WO2008097134A2

WO2008097134A2 - Pace simulator, providing natural gait pattern, in rehabilitation of patients with infantile cerebral paralysis

Info

Publication number: WO2008097134A2
Application number: PCT/RU2008/000059
Authority: WO
Inventors: Yelena Vladimirovna Filatova
Original assignee: Yelena Vladimirovna Filatova
Priority date: 2007-02-05
Filing date: 2008-02-01
Publication date: 2008-08-14
Also published as: RU2007104242A; WO2008097134A3; RU2351304C2

Abstract

The trainings using PS allow on the cortex level to restore and fix the continuous process of information exchange between the CNS and skeleton muscles, malfunctioning due to the local cerebral lesions. It happens at learning natural gait pattern: 'heel - left foot toes, heel - right foot toes'. The basic element of PS (fig. 2, 3, 4) is a wheeled tent with pneumatic fixtures, keeping the patient in a vertically stable position. Teaching gait requires boots (fig. 6), the front and back cameras of which, following the natural gait pattern, are alternately pumped with a special liquid, (fig. 7). The extremities weighting is accompanied by simultaneous sound and light effects. Step- by-step movement of PS and the patient is achieved with the help of electric motor. The creation of the new 'artificial' dominant center of upright walking in the cortex (fig. 8) will be marked by building-up stable reverse links between central departments of the motor, kinesthetic, visual and auditory analyzers. It is assumed, that it will be clinically demonstrated by improving aligning skills, better balancing, stability and coordination, developing of new motor skills and stereotypes, including walking with the stop on the heel. It is also assumed, that a new dominant center, in accordance with neurophysiologic phenomena 'competition for the common final distance' (fig. 8) and 'central relief (fig. 9) will intensify the positive influence of the other methods of physical rehabilitation. References: A. V. Bogdanov. Physiology Of The CNS And Basics Of The Common Forms Of The Adaptive Behavior. Moscow: «PoligraphMaster», 2005. NK. Lysenkov, P.I. Karuzin. Surface Anatomy. Moscow: AST «Astrel», 2003. S. N. Popov. Physical Rehabilitation. Rostov-on-the Don: «Phoenix», 2005. E. D. Khomskaya. Neuropsychology. Fourth edition. Moscow, St. Petersburg: «Piter», 2005.

Description

Pace Simulator, Providing Natural Gait Pattern, Ia Rehabilitation Of Patients With Infantile Cerebral Paralysis

1. The Technical Field To Which The Invention Relates

The invention relates to medicine. To restore the locomotor function of the children, having local cerebral injuries, mainly, for the children with cerebral spastic infantile paralysis, pace simulator (PS), providing learning the natural gait pattern, is used.

2. Level Of Technique

The technology of physical rehabilitation of the patients with firm movement disorders as the result of malfunctions and injuries of the central nervous system (CNS) is represented by different types of therapeutic physical training (simulators, physical exercises, mechanotherapy, work therapy), tthe purpose of which is to fuller and faster restore the locomotor function of the patient. In ordeτ to achieve this goal, all methods of physical rehabilitation have one general principle - they are applied to the skeleton muscular system and are based on the combination of static, isometric and dynamic exercises to increase muscular bulk and strength, range of motions in joints, better lbalancing, as well as, to expand motor skills.

We did not find any similar pace simulator in the available literature. The pace simulator we offer (fig. 2, 3, 4) is principally different from the existing ones. Its construction allows to stabil ize the patient in an upright position, and to teach him/her natural gait pattern: "heel - left foott toes, heel - right foot toes". Pneumatic fixtures, attached to the metal stand of the wheeled tent, keep the patient vertically stable. Teaching gait requires training boots, the front and back cameras of which are alternately pumped ( by the 'pump' device) with a special liquid, thus, weighting corresponding parts of the extremities in a natural gait pattern (fig. 7). Weighting of the extremities is accompanied by simultaneous sound and light effects. Electric motor sets pace for the simulator and, consequently, for the patient.

It is assumed, that consistent trainings using PS will have a combined influence over the kinesthetic system, thus, building up a new 'artificial' dominant center in the cortex, focusing on the upright walk in a natural gait pattern: "heel - left foot toes, heel - right foot toes" (fig. 8) with correct distribution of the centre of gravity, coordinating and aligning the muscles (fig. 1). Hence, trainings using PS are applied to the CNS and are based on the complex influence over the afferent system of the kinesthetic analyzer in order to build up a new 'artificial' dominant center in the cortex, focusing on an upright walk in a natural gait pattern.

3. Disclosure Of The Invention

3.1. Modern neurophysiology concepts of the dominant, underlying in the PS construction and methods of use, promote the original approach to the restoration of the locomotor function of the patient. The task is being solved indirectly, by creating a new 'artificial' dominant center in the cortex, focusing on an upright walk in a natural gait pattern with bilateral (direct and reverse) associative links between motor, kinesthetic, visual and auditory analyzers (fig. 8).

The tent with pneumatic fixtures, supporting the patient's body in a stable upright position 'sitting;' or 'standing' (fig. 3, 4), make for creating the centre of gravity while upright walking, and, consequently, for creating many other aligning reactions, directed on keeping the balance and improving coordination in an upright position.

Teaching natural gait pattern "heel - left foot toes, heel — right foot toes" is performed with the help o f training boots, having front and back cameras (fig. 6, 7). The 'pump' device automatically and alternately, according to the set pace, supplies a special liquid, weighting corresponding parts of the extremities. Weighting of the extremities is accompanied by simultaneous sound and light effects. Electric motor sets pace for the simulator and, consequently, for the patient.

In the result of trainings using PS, the complex influence over the afferent system of the kinesthetic, visuial and auditory analyzers is achieved; stable associative links between them are built up in the cortex (fig. 8).

3.2. The formation of the stable reverse links between the above-mentioned analyzers will evidence the technical result of the trainings using PS, that is, the formation of the new 'positive' cortex dominant center of the upright walking in a natural gait pattern (fig. 8).

The achievement of the technical result will be evidenced by the appearance of direct positive clinicopathologic effects, their degree depending on the initial condition of the patient. It is assumed, tihe patients in a serious condition will require less number of pneumatic fixtures to keep him/her upright or there will appear a possibility to sit independently due to the increased umber of aligning reflexes, better balancing and keeping stable, the appearance of the centre of gravity in the proper place while sitting (fig.l - b, c, d). The patients with less morbid condition might have fuller, or closer to the fullest, restoration of the natural gait pattern with the heel footing, diminution of the arm and leg 'swing', better step balancing, fading away of the pathologic motor stereotypes, acceleration ol me development new motor skills. Indirect positive clinical effects after using PS will demonstrate themselves in increased bulk of the lower extremities, improved cognitive and fine motor skills, speeding-up the psycho-speech development, etc.

It is assumed, according to the neurophysiologic phenomena 'competition for the common final distance' (fig. 8) and 'central relief (fig. 9), a new dominant centre will intensify positive influence of the other methods of physical rehabilitation of the patient, thus, indirectly promoting fuller and faster restoration of his/her locomotor function.

4. Brief Description Of Figures

Vertical arrows in figure 1 demonstrate position and direction of the plumming line, going through the centre of gravity and inside the base in different starting positions of a healthy man:

Fig. 1 (a) - 'standing'. In the upright symmetrical position, when the body rests on both legs, the centre of gravity is located in the sacral canal, above the second sacral vertebra. The plumming line, going through it, falls between both feet;

Fig. 1 (b) - 'sitting', the back is upright. The plumming line, going through the centre of gravity, goes behind the line, connecting both tuber ischiadicum;

Fig. 1 (c)> - 'sitting', the body bends forward. The plumming line, going through the centre of gravity, goes in front of the line, connecting both tuber ischiadicum; and, in different starting positions of the patient using PS while training: Fig. 1 (d> - 'sitting', Fig. 1 (e) - 'standing'.

Figure 2 represents pace simulator (PS), providing learning the natural gait pattern (front view):

1 - vertical part of the tripod in the centre of the back wall,

2 - pneumatic fixtures for the head and the body,

3 - dome, - A - 4 - lateral side,

5 - wheel,

6 - horizontal stick for hand support,

7 - handle for moving PS when using it as a transport means,

8 - the 'pump' device for automatic supply of the special liquid into the boots, and taking it back,

9 - electric motor, setting pace for the PS and for the patient,

10 - trainiing boots,

11 - hollow tubes for circulation of the special liquid, from the 'pump' device into the boots and back.

Note: Dotted lines show the electric connection between the electric motor and PS wheels.

Figure 3 represents pace simulator (lateral view) while training, the patient is in the 'sitting' starting position.

1 - vertical part of the tripod in the centre of the back side,

2 - pneumatic fixtures for the head and the body,

3 - dome,

5 — wheel,

6 - horizontal stick for hand support,

9 - electric motor, setting pace for the PS and for the patient,

10 - training boots,

11 - hollow tubes for circulation of the special liquid, from the 'pump' device into the boots and back,

12 - hat, with pneumatic fixtures for the head,

13 - collar, with pneumatic fixtures for the neck, 14 - waistcoat, with pneumatic fixtures for the body,

15 -tanks,

16 - cramp, for fastening a tank to the tripod,

17 - pump, for hand or automatic air supply into the tanks,

18 - detachable base,

19 - opening on the lateral side of the tank, framed by a cylinder and ending with a screwing head,

20 - opening on the front side of the tank, framed by a cylinder and ending with a screwing head,

21 - pnemmatic fixture on the waistcoat back in the folded position,

22 - free end of the pneumatic fixture in the form of a hollow cylinder,

23 - clip, keeping the pneumatic fixture in the folded position,

24 - opening on the upper part of the inside surface of the bootleg, framed by a cylinder and ending with a screwing head,

25 - detachable seat.

Figure 4 represents pace simulator (lateral view) while training, the patient is in the 'standing' starting position.

1 - vertical part of the tripod in the centre of the back side,

2 - pneumatic fixtures for the head and the body,

3 - dome,

5 - wheel,

6 - horizontal stick for hand support,

9 - electric motor, setting pace for the PS and for the patient, 10 — trainting boots,

12 - hat, with pneumatic fixtures for the head,

13 — collar, with pneumatic fixtures for the neck,

14 - waistcoat, with pneumatic fixtures for the body, 15 -tanks,

16 - cramp, for fastening a tank to the tripod,

17 - pump, for hand or automatic air supply into the tanks,

18 - detachable base,

24 - opening on the upper part of the inside surface of the bootleg, framed by a cylinder and ending with a screwing head.

Figure 5 demonstrates schematically the unfolded waistcoat.

12 - hat, with pneumatic fixtures for the head,

13 - collar, with pneumatic fixtures for the neck,

21 - pneumatic fixture on the waistcoat back in the folded position,

22 - free end of the folded pneumatic fixture to be put on the appropriate tank cylinder,

23 - clip,, keeping the pneumatic fixture in the folded position,

26 - upper part of the back,

27 - front flap,

28 - medial and lower parts of the back,

29 - fixtures connecting front flaps with each other and with the back. Note: Dotted lines show the projection of the attachment of the pneumatic fixtures to the hat, collar and back of the waistcoat Figure 6 depicts training boots. 5 - wheel,

9 - electric motor, setting pace for the PS,

11 - holkow tubes for circulation of the special liquid, from the 'pump' device into the boots and back,

24 - opeiαing on the upper part of the inside surface of the bootleg, framed by a cylinder and ending with a screwing head,

30 - front camera of the right boot,

31 - back camera of the right boot,

32 - right heel instep supporter in a free position,

33 - righ t front instep supporter in a free position,

34 - right sound and light elements in the position 'off,

35 - left heel instep supporter with closed plates,

36 - left front instep supporter with closed plates,

37 - left front sound and light element in the position 'on',

38 - back camera of the left boot, filled with liquid,

39 - left lback light element in the position 'on' (the sound is off),

40 - front camera of the left boot, filled with liquid,

Figure 7 represents the succession of the stages of the extremities' weighting while training, forming natural gait pattern: "heel - left foot toes, heel - right foot toes".

Fig. 7 (a) - "stop on the left heel":

9 - electric motor, setting pace for the PS, 11 - hollow tubes for circulation of the special liquid, from the 'pump' device into the boats and back,

30 - front camera of the right boot,

31 - back camera of the right boot,

32 - right heel instep supporter in a free position,

33 - right front instep supporter in a free position,

34 - right sound and light elements in the position 'off,

35 - left heel instep supporter with closed plates,

37 - left front sound and light element in the position 'on',

38 - back camera of the left boot, filled with liquid,

Note 1: For better perception of the further images of figure 7, the 'pump' device (8), electric motor (9), hollow tubes for circulation of the special liquid (11) are not presented in them.

Note 2: Arrows in all images of figure 7 indicate the direction of the liquid flow: black - liquid inflow from the device into the boot cameras, white - liquid outflow from the boot into the 'pump' device.

Fig. 7 (b) - "stop on the heel and left foot toes":

34 - rightt sound and light elements in the position 'off,

35 - left ttieel instep supporter with closed plates,

36 - left front instep supporter with closed plates,

37 - left front sound and light element in the position 'on',

38 — back camera of the left boot, filled with liquid,

39 - left back light element in the position 'on' (the sound is off),

40 - front camera of the left boot, filled with liquid. Fig. 7 (c) - "step forward, rest on the right heel": 32 - left lheel instep supporter in a free position, 33 - right front instep supporter in a free position,

34 - left back sound and light element in the position OfF,

35 - right heel instep supporter with closed plates,

36 - left front instep supporter with closed plates,

37 - right back sound and light element in the position 'on',

38 - back camera of the right boot, filled with liquid,

39 — left front light element in the position 'on' (the sound is off),

40 - front camera of the left boot, filled with liquid.

Fig. 7 (d)) - "stop on the heel and toes of the right foot":

34 - left back sound and light element in the position 'off,

35 - right heel instep supporter with closed plates,

36 - right front instep supporter with closed plates,

37 - right front sound and light element in the position 'on',

38 - back camera of the right boot, filled with liquid,

39 - right back light element of the camera in the position 'on' (the sound is off),

40 - front camera of the right boot, filled with liquid. Fig. 7 (e)» - "step forward, stop on the left heel": 32 - right heel instep supporter in a free position,

34 - right back sound and light element in the position 'off,

35 - left heel instep supporter with closed plates,

36 — right front instep supporter with closed plates,

37 - left back sound and light element in the position 'on',

38 - back camera of the left boot, filled with liquid,

39 - right front light element of the camera in the position 'on' (the sound is off),

40 - front camera of the right boot, filled with liquid. Fig. 7 (f> - "rest on the heel and toes of the left foot":

34 - right sound and light elements in the position 'off, 35 - left heel instep supporter with closed plates,

36 — left Jfront instep supporter with closed plates,

37 - left ifront sound and light element in the position 'on',

38 - back camera of the left boot, filled with liquid,

39 - left back light element of the camera in the position 'on' (the sound is off),

40 - front camera of the left boot, filled with liquid.

Figure 8 depicts a neurophysiologic phenomenon of 'competition for the common final distance".

Sensory zones of the cortex:

41 - prernotor,

42 - motor,

43 - sens ory,

44 — visual sensory,

45 - visual associative,

46 - auditory sensory,

47 - audi tory associative, Cortex centers:

48 - pathologic lesion,

49 - new associative links between central departments of the motor, kinesthetic, visual and auditory analyzers of the cortex,

50 - positive 'artificial' centre,

51 — efferent impulsation from 'artificial' positive center, suppressing negative influence of the pathologic lesion ('competition for the common final distance' phenomenon).

Figure 9 represents a neurophysiologic phenomenon of 'central relief.

The neuron at the periphery location (between circumferences) becomes excited only with a simultaneous excitement of two neurons from the left nervous center and two neurons from the right center. Joint stimulation of the fibrae leads to the reaction the way more powerful than just the common sum of reactions of the stimulation of each fiber separately (2+2=5). 5. Realization Of The Invention 5.1. Detailed Description Of The Pace Simulator

Pace simulator consists of the two main parts: a tent with pneumatic fixtures and training boots.

The temt with pneumatic fixtures (fig. 2, 3, 4) is aimed at keeping the patient in a vertically stable position during the trainings in the starting positions 'sitting' and 'standing'. The training boots (fig. 6, 7), the front and back cameras of which are alternately pumped (by the 'pump' device) with a special liquid, are used for weighting extremities in a gait pattern, similar to the natural: "heel - left foot toes, heel - right foot toes".

The tent, made of metal and plastic, has a back wall, 2 side walls, a dome-like ceiling and a base (fig. 2). The base is detachable; in this case, PS can be placed on the floor. Most weight of the tent makes the tripod, having a rectangular shape (fig. 3, 4). The vertical part of the tripod takes the central part of the back wall, horizontal - the central part of the tent dome. The main area of the walls and the ceiling consists of the clear light material, framed with a wide metal belt: downwards, contributing to the construction stability. The wheels are attached to the belt, making the tent easy to move while training. The sizes of the tent depend on the patient's height. For instance, if the patient is 100 cm tall, the tent is supposed to be 120-130 cm, the same size is the width and length of its base. The tent can consist of separate components, thus, allowing variable sizes at folding. A handle can be attached to the dome of the tent, thus, making possible to use PS as a transport means while taking a stroll outside.

Additional components of the tent are: a removable seat, attached to the vertical part of the tripod at a desirable height; a wooden stick for hand support; a wooden or plastic table in the shape of a wide shelf for studying (modeling, playing games) while exercising in the 'sitting' position. The stuck and the table are attached in front of the patient at a desirable height.

Three tanks, made of plastic or metal, having a parallelepiped shape are attached to the tripod by means of cramps. The first (smaller) one is attached to the horizontal part of the dome, the second and the third (medium and big) ones - to the vertical part in the upper half. The square of the front wall of the smaller tank is approximately equal to the square of the parietal part of the head, medium - to the back surface of the neck and occipital. The square of the front wall of the big tank, consequently, is equal to the square of the child's body. The height of the tanks is 5 cm. Each tank is supplied with air by a hand or automatic pump before training. The air goes through the openings on the lateral side with the radius from 1.5 cm to 2.0 cm, framed with cylinders wfώ screwing heads. Along vertical medial line on the front waM of each tank there are openings with the radius from 2.5 cm to 10 cm, framed with cylinders with screwing heads. The front waft of fee smaller tank there is 1 opening, oϊ fee medium -2, ^"big - 3 (fig. 3, 4).

Pneumatic fixtures (fig. 3, 4, 5), aimed at head, neck and body support in a vertically stable position, are represented by crimped hoses. The hoses are made of rubberized material, characterized by elasticity and flexibility. Due to feat, they expand at air supply and they return to regular size at fixture depressurization. An end of fee pneumatic fixture is inducted into fee appropriate part of fee outfit: a hat, a collar and a waistcoat, made of flexible, tight-fitting material (fig. 5). Another end remains free; it is an elastic tube wife fee diameter equal to fee diameter of fee corresponding cylinder, framing fee opening on fee front wall of fee tank. Free flexible ends of fee hoses are put on fee tank cylinders, providing the system impermeability: "tank - pneumatic fixture".

There provided 6 pneumatic fixtures, different in diameter (fig. 3, 4, 5):

2 for the head - parietal and occipital, 1 for fee neck, 3 for fee body: shoulder, spinal and lumbar. The hose diameter is 5-7 cm for fee head and neck fixtures, 7-12 cm for fee body fixtures, increasing from top to bottom. The length of all fixtures is fee same and makes 50-70 cm. When not working, they are folded and attached to fee clothes by clips. While working, fee clips allow adjusting fee fixture length, fastening part of fee hose in fee folded position (fig. 3, 5).

The aijr supplies into fee fixtures wife fee help of a hand or automatic pump (fig. 2, 3, 4). First, fee aiir goes through fee lateral openings into fee tanks, Λen - through fee openings in fee front wall imto fee fixtures, hermetically attached to them. Being filled wife air, the fixtures secure fee head, neck and body of fee patient in a vertically stable position wife fee slightest amplitude of fee body deviating forward or into fee sides from fee plumming line, going through fee centre of gravity in fee position 'sitting' or 'standing'.

The second main part of PS is fee training boots (fig. 6). They provide alternate weighting of fee front and back parts of fee extremities in fee pattern, similar to natural: "heel - left foot toes, heel - right foot toes". The boots are made of 2 layers of waterproof fabric. The fabric of fee inner layer, besides being waterproof, is flexible and elastic, feat allows it to tightly fit shanks and feet. The airea between inner and outer layers is filled wife porous material, good for free liquid circulation. The material of fee porous inner layer is also characterized by flexibility and elasticity; its vo lume increases when filled with liquid, and returns to the regular size with liquid outflow. Every boot is separated into two parts: rroπr and back cameras, inner areas of winch are isolated from each other on the side of the outer surface by a dense stitch, going through all layers; on the ^'miner surface -^"by a detachable zipper and a stitch. The plantar part of the ^"boots is made of one layer of the flexible tight-fitting material 0.3 - 0.5 cm wide. Outer plantar parts have two instep supporters: heel and front with the size similar to the size of the corresponding plantar parts. Every instep supporter has 2 thin metal plates (upper and lower) with the elements, sealing the electric circuit. Between plates there is porous elastic material, easily compressing with the extremity stopping on the heel or on the toes, providing plates closure and elements contact. Due to the material elasticity when not stepping on a heel or on toes, the instep supporter returns to its initial shape, the elements get disconnected.

The instep elements are electrically connected with 4 sound and light elements, the latter having a round shape and located on the front and back boot cameras. They provide simultaneous sound and light effect at the closure of each instep supporter.

Special colloid liquid, used in toy manufacturing, is pumped into each boot camera from the 'pump' device lby means of 4 soft flexible tubes. Free ends of the tubes are put on 4 cylinders, framing the openings of 1.0 - 2.0 cm in radius, located in the upper part of the internal surface of the bootlegs. Easy circulation of the liquid from the 'pump' device into the boots and back is provided by 4 systems: the 'pump' device - tube - opening in the upper part of the bootleg - corresponding part of the boot. The tubes, connecting the 'pump' device with the back cameras of the boots are red; the tubes, connecting the 'pump' device with the front cameras of the boots are green. Colloid liquid, going into the back and front parts of the boots, has the similar fluorescent colors: red liquid goes into the back cameras, green liquid - into the front.

The 'pump' device has 2 similar tanks, for green and for red liquids, with the volume of 300- 500 ml each. The dispenser on the front wall of the 'pump' device sets necessary amount of the liquid, going unto the boot cameras and providing weighting of the corresponding part of the extremity until it stops on the heel, and the plates of the heel instep supporter get closed, or, until it stops on the toes, and the plates of the front instep supporter get closed. As soon as the plates of the heel instep supporter get closed, the back sound and light element turns on. Note 'C is playing, the red fluorescent liquid is blinking simultaneously. As soon as the plates of the front instep supporter get closed, the front sound and light element turns on. Note 'D' is playing, the green fluorescent liquid is blinking simultaneously. The sounds are short, their length is equal to the first 2-3 seconds of the instep supporters' closure. The length of the light effects is similar to the time the extremity rests on the heel or on the toes, that makes 5-10 seconds and depends on the pace set.

The pace and the order of the liquid flow into the each camera of the boot and back by means of the 'pump' device, as well as me duration oϊ fhe training, is set ^"by a controller wϊfh a special scale, located on the front wall of the 'pump' device (fig. 2, 3, 4). The 'pump' device is cramped to the vertical part of the tripod (in the lower third part) above the electric motor. The 'pump' device and the electric motor are electrically connected.

The electric motor, connected electrically with the PS wheels, provides step-by-step movement of the PS in a set pace. It can work either as an AC or DC device, the electric motor is cramped in the lowest part of the tripod. Special controlling device provides simultaneous work of the 'pump' device and the electric motor.

5.2. Brief Description Of Trainings. Using Pace Simulator

The program of trainings using PS consists of different stages, the length of each one depending on the seriousness of the patient's clinical condition.

1st stage. Keeping the patient upright in the 'sitting' starting position (fig. 1-d; 3).

The patient puts on a hat, a collar and a waistcoat. Then, he is placed on the seat with his feet touching the base of the tent or the floor. A distance piece or a soft bolster is used to open the hips. The heads of the cylinders, framing the openings on the front walls of the tanks, are taken off. The clips on the outfit, holding the fixtures in the folded position, are unbuckled. Free ends of the fixtures are put on the corresponding cylinders. The clips adjust the length of each fixture so that they are strained in a straight line, parallel to the PS base. After taking the head on the lateral side of the tank of each cylinder off, the air is pumped into the systems: 'tank - pneumatic fixture'. Having filled each system, the lateral openings are closed with a screwing cap.

If the above-mentioned procedure is done properly, every fixture keeps stable the corresponding part of the body, providing mostly upright position for the head, neck and the body with the slightest left-right and back-forward amplitude. The plumming line goes through the center of gravity, located in the centre, between tuber ischiadicum, with the smallest amplitude back, and forward (fig. 1 - b, c, d). A horizontal stick with hanging toys, or a table with games are placed in front of the child. The duration of keeping vertical in the starting position 'sitting' is individually selected. It depends on the initial clinical condition of the child. The PS can be uised while having meals, studies or taking walks. It is assumed, that the beginning of the formation of the new associative links and a new positive 'artificial' dominant center in the motor zone of the cortex will be evidenced by the development of new independent coordination skills - the skill to keep the head, neck and body in an upright position without ^"1 or 2 pneumatic fixtures.

If, in the result of the trainings to keep vertically stable in the 'sitting' starting position, the above-mentioned dynamics appears, or the child initially keeps good balance in the 'sitting' starting position, it is recommended to go on to the next stage immediately or after a several sessions of exercises.

2nd stage: 'pireparatory'. Alternate weighting of the extremities in a natural pace gait: "heel - left foot toes, heel — right foot toes" within a 'sitting' starting position (fig. 1-d, 3).

The patient gets fixed in a 'sitting' starting position as it is explained in stage 1. The child gets hold on the horizontal stick or plays with the items on the table. He/she puts on training boots of the coαrect size (fig. 6). Soft tubes, connecting the 'pump' device with the training boots are put on the cylinders, framing openings on the inner surface of bootlegs. Red tubes go onto the cylinders of the back cameras, green - onto the cylinders of the front cameras. The dispenser on the front wall of the 'pump' device sets the necessary amount of liquid, going into each boot camera and weighting of the corresponding part of the extremity until it stops on the heel and the plates of the heel instep supporter close, or, until it stops on the toes and the plates of the front instep supporter close. The controller on the front wall of the 'pump' device sets the temporary parameters of the pace and total time of the training. E.g.:

Step 1 — supply of the liquid into the back camera of the left boot - 5 sec,

Step 2 - supply of the liquid into the front camera of the left boot - 5 sec,

Step 3 - pause - 5 sec,

Step 4 - siiwultaneous outflow of the liquid from the back camera of the left boot, liquid inflow into the lback camera of the right boot - 5 sec,

Step 5 - sim ultaneous outflow of the liquid from the front camera of the left boot, liquid inflow into the back camera of the right boot - 5 sec,

Step 6 - pause - 5 sec,

Step 7 - simiultaneous outflow of the liquid from the back camera of the right boot, liquid inflow into the back camera of the left boot - 5 sec

Step 8 - simultaneous outflow of the liquid from the front camera of the right boot, liquid inflow into the lback camera of the left boot — 5 sec,

Step 9 - pause - 5 sec,

Total time of the training - 10 min." The 'pump' device is on. The alternate weighting of the extremities with the simultaneous sound and light effects in a set pace, similar to the natural gait pattern, takes place (ftg. 7).

Step 1: red liquid of the pre-set amount with the help of the 'pump' device is supplied into the back camera oϊ the left ^'boot. Due to the weighting, the extremity stops on the ^"heel, the plates of the left heel instep supporter close, turning the back left sound and light element on. Note 'C is performed for 3 seconds — simultaneously, red blinking light is on. The duration of the step is 5 sec.

Step 2: greem liquid of the pre-set amount with the help of the 'pump' device is supplied into the front camera of the left boot. Due to the weighting, the extremity stops on the toes, the plates of the left front instep supporter close, turning the front left sound and light element on. Note 'D' is performed for 3 seconds - simultaneously, green blinking light is on. Weighting of the heel continues, so, the red light of the back camera of the boot is on too. The duration of the step is 5 sec.

Step 3: pause - 5 sec. Due to the gravity of the liquid in both boot cameras, the left extremity stops on the heel and on the toes. Plates of the both instep supporters close. Blinking light in both cameras off the left boot goes on.

The weight of the body gets transferred on the left extremity, thus, making it bearing; the right extremity is free.

Step 4: red liquid from the back camera of the left boot gets back into the 'pump' device, the weighting is offf, the heel is rising, the plates of the left heel instep supporter open, the left back light element is off, red illumination ceases.

Simultaneously with the liquid outflow from the back camera of the left boot, red liquid flows into the back camera of the right boot. Due to the gravity of the flowing liquid, the right extremity stops on the heel, the plates of the right heel instep supporter close, turning the right back sound and light element on. Note 'C is performed for 3 seconds, red blinking illumination appears simultaneously.

The gravity continues its action on the left foot toes, green illumination of the front camera of the left boot goes on. The duration of the step is 5 sec.

Step 5: green liquid from the front camera of the left boot gets back into the 'pump' device, the weighting is off, the front part of the foot is rising, the plates of the left front instep supporter open, the left front light element goes off, green illumination ceases.

Simultaneously, green liquid of the set amount by means of the 'pump' device flows into the front camera off the right boot. Due to the gravity of the flowing liquid, the extremity stops on the toes, the plates of the right front instep supporter close, right front sound and light element is on. Note 'D' is performed for 3 seconds, green blinking illumination appears simultaneously. The cftxratrorr of the step is 5 sec.

Step 6: pause - 5 sec. Due to the gravity of the liquid in both boot cameras, the right extremity stops on the ^"heel and on the foot. The plates of ^"both ϊnstep supporters close. Blinking light in both carmeras of the right boot is on.

The weight of the body gets transferred on the right extremity, thus, making it bearing; the left extremity is free.

Step 7: red lliquid from the back camera of the right boot gets backs into the 'pump' device, the weighting is: off, the heel is rising, the plates of the right heel instep supporter open, the right back light element goes off, red illumination ceases.

Simultaneously with the liquid outflow from the back camera of the right boot, red liquid flows into the back camera of the left boot. Due to the gravity of the flowing liquid, the left extremity stops on the heel, plates of the left heel instep supporter close, turning the left back sound and light element on. Note 'C is performed for 3 seconds, red blinking illumination appears simultaneously.

The gravity continues its action on the right foot toes, green illumination of the front camera of the right boot is on. The duration of the step is 5 sec.

Step 8: green liquid from the front camera of the right boot gets back into the 'pump' device, the weighting is off, the front part of the foot is rising, plates of the right front instep supporter open, the right front light element goes off, green illumination ceases.

Simultaneously, green liquid of the set amount by means of the 'pump' device flows into the front camera of the left boot. Due to the gravity of the flowing liquid, the extremity stops on the toes, plates of the left front instep supporter close, left front sound and light element goes on. Note 'D' is performed for 3 seconds, green blinking illumination appears simultaneously. The duration of the step is 5 sec.

Step 9: pause - 5 sec. Due to the gravity of the liquid in both boot cameras, the left extremity stops on the heel and on the foot. The plates of both instep supporters close. Blinking light in both cameras of the left boot is on.

Then, during the next 10 minutes the following pattern is repeated:

4 - 5 - 6 - 7 - 8 - 9 - 4 -...

At the end of the training the 'pump' device automatically takes the liquid back from the cameras into the pump. The duration of the trainings becomes gradually longer. There may be several trainings a day.

3^rd stage. Teaching gaft in a natural pace pattern: "heel - left foot toes, heel - right foot toes" (fig. 1-e, 4, 7).

This stage of foe training teaches gait in a natural pace pattern: "heel -left loot toes, ^"heel - right foot toes".

The base of the PS is removed, the patient stops on the floor of the training room.

Pneumatic fixtures keep the patient vertically stable in the 'standing' starting position, as it is described above (see "The 1^st stage'). If the above-mentioned procedure is done properly, every fixture keeps stable the corresponding part of the body, providing symmetrically vertical position for thie head, neck and the body with the slightest left-right and back-forward amplitude, the instructor helps to unbend knee joints, the heels touch the floor. The center of gravity is in the sacral canal above the second sacral vertebra; the plumming line, going through it, falls between both feet (1-a, 1-e, 4). The child gets hold on the horizontal stick.

He/she puts on training boots of the correct size. Soft tubes, connecting the 'pump' device with the training boots are put on the cylinders, framing openings on the inner surface of bootlegs. Red tubes go on the cylinders of the back cameras, green - on the cylinders of the front cameras. The dispenser on the front wall of the 'pump' device sets the necessary amount of liquid, going into each boot camera and weighting the corresponding part of the extremity until it stops on the heel and the plates of the heel instep supporter close, or, until it stops on the toes and the plates of the front instep supporter close. The controller on the front wall of the 'pump' device sets the temporary parameters of the pace and the total time of training (see 'The 2^nd stage '). The electric motor is fastened to the vertical part of the tripod under the 'pump' device. It is necessary to check its connection to the electric circuit or to check the battery. The controller on the front wall sets the parameters of the electric motor movement. E.g.: pace length — 10 cm, moving time — 2 sec.

Another controller sets the mode, simultaneous to the mode of operation of the 'pump' device, so, that the patient and the tent could move forward at the 3^rd, 6^th, and 9^th steps of training (see 'The 2^nd stage ').

The 'pump' device is on. The extremities weighting is accompanied by simultaneous sound and light effects in a natural gait pattern with PS and the patient moving accordingly in a set pace.

Step 1 (fig. 7- a): red liquid of the pre-set amount with the help of the 'pump' device is supplied into the back camera of the left boot. Due to the weighting, the extremity stops on the heel, the plates of the left heel instep supporter close, turning the back left sound and light element on. Note 'C is performed for 3 seconds — simultaneously, red blinking light is on. The duration of the step is 5 sec.

Step 2 (fig. 7- TJ): green liquid of fhe pre-set amount with the ^"help oϊ the "pump^"' device is supplied into th<e front camera of the left boot. Due to the weighting, the extremity stops on the toes, the plates of the left front instep supporter close, turning the front left sound and light element on. Note 'D' is performed for 3 seconds - simultaneously, green blinking light is on. Weighting of the heel continues, so, the red light of the back camera of the boot is on too. The duration of the step is 5 sec.

Step 3 (fig. 7- b): pause - 5 sec. Due to the gravity of the liquid in both boot cameras, the left extremity stops on the heel and on the toes. Plates of the both instep supporters close. Blinking light in both cameras of the left boot is on.

The weight of the body gets transferred on the left extremity, thus, making it bearing; the right extremity is free to move forward.

For the last 2 sec. of the step, the electric motor turns on and PS moves forward for 10 cm, involving the patient into the movement; to make a step the right foot moves forward with the instructor's help.

Step 4 (fig. 7- c): red liquid from the back camera of the left boot gets back into the 'pump' device, the weighting is off, the heel is rising, the plates of the left heel instep supporter open, the left back light element is off, red illumination ceases.

The gravity continues its action on the left foot toes, green illumination of the front camera of the left boot is on. The duration of the step is 5 sec.

Step 5 (fig. 7-d): green liquid from the front camera of the left boot gets back into the 'pump' device, the weiighting is off, the front part of the foot is rising, the plates of the left front instep supporter open, the left front light element goes off, green illumination ceases.

Simultaneously, green liquid of the set amount by means of the 'pump' device flows into the front camera of the right boot. Due to the gravity of the flowing liquid, the extremity stops on the toes, the plates of the right front instep supporter close, right front sound and light element is on. Note 'D' is performed for 3 seconds, green blinking illumination appears simultaneously. The duration of the step is 5 sec.

Step 6 (fig. 7-d): pause - 5 sec. Due to the gravity of the liquid in both boot cameras, the right extremity stops on the ^"hee^'l anά on fhe foot. The plates oϊ ^"both instep supporters close. Blinking light in both cameras of the right boot is on.

The weight of the body gets transferred on the right extremity, thus, making it bearing; the left extremity is free to move forward.

For the last 2 sec. of the step, the electric motor turns on and PS moves forward for 10 cm, involving the p.atient into the movement; to make a step the left foot moves forward with the instructor's help.

Step 7 (fig. 7-e): red liquid from the back camera of the right boot gets back into the 'pump' device, the weighting is off, the heel is rising, the plates of the right heel instep supporter open, the right back Ii ght element goes off, red illumination ceases.

Step 8 (fig. 7-f): green liquid from the front camera of the right boot gets back into the 'pump' device, the weighting is off, the front part of the foot is rising, plates of the right front instep supporter open, the right front light element goes off, green illumination ceases.

SimultaneoiEsly, green liquid of the set amount by means of the 'pump' device flows into the front camera of the left boot. Due to the gravity of the flowing liquid, the extremity stops on the toes, plates of the left front instep supporter close, left front sound and light element goes on. Note 'D' is performed for 3 seconds, green blinking illumination appears simultaneously. The duration of the step is 5 sec.

Step 9 (fig. 7-f): pause - 5 sec. Due to the gravity of the liquid in both boot cameras, the left extremity stops on the heel and on the foot. Plates of the both instep supporters close. Blinking light in both cameras of the left boot is on.

The weight of the body gets transferred on the left extremity, thus, making it bearing; the right extremity is free to move forward. For the last 2 sec. of the step, the electric motor turns on and PS moves forward for 10 cm, iamlviag the p&tient into the movement; to rπafce a step die right foot moves forward with the instructor's help.

Then, during the next 10 minutes the following pattern ϊs repeated:

4 - 5 - 6 - 7 - 8 - 9 - 4 -...

At the end of the training the 'pump' device automatically takes the liquid back from the cameras into the pump.

The duration of the trainings becomes gradually longer. There may be several trainings a day.

It is assumed, that building-up new stable associative links between motor, kinesthetic, visual and auditory analyzers and the formation of the artificial 'positive' dominant center in the cortex, focusing on an upright walk in a natural gait pattern, will be evidenced by:

- the development of the positive independent coordination skills; in particular, the skill to independently hiold the head, neck, and body without one or two pneumatic fixtures,

- reduction of the amount of the liquid, necessary for weighting the extremities,

- development of the skill to throw the leg to make a step forward and move the tent independently without the help of the electric motor.

It is estimated, that beyond the trainings, the formation of the new dominant 'positive' center will clinically demonstrate itself in improving cognitive skills: faster acquiring new motor skills and stereotypes., speeding-up the psycho-speech.

Claims

6. Formula Of The Invention

To restore the locomotor function of the patients having local cerebral lesions, infantile cerebral paralysis, in particular, we offer a pace simulator (PS), providing learning gait in a natural pattern, "heel - left foot toes, heel - right foot toes", consisting of functionally and electrically connected:

- wheeled plastic tent with a metal tripod, vertical part of which is inducted into the central part of the back wall of the tent, horizontal — into the central part of the dome;

- 3 tanks (smaller, medium and big), attached to the tripod on the head, neck and body levels; having openings on the lateral and front walls, framed by cylinders with screwing heads for supplying air into the fixtures;

- pneumatic fixtures for head, neck and body support in a vertically stable position (2 for the head - parietal and occipital, 1 for the neck, and 3 for the body), represented by flexible crimped hoses, one end of whose is inducted into the hat, collar or waistcoat, another one is put on the corresponding tank cylinders;

- a puirap for hand or automatic air supply into the tanks and pneumatic fixtures;

- training boots, including front and back cameras, made of 2 layers of the waterproof elastic fabric, with a porous area between them;

- special colloid liquid, easily circulating in the internal surface of the front and back cameras of the boots, providing weighting of the corresponding part of the extremity; green liquid is supplied into the front cameras, red - into the back ones;

- the 'pump' device, attached to the lower third of the tripod vertical part and providing automatic alternate liquid supply into the boot cameras in a natural gait pattern;

- 4 soft hollow tubes, connecting the 'pump' device with the boot cameras: 2 green ones - for supplying liquid into the front cameras, 2 red ones - for supplying liquid into the back cameras; put on the cylinders, framing openings in the upper part of the bootlegs;

- front and heel instep supporters, located on the boots' soles, having two metal plates (upper and lower) with the elements of electric circle; closing due to the gravity of the liquid and turning the light and sound elements, electrically connected with them, on; - 4 sound and light elements, located in the boot cameras, providing simultaneous sound and light effects at weighting corresponding part of the extremity;

- electric motor, providing movement of the patient and the tent in a set pace; attached to the lower third of the vertical part of the tripod, electrically connected and simultaneously working with the 'pump' device.