor Gait Sensor Pads Shoe Spacers Phillips Screwdriver Hydrogel Electrode Gait Sensor Battery 14 User’s Guide Hydrogel Electrode Base Neck Strap Gait Sensor Pads Cloth Electrode Cloth Electrode Base Wrist Strap Belt Pouch Shoe Spacers Phillips Screwdriver Chapter 4 - Your NESS L300 Plus System Kit 15 NESS L300 Plus L300 Plus Accessories •• •• •• •• •• •• •• •• L300 Plus System Charger Set Thigh FS Cuff Distal Panel Subassembly, Large Thigh FS Cuff Elongation Bar Lock Set Thigh FS Cuff Electrode Marking Ring Set Thigh FS Cuff Cloth Electrodes L300 Plus System Kit Carrying Case with Strap NESS L300 Plus User’s Guide NESS L300 Plus User's Instruction Card System Charger Set Thigh FS Cuff Elongation Thigh FS Cuff Distal Panel Subassembly Bar Lock Set Thigh FS Cuff Electrode Thigh FS Cuff Cloth Electrodes 16 User’s Guide Marking Ring Set L300 Plus Upgrade Kit For individuals who already have a NESS L300 Foot Drop System, an L300 Plus System upgrade kit is provided. Contents •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• Thigh FS Cuff with Straps, Right or Left Thigh RF Stim Unit L300 Plus Control Unit L300 Plus System Charger Set Thigh FS Cuff Distal Panel Subassembly, Large Thigh FS Cuff Elongation Bar Lock Set Thigh FS Cuff Electrode Marking Ring Set Thigh FS Cuff Cloth Electrodes L300 Plus System Kit Carrying Case with Strap Replacement Battery, Gait Sensor Control Unit Neck Strap Control Unit Wrist Strap Control Unit Belt Pouch NESS L300 Plus User’s Guide NESS L300 Plus User's Instruction Card Chapter 5 - System Components and Accessories 17 NESS L300 Plus 18 User’s Guide System Components and Accessories This section describes the components and accessories of the L300 Plus System. L300 Functional Stimulation (FS) Cuff The L300 FS Cuff is an ergonomic orthosis that fits on the leg below the knee. The L300 FS Cuff is designed to facilitate dorsiflexion of the foot. It is lightweight, easy to put on with one hand, and can be worn under loose clothing. An ergonomic locator on the L300 FS Cuff ensures accurate and repeatable positioning of the surface electrodes on the lower leg. See Figure 1. Liner Electrode Locator Flexible Strap Handle Cradle for the RF Stim Unit Adjustable Strap L300 RF Stim Unit Stimulation Light Status Light Figure 1: The L300 FS Cuff (right configuration) and L300 RF Stim Unit. Chapter 5 - System Components and Accessories 19 NESS L300 Plus The L300 FS Cuff is available in right and left configurations. It is designed to house an integrated L300 RF Stim Unit and two surface electrodes. The RF Stim Unit produces the stimulation signal. The surface electrodes deliver the stimulation signal from the RF Stim Unit to the leg. Both hydrogel and cloth surface electrodes and electrode bases are provided. Locator The L300 FS Cuff features an ergonomic locator for accurate and repeatable positioning of the surface electrodes. The locator forms a "V" and is placed just under the kneecap. RF Stim Unit Cradle The L300 FS Cuff includes a cradle for the L300 RF Stim Unit. The RF Stim Unit snaps in and out of the cradle, and is removed for maintenance and cleaning. Strap The strap on the L300 Plus FS Cuff is adjustable and features a flexible strap handle. Three strap sizes are available: small, medium, and large. The strap can be removed and is replaceable. Electrode Bases and Surface Electrodes The L300 FS Cuff uses two surface electrodes to stimulate the skin. The surface electrodes attach to two electrode bases, which connect to the FS Cuff liner. During your fitting session, your clinician will determine the best position for the electrode bases and electrodes on the L300 FS Cuff. 20 User’s Guide L300 RF Stim Unit The L300 RF Stim Unit generates the electrical stimulation pulses used to dorsiflex the foot. The L300 RF Stim Unit responds to wireless signals from the L300 Plus Control Unit and the Gait Sensor to turn stimulation on/off. Features include a rechargeable battery, a status light, and a stimulation light. See Table 1. Display Status Light Stimulation Light Description Definition Flashes GREEN System is On Flashes YELLOW Low Battery Alternately Flashes YELLOW and GREEN Battery Charging Solid GREEN Battery Fully Charged Flashes RED Radio Communication Failure Solid RED RF Stim Unit Malfunction Flashes YELLOW SLOWLY Stimulation is Off Flashes YELLOW RAPIDLY Stimulation is On Table 1: L300 RF Stim Unit displays and definitions. Chapter 5 - System Components and Accessories 21 NESS L300 Plus The L300 RF Stim Unit emits both visual and audio alerts when radio communication fails or the component malfunctions. The L300 RF Stim Unit snaps in and out of the cradle of the L300 FS Cuff. See Figure 2. The L300 RF Stim Unit should only be removed from the cradle for maintenance and when cleaning the L300 FS Cuff. RF Stim Unit Cradle L300 FS Cuff L300 RF Stim Unit Figure 2: Removing the L300 RF Stim Unit. 22 User’s Guide Thigh FS Cuff The Thigh FS Cuff is an ergonomic orthosis that fits over the hamstrings or quadriceps muscles. The Thigh FS Cuff is designed to be used in unison with the L300 FS Cuff, to assist with knee flexion or extension throughout the gait cycle. See Figure 3. The Thigh FS Cuff is available in right and left configurations, and houses an integrated Thigh RF Stim Unit and two surface electrodes. The Thigh RF Stim Unit produces the stimulation signal. The electrodes deliver the stimulation signal from the Thigh RF Stim Unit to the hamstrings or quadriceps muscles. RF Stim Unit Cradle Thigh FS Cuff Thigh RF Stim Unit Figure 3: The Thigh FS Cuff. Caution: The FS Cuffs should be removed from the skin every three to four hours for 15 minutes to allow the skin to breathe. Chapter 5 - System Components and Accessories 23 NESS L300 Plus Distal and Proximal Panels The Thigh FS Cuff features two panels: a distal panel that is positioned closer to the knee and a proximal panel that is positioned farther from the knee. The distal panel features a cradle for the Thigh RF Stim Unit. The L300 Plus System Kit includes a replacement large distal panel that fits a larger leg circumference, if needed. Elongation Bar Connecting the distal and proximal panels is an elongation bar. The elongation bar is used to adjust the distance between the distal and proximal panels. (Your clinician will determine the distance most appropriate for you and adjust the elongation bar accordingly.) The elongation bar features a locator arrow used to position the Thigh FS Cuff on the leg. Straps The distal and proximal panels each feature two straps used to secure the Thigh FS Cuff on the leg. The straps are adjustable and can be fastened with one hand. The straps are also washable and replaceable. Surface Electrodes The Thigh FS Cuff features two cloth electrodes. One electrode attaches to the distal panel. One attaches to the proximal panel. During your fitting session, your clinician will fit the electrodes to the Thigh FS Cuff. Afterward, you will need to replace the electrodes every two weeks. 24 User’s Guide Thigh RF Stim Unit The Thigh RF Stim Unit snaps in and out of the cradle of the Thigh FS Cuff. See Figure 4. The Thigh RF Stim Unit generates the electrical stimulation pulses used to extend the quadriceps muscles or flex the hamstrings muscles. The Thigh RF Stim Unit responds to wireless signals from the L300 Plus Control Unit and the Gait Sensor to turn stimulation on/off. It has a rechargeable battery, a status light, and a stimulation light. See Table 2. RF Stim Unit Cradle Thigh FS Cuff Thigh RF Stim Unit Figure 4: Removing the Thigh RF Stim Unit. Chapter 5 - System Components and Accessories 25 NESS L300 Plus The Thigh RF Stim Unit emits both visual and audio alerts when radio communication fails or the component malfunctions. The Thigh RF Stim Unit should be removed from the cradle for maintenance and when cleaning the Thigh FS Cuff. Display Status Light Description Flashes GREEN Definition System is On Flashes YELLOW Low Battery Alternately Flashes YELLOW and GREEN Solid GREEN Battery Charging Flashes RED Solid RED Stim Light Flashes YELLOW SLOWLY Flashes YELLOW RAPIDLY Battery Fully Charged Radio Communication Failure RF Stim Unit Malfunction Stimulation is Off Stimulation is On Table 2: Thigh RF Stim Unit displays and definitions. 26 User’s Guide Gait Sensor The Gait Sensor consists of a pressure sensor and a transmitter. See Figure 5. The pressure sensor is used to detect when your foot is in the air and on the ground. The transmitter is used to signal the L300 RF Stim Unit and the Thigh RF Stim Unit to move your foot and knee accordingly. The Gait Sensor communicates wirelessly with the L300 RF Stim Unit and the Thigh RF Stim Unit. Transmitter Clamp Pressure Sensor Figure 5: NESS L300 Gait Sensor. Chapter 5 - System Components and Accessories 27 NESS L300 Plus The pressure sensor fits under the insole of the shoe of the affected leg, attached to a Gait Sensor pad. See Figure 6. The transmitter is worn clamped to the inner rim of the shoe. Shoe spacers are provided to protect the shoe from damage from the clamp. The Gait Sensor can be transferred to a different shoe, or additional sensors can be purchased for different shoes. You do not need to detach the Gait Sensor between uses. Figure 6: Gait Sensor placed in a left shoe. The Gait Sensor is powered by a small non-rechargeable battery. The battery will need to be replaced after approximately six months of use. The L300 Plus System Kit includes a replacement battery and a Phillips screwdriver for changing the battery. Caution: The Gait Sensor has not been validated for use by individuals weighing more than 300 pounds (136 kilograms). 28 User’s Guide L300 Plus Control Unit The L300 Plus Control Unit is used to turn on/off the L300 Plus System, select an operating mode (gait, training, standby, or clinician), fine-tune stimulation intensity, mute audio alerts, test stimulation intensity of the individual RF Stim Units, and monitor system performance. See Figure 7. The Control Unit communicates wirelessly with the L300 RF Stim Unit, the Thigh RF Stim Unit, and the Gait Sensor. It is powered by a single rechargeable AAA battery. It is also small enough to be worn around the neck or wrist, or carried in a pocket or belt pouch. Loop Hole for Wrist and Neck Straps On/Off Button Mute Button Mode Button Digital Display Intensity Adjustment (Plus/Minus) Buttons RF Stim Unit Selection Buttons Stimulation Test Button Figure 7: Control Unit operating buttons and digital display. Chapter 5 - System Components and Accessories 29 NESS L300 Plus Your L300 Plus System Kit includes a system charger set for charging the Control Unit, the L300 RF Stim Unit, and the Thigh RF Stim Unit. It also includes a belt pouch, wrist strap, and neck strap for carrying the Control Unit. A Phillips screwdriver is provided for changing the Control Unit battery. Control Unit Operating Buttons The Control Unit operating buttons and their functions are described in Table 3. Control Unit Operating Modes The Control Unit has four operating modes: standby, gait, training, and clinician. Only clinicians use clinician mode. Standby Mode In standby mode, the L300 Plus System is on and waiting for commands. Stimulation is off. Gait Mode Gait mode is used when walking. In gait mode, the Gait Sensor signals the L300 and Thigh RF Stim Units when your heel leaves the ground, turning stimulation on. It also signals when your heel contacts the ground, turning stimulation off. Training Mode Training mode is used to train muscles when you are not walking (for example, sitting or lying down). Training mode should not be used when walking. Training mode works independently of the Gait Sensor. Stimulation is delivered in cycles pre-set by your clinician. Training mode is designed to facilitate 30 User’s Guide Control Unit Operating Button Description Function On/Off Turns On/Off the Control Unit Mode Selects Standby, Gait, Training, or Clinician Mode Intensity Adjustment (Plus/Minus) RF Stim Unit Selection Adjusts Stimulation Intensity Level "Up" Button Selects the Thigh RF Stim Unit "Down" Button Selects the L300 RF Stim Unit Mute Mutes the Audio Indicators; Selects Single Component Mode Stimulation Test Tests Stimulation for the Selected RF Stim Unit (Functional Only in Standby Mode) Table 3: Control Unit operating buttons and functions. Chapter 5 - System Components and Accessories 31 NESS L300 Plus muscle re-education, prevent or retard disuse atrophy of the lower leg and thigh muscles, maintain or improve range of motion of the ankle and knee joints, and improve local blood circulation. Control Unit Digital Display and Indicator Lights The Control Unit digital display and indicator lights indicate stimulation intensity level, operating mode, battery charge status, electronic registration status, and error messages. See Figure 8 and tables 4 and 5. Control Unit Indicator RF Communication Error Indicator Thigh RF Stim Unit Indicator L300 RF Stim Unit Indicator Intelli-Sense Gait Sensor Indicator Figure 8: Control Unit digital display and indicators. 32 User’s Guide Display Description Definition On/Off Button Flashes GREEN System is On Mode Button Flashes YELLOW SLOWLY System is in Gait/Training/ Clinician Mode, Stimulation is Off Mode Button Flashes YELLOW RAPIDLY System is in Gait/Training/ Clinician Mode, Stimulation is On Displays 0–9 Intensity Level Intensity Level and “t” Alternate System is in Training Mode A Component Indicator Flashes YELLOW Component Low Battery Top Arrow and Thigh RF Stim Unit Indicator are GREEN Thigh RF Stim Unit Selected Bottom Arrow and L300 RF Stim L300 RF Stim Unit Selected Unit Indicator are GREEN Rotating GREEN Circle Control Unit Charging Horizontal GREEN Line Control Unit Fully Charged Table 4: Control Unit visual displays and definitions. Chapter 5 - System Components and Accessories 33 NESS L300 Plus Display Description Definition Thigh RF Stim Unit Indicator Flashes RED Faulty Electrode Contact Control Unit and RF Stim Unit Indicators Alternately Flash RED and “E” Flashes Radio Communication Failure Between the Control Unit and RF Stim Unit Gait Sensor and RF Stim Unit Indicators Alternately Flash RED Gait Sensor Hibernation or Radio Communication Failure between the Gait Sensor and RF Stim Unit A Component Indicator is Solid RED Component Malfunction Table 4: Control Unit error displays and definitions. Control Unit Audio Indicators The Control Unit beeps to indicate: •• •• •• •• The system is on. A button was pressed. Low battery. An error (usually accompanied by a visual indicator). 34 User’s Guide
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13:03:41-08:00, 2009:11:30 13:04:58-08:00, 2009:11:30 13:07:22-08:00, 2009:11:30 13:07:39-08:00, 2009:11:30 13:08:49-08:00, 2009:11:30 13:10:57-08:00, 2009:11:30 13:11:08-08:00, 2009:11:30 13:11:56-08:00, 2009:11:30 13:23:23-08:00, 2009:11:30 13:24:15-08:00, 2009:11:30 13:26:33-08:00, 2009:11:30 13:29-08:00, 2009:11:30 13:30:52-08:00, 2009:11:30 13:33:56-08:00, 2009:11:30 13:38:06-08:00, 2009:11:30 13:40:13-08:00, 2009:11:30 13:43:08-08:00, 2009:11:30 13:53:15-08:00, 2009:11:30 13:55:45-08:00, 2009:11:30 13:58:22-08:00, 2009:11:30 14:00:05-08:00, 2009:11:30 14:00:58-08:00, 2009:11:30 14:01:49-08:00, 2009:11:30 14:04:20-08:00, 2009:11:30 14:06:38-08:00, 2009:11:30 14:08:13-08:00, 2009:11:30 14:08:54-08:00, 2009:11:30 14:11:15-08:00, 2009:11:30 14:11:34-08:00, 2009:11:30 14:12:33-08:00, 2009:11:30 14:13:09-08:00, 2009:11:30 14:15:28-08:00, 2009:11:30 14:18:42-08:00, 2009:11:30 14:21:01-08:00, 2009:11:30 14:22:14-08:00, 2009:11:30 14:24:50-08:00, 2009:11:30 14:25:30-08:00, 2009:11:30 14:25:54-08:00, 2009:11:30 14:31:45-08:00, 2009:11:30 14:31:59-08:00, 2009:11:30 14:38:11-08:00, 2009:11:30 14:38:43-08:00, 2009:11:30 14:39:30-08:00, 2009:11:30 14:40:14-08:00, 2009:11:30 14:43:11-08:00, 2009:11:30 14:44:17-08:00, 2009:11:30 14:44:58-08:00, 2009:11:30 14:46:40-08:00, 2009:11:30 14:47-08:00, 2009:11:30 14:55:10-08:00, 2009:11:30 14:57:58-08:00, 2009:11:30 15:01:26-08:00, 2009:11:30 15:04:44-08:00, 2009:11:30 15:05:18-08:00, 2009:11:30 15:15:42-08:00, 2009:11:30 15:17:09-08:00, 2009:11:30 15:19:09-08:00, 2009:11:30 15:19:50-08:00, 2009:11:30 15:20:57-08:00, 2009:11:30 15:21:52-08:00, 2009:11:30 15:26:40-08:00, 2009:11:30 15:27:25-08:00, 2009:11:30 15:37:51-08:00, 2009:11:30 15:38:10-08:00, 2009:11:30 15:41:15-08:00, 2009:12:01 09:14-08:00, 2009:12:01 09:30:51-08:00, 2009:12:01 09:34-08:00, 2009:12:01 09:42:52-08:00, 2009:12:01 09:44:07-08:00, 2009:12:01 09:46:58-08:00, 2009:12:01 09:51:56-08:00, 2009:12:01 09:54-08:00, 2009:12:01 09:58:34-08:00, 2009:12:01 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6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0 History Changed : /, /metadata, /metadata, /;/metadata, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, 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/, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, / Warning : [Minor] Extracted only 1000 xmpMM:History items. 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Y Resolution : 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 72.00, 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72.00, 72.00, 72.00 Manifest Placed Resolution Unit : Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, Inches, 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xmp.did:74117FED20071168AE56EA76C4861F44, uuid:06BF6F62D275DC11AC638CEC1D671DFD, uuid:06BF6F62D275DC11AC638CEC1D671DFD, uuid:982BECC7952F11DD9A6FB23F35800D93, uuid:39CB98C3443F11DD8A68A95C3D41E62D, xmp.did:74117FED20071168AE56EA76C4861F44, uuid:982BECC7952F11DD9A6FB23F35800D93, adobe:docid:photoshop:7210e05c-6495-11dd-95cf-aa9d97986f9e, adobe:docid:photoshop:5e747834-6495-11dd-95cf-aa9d97986f9e, adobe:docid:photoshop:5e74782c-6495-11dd-95cf-aa9d97986f9e, xmp.did:74117FED20071168AE56EA76C4861F44, adobe:docid:photoshop:21727261-6495-11dd-95cf-aa9d97986f9e, adobe:docid:photoshop:21727259-6495-11dd-95cf-aa9d97986f9e, uuid:982BECC7952F11DD9A6FB23F35800D93, uuid:ADF67578171B11DFB1F3F8485B53F00B, xmp.did:74117FED20071168AE56EA76C4861F44, uuid:C3E62B31E3F611DE8073F6A3F5BC7B09, uuid:C3E62B33E3F611DE8073F6A3F5BC7B09, uuid:ADF6757A171B11DFB1F3F8485B53F00B, xmp.did:74117FED20071168AE56EA76C4861F44, uuid:982BECC7952F11DD9A6FB23F35800D93, uuid:71179B25171C11DFB1F3F8485B53F00B, uuid:ADF67580171B11DFB1F3F8485B53F00B, uuid:AC87956217C411DF805994CDCCC80EA8, xmp.did:74117FED20071168AE56EA76C4861F44, uuid:ADF67582171B11DFB1F3F8485B53F00B, uuid:71179B27171C11DFB1F3F8485B53F00B, uuid:982BECC7952F11DD9A6FB23F35800D93, xmp.did:74117FED20071168AE56EA76C4861F44, xmp.did:74117FED20071168AE56EA76C4861F44, uuid:101F77EE170811DFB1F3F8485B53F00B, xmp.did:74117FED20071168AE56EA76C4861F44, uuid:27332663171311DFB1F3F8485B53F00B, uuid:94E18DAE441811DD8A68A95C3D41E62D, uuid:0FD99FE4443211DD8A68A95C3D41E62D, uuid:2D4C5691444811DD8A68A95C3D41E62D, uuid:2D4C568F444811DD8A68A95C3D41E62D, uuid:A5AEEB28448311DD8A68A95C3D41E62D, uuid:A5AEEB28448311DD8A68A95C3D41E62D, xmp.did:74117FED20071168AE56EA76C4861F44, uuid:A5AEEB28448311DD8A68A95C3D41E62D, uuid:2D4C568F444811DD8A68A95C3D41E62D, uuid:2D4C5691444811DD8A68A95C3D41E62D, uuid:403A55CB170511DFB1F3F8485B53F00B, uuid:982BECC7952F11DD9A6FB23F35800D93, uuid:403A55CD170511DFB1F3F8485B53F00B, xmp.did:74117FED20071168AE56EA76C4861F44, uuid:94E18DAE441811DD8A68A95C3D41E62D, uuid:0FD99FE4443211DD8A68A95C3D41E62D, uuid:27332663171311DFB1F3F8485B53F00B, uuid:2D4C5691444811DD8A68A95C3D41E62D, uuid:2D4C568F444811DD8A68A95C3D41E62D, uuid:A5AEEB28448311DD8A68A95C3D41E62D, uuid:A5AEEB28448311DD8A68A95C3D41E62D, xmp.did:74117FED20071168AE56EA76C4861F44, uuid:94E18DAE441811DD8A68A95C3D41E62D, uuid:0FD99FE4443211DD8A68A95C3D41E62D, uuid:2D4C5691444811DD8A68A95C3D41E62D, uuid:2D4C568F444811DD8A68A95C3D41E62D, uuid:27332663171311DFB1F3F8485B53F00B, uuid:101F77EC170811DFB1F3F8485B53F00B, uuid:18BAA929441A11DD8A68A95C3D41E62D, xmp.did:74117FED20071168AE56EA76C4861F44, uuid:18BAA92F441A11DD8A68A95C3D41E62D, uuid:2DE22A0843BE11DD8A68A95C3D41E62D, uuid:A5AEEB28448311DD8A68A95C3D41E62D, uuid:05A06E0E441B11DD8A68A95C3D41E62D, uuid:05A06E0C441B11DD8A68A95C3D41E62D, uuid:94E18DB4441811DD8A68A95C3D41E62D, uuid:36207CE843B711DD8A68A95C3D41E62D, xmp.did:74117FED20071168AE56EA76C4861F44, uuid:05A06E0A441B11DD8A68A95C3D41E62D, uuid:05A06E10441B11DD8A68A95C3D41E62D, uuid:18BAA931441A11DD8A68A95C3D41E62D, xmp.did:74117FED20071168AE56EA76C4861F44, uuid:2D4C568F444811DD8A68A95C3D41E62D, uuid:0FD99FE4443211DD8A68A95C3D41E62D, uuid:94E18DAC441811DD8A68A95C3D41E62D, uuid:0FD99FE4443211DD8A68A95C3D41E62D, uuid:94E18DAE441811DD8A68A95C3D41E62D, uuid:0FD99FE4443211DD8A68A95C3D41E62D, uuid:94E18DAE441811DD8A68A95C3D41E62D, xmp.did:74117FED20071168AE56EA76C4861F44, xmp.did:74117FED20071168AE56EA76C4861F44, xmp.did:74117FED20071168AE56EA76C4861F44 Metadata Date : 2010:07:05 16:15:07-07:00 Creator Tool : Adobe InDesign CS4 (6.0) Thumbnail Format : JPEG Thumbnail Width : 256 Thumbnail Height : 256 Thumbnail Image : (Binary data 8022 bytes, use -b option to extract) Doc Change Count : 95588 Format : application/pdf Producer : Adobe PDF Library 9.0 Trapped : False Page Count : 41EXIF Metadata provided by EXIF.tools