Order form CMAX (distributor) For assistance in filling out this form, please contact our product specialist: Jiska Kempen: [email protected] / +31 6 42 37 50 40 1. System requirement/wishes Camera views Dorsal/Frontal 2nd Dorsal/Frontal Other Force plate Yes (push off and force vector) No Electromyography 8 Channels (muscle activity) Specify other ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ Sagittal (maximum of 4) 16 Channels No (2nd sagittal, focussed on the feet etc.): Extra comments * Bold/underlined options are the basic solution (basic solution always include a PC, power unit and software) 2. System purposes Organisation Type of analysis Kies een item. Define other: Clinical Gait Analysis Alignment orthosis/prosthetics Population Research Kies een item. ☐ ☐ ☐ 3. Usability Stand alone system Network system Yes ☐ Server Client: CMAX database on measurement PC; CMAX viewer to analyse data on another PC (export/import function); CMAX viewer builds an own local database (changes not visible in database measurement PC) No ☐ ☐ Kies een item. CMAX database on a server, all PCs with a CMAX license use the same database; different types of licenses* (different costs); specifications network: System Page 1 of 7 Order form CMAX (distributor) * Licenses: Server Analysis: ☐ Kies een item. Server Viewer: ☐ Kies een item. windows server 2003 R2, 2008 R2 SP1 & 2012, windows vista SP2, windows 7 SP1, windows 8 (32 and 64 Bits); Processor Intel@pentium processor 1.5 GHz; Memory: 1GB; Hard disk space: min. 10GB for database; min. 1000GB for video files; Network Connectivity: 1000Mbit/s (GiGE) netwerk. Server client: necessary to create the server database. In a server set up all measurement PCs need a server client; Server Analysis: license to use all analysis and report tools/functions of CMAX, changes will be saved in the database; Server Viewer: license to view all analysis, making/saving changes is not possible. 4. Overview gait lab* New or existing room Kies een item. Min. 400 x 800 cm (min. distance Width [cm] x Length [cm] sagittal camera - force plate: 300cm) Force plate(s) Pit: ☐ Walkway: Windows Yes: ☐ No: ☐ ☐ If yes: blindings required Min. 400 lux; measured on the Illumination [lux] walkway, foot height and hip height * please draw a map as precise as possible (see examples) and insert this drawing into this document (page 4 Floor plan) System Page 2 of 7 Order form CMAX (distributor) 5. Floor plan Exact dimension room, location cameras, force plate and workstation, distance between cameras and force plate, doors & windows Examples floor plan Example 1: Example 2: System Page 3 of 7 Order form CMAX (distributor) Floor plan customer Exact dimension room, location cameras, force plate and workstation, distance between cameras and force plate, doors & windows System Page 4 of 7 Order form CMAX (distributor) 6. Photos gait lab Photos of the room where the gait lab will be situated. System Page 5 of 7 Order form CMAX (distributor) 7. Installation information Cameras and force plate(s) have to be installed in the gait lab. The different options are selectable below and are important to know at forehand in order to send the correct products. Installation cameras Fixation Fixed to the wall Amount: Kies een item. Flexible (tripod) Amount: Kies een item. Cable length (cables from camera to PC should be neatly concealed in a cable tray or along the wall) Length Kies een item. * Bold/underlined options are the basic solution Installation force plate(s) Pit * Size (L*W*D): 700mm*700mm*±54.7mm (take into account the thickness of the top floor; check exact depth always with Lode) * Bottom of the pit perfectly straight * Own responsibility for the correct cover for the pit * The cover should be removable Walkway Lab requirements Floor Walls (only for the walls in the view of a camera) Light * Size depends on the room, minimum width 1220mm, height ±54.7mm (check exact height always with Lode) * Subfloor and walkway perfectly straight *Cut out for the force plate: 502mmx502mm * part around the force plate should be removable * Different colors between the floor and the walking track * Start and stop stripes * Colors not too dark * No shiny surface * Off-white or other light, matt color * No lights direct on the wall * Not too much decorations on the walls * Evenly distributed light * No lights direct above the walkway * No light from outside * Minimum requirement is 500lux Discussed with customer: Not applicable: Local partner: Order at Lode BV: Not applicable: ☐ ☐ ☐ ☐ ☐ Discussed with customer: ☐ Discussed with customer: ☐ Discussed with customer: ☐ System Page 6 of 7 Order form CMAX (distributor) Please return this order form to: Lode B.V. Zernikepark 16 9747 AN Groningen the Netherlands Tel: +31 50 571 28 11 Fax: +31 50 571 67 46 Web: www.lode.nl Mail: [email protected] System Page 7 of 7