GB2217208A - Standing frame apparatus to augment physiotherapy treatment in training of the neuromuscular system - Google Patents

Abstract

A standing frame has foot-positioning means 16 pivotally mounted on mounting blocks 12 so that it can tilt forwardly and rearwardly about a transverse axis of the apparatus. The foot-positioning means is provided with a longitudinally adjustable heel stop 20 and foot straps 32 and 36 to hold the patient's feet in position. Upstanding swing arms 24 are also pivotally mounted on the outside of the mounting blocks 12 and a knee bar 26 extends between the upper ends of the swing arms. The position of the knee bar is adjustable longitudinally, being suported by means of telescopic stays 28 and 30 extending between the arms 24 and the foot positioning means. The standing frame may be used to dispose the patient's feet and lower legs suitably in order to concentrate motor learning on the knee and hip joints. <IMAGE>

Description

STANDING FRAt4E APPARATUS TO AUGMENT PHYSIOTHERAPY TREATMENT IN TRAINING OF THE NEUROMUSCULAR SYSTEM The physiotherapy treatment of people handicapped by cerebral palsy involves careful handling of the patient in order that only appropriate and desirable responses are elicited. In order to obtain the maximum effect on motor learning the patient should be maintained in an environment of appropriate input and stimulation for as much of each day as possible.

However, available physiotherapy time is very limited and this ideal is difficult to achieve.

Video analysis of the physiotherapist's input to achieve independent standing in ouadripleaic or diplegic patients shows that three factors are involved: Firstly, the physiotherapist works to gain stahility and control of the spinal column from the head downwards, so following the normal developmental secuence.

Secondly, the physiotherapist, when treating a patient, guides the patient into the required standing posture and manually holds the trunk and limbs in the desired position. In a very heavily handicapped or active patient this can prove difficult.

Thirdly, and perhaps most importantly, the physiotherapist's aim is then to let go of the patient and so to teach him to hold the desired posture by himself. Effective motor learning will only take place through free active movement of the joints. Hoiever, this movement must be carefully controlled to ensure that the joint geometry remains normal and appropriate to the situation.

It is an object of the present invention to provide standing frame apparatus the use of which can augment physiotherapy treatment in training of the Neuromuscular system, for example of cerebral palsied children, the apparatus permitting a patient under treatment to respond actively rather than imposing passive positioning as would a conventional standing frame.

The invention provides, in one of its aspects, standing frame apparatus suitable for use in augmenting physiotherapy treatment in training of the Neuromuscular system, the apparatus comprising foot-positioning means on which a patient can stand and by means of which the patient's feet can be secured in the apparatus, and adjustable knee-positioning means whereby the patient's knees can be retained in required positions of longitudinal adjustment relative to the feet, the foot-positioning means being adjustable to vary the inclination of the feet to the lower leg for a given position of the knee-positioning means relative to the feet.

By means of such apparatus one can prevent movement at the foot and ankle (held by the foot-positioning means) in order to focus motor learning on the knee, hip and trunk. By positioning the knee joint suitably (by means of the knee-positioning means) relative to the position of the foot, ane establishing a suitable inclination of the foot (determined by the adjustment of the foot-positioning means) in plantArflexion, dorsiflexion or its neutral inclination, a balanced geometry can be created.

Preferably the subtalar and forefoot joints should be held in neutral inversion/eversion. This neutral position may be obtained only b the use of, for example, a longitudinally placed wedge beneath the foot to restore alignment in cases of deformity which can be corrected. The wedge could be used beneath the inside or outside border of the foot as desired. Movements at the forefoot, subtalar and ankle should be eliminated.

The lower leg may he supported by the knee-positioning means as high as the tibial tuberosity, but should permit flexion and extension of the knee and free movement of all joints above the knee.

The apparatus may desirably permit a variation of foot inclination from 200 plantarflexior. to 200 dorsiflexion. The angle should preferably be infinitely variable within the given range, lockable at any position.

Safety systems can be provided to cater for failure of the patient's neuromuscular system to control movement within a prescribed range. This will apply at hip level (buttock: support) in the event of collapse at the knees, trunk support in the event of forward or backward collapse at the hips, and possibly head support. These safety features, for example a harness-type device, should not influence the free standing position but should be adjustable to come into effect only when a pre-defined freedom of movement is exceeded.

The knee-positioning means should preferably not dictate knee spacing, in order that a greater range of patient sizes can be accommodated by one apparatus.

However, load at the tibial tuberosity should be distributed over as wide an area as possible.

The foot-positioning means of the apparatus may comprise a single support on which the patient stands with both feet and which is pivotally mounted to tilt forwardly and rearwardly about a horizontal transverse axis. Suitable locking means can enable the support to be secured in a required adjusted position. A heel stop and foot securing straps, for example arranged to pass over the instep and forefoot, may be incorporated in the foot-positioning means for positioning and securing each foot. The position of the heel stop may itself be adjustable longitudinally (i.e. in the direction forwards and rearsvards of the apparatus).

The foot-positioning means may instead comprise two foot supports of which the relative heights can be continuously adjustable by the therapist when the patient is in the device. This should be a reciprocal action, through a distance of, perhaps, up to 50mm above and below a ccralon level.

The knee-positioning means max conveniently comprise a knee-supporting member (e.g. a transversely extending pad) arranged to the front of the legs to be abutted by the tibial tuberosity or a lower portion of the lower leg. Securing straps may extend from the knee-supporting member for fastening around the patient's leg, without restricting free movement of the knee joint, so to retain the knee in position relative to the member.

The apparatus could be mounted on a base structure permitting tilting of the apparatus about a fore-and-aft axis to extend the range of motor learning.

Use of the apparatus could be extended by providing an adjustable support at the sacrum (base of the spine) with a securing strap around the pelvis (for example). Movement at the knee and hip joints would thus be eliminated, so focussing motor learning more specifically on the trunk, but still enabling a balanced geometry to be first obtained.

Such apparatus may find application in the treatment of both children and adults with a wide range of neurological conditions for which training of the Neuromuscular system by physiotherapy is indicated. An example of such a condition may be hemiplegia (or stroke!, in addition to Cerebral Palsy.

There now follows a detailed description, to be read with reference to the accompanying drawings, of standing frame apparatus which illustrates the invention by way of eample.

In the accompanying drawings: Figure 1 is a perspective view of the apparatus; and Figures 2A and 2B are diagrammatic views, from one side of the apparatus, illustrating use of the apparatus.

The apparatus, which is for use in augmenting physiotherapy treatment of cerebral palsied children, comprises a horizontal base board 10. Two mounting blocks 12 (one only shown) project up from a flat top surface 14 of the base board to form two co-axially and horizontally aligned pivotal mountings, spaced apart across the width of the base board.

A mounting board 16 having a flat top surface 18 is mounted between the blocks 12 to tilt, on the pivotal mountings, up to 200 to either side of a level position. Blocks (not shown) may be placed beneath the mounting board 16, on the top surface 18 of the base 10, to position the mounting board in a required attitude; more preferably a suitable locking mechanism, allowing infinitely variable adjustment of the mounting board position, may be provided. A heel stop is provided in the form of a heel board 20 which stands up perpendicularly from the top surface 18 of the mounting board 16 at a position rearwardly of the pivot axis formed by the mounting blocks 12. The heel board is secured in parallel with the pivot axis, and its distance fro the pivot axis is variable.

Two upstanding swing arms 22 and 24 are pivotally mounted on the outsides of the mounting blocks 12, to pivot about the same pivot axis as the mounting board 16. The arms are interconnected at their top ends by a padded knee bar 26 which extends between them. The arms are supported by telescopic stays 28 and 30, extending between them and the mounting board 16, the stays permitting up to 450 forwards and 5 rearwards inclination of the arms from a perpendicular to the mounting board 16 and being lockable (by means not shown) in any required position of adjustment within that range. Adjustment is provided for (not shown) enabling the arm length to be varied in order to vary the height of the knee bar above the mounting board 16.

Use of the apparatus is illustrated by Figures 2A and 22. The mounting board 16, the heel board 20, two securing straps 32 (one only shown) secured to the heel board, and two securinc straps 36 (one only shown) secured to the mounting board form foot-positioning means of the apparatus; as shown in the drawings, a child can stand on the mounting board 16 with his heels against the heel board 20 and with his feet retained b means of the straps 32 and 36, which pass across the instep and forefoot respectively, so that his feet are secured in predetermined positions.

The child's knees are retained in required positions longitudinally relative to the feet by means of the knee bar 26 and securing straps 3t (one only shown) which extend from the bar 26 around the child's legs. The bar 26 and straps 34 form knee-positioning means of the apparatus, to be abutted by the tihial tuberosity or a lower portion of the lower leg, so to retain the knees in a required position without restricting free movement of the knee joints.

Depending upon the stage of the child's treatment the inclination of the mounting board 16 (and so the child's feet) to the horizontal, and the inclination of the swing arms 22 and 24 to the vertical, can be set suitably.

The standing frame apparatus stabilises the ankle by means of the knee bar and straps, the heel board and straps, and the mounting board and straps. The mounting board can be tilted and fixed in any position as required to accommodate ankle deformity, such as fixed equinus, or to permit the wearing of ankle foot orthoses while using the frame. The angle at which the lower leg is held can be finely adjusted by adjustment of the knee bar position. The standing frame can be used either barefoot or with shoes. It can be easily adjusted for different foot and leg lengths and so could be used by two or three children each day. In the illustrated form the standing frame is suitable for use by a child whose voluntary motor control extends down to the lumbar spine and who is showing some element of hip stability.

Claims (12)

1. Standing frame apparatus suitable for use in augmenting physiotherapy treatment in training of the neuromuscular system, the apparatus comprising foot-positioning means on which a patient can stand and by means of which the patient's feet can be secured in the apparatus, and adjustable knee-positioning means whereby the patient's knees can be retained in required positions Oi longitudinal adjustment relative to the feet, the foot-positioning means being adjustable to vary the inclination of the feet to the lower leg for a given position of the knee-positioning means relative to the feet.

2. Apparatus according to claim 1 wherein the foot-positioning means comprises a single support on which the patient stands with both feet.

3. Apparatus according claim 1 wherein the foot-positioning means comprises two foot supports the relative heights of which are adJustable.

4. Apparatus according to claim 2 or claim 3 wherein to vary the inclination of the feet the foot-positioning means is pivotable about a transverse axis of the apparatus and is arranged to be secured in a required pivotally-adjusted position.

5. Apparatus according to claim 4 in which the foot-positioning means can be pivotally adjusted to tilt both forwardly and rearwardly cf the apparatus te provide for plantarflexion and dorsiflexion as may be required.

6. Apparatus according to claim 4 wherein the foot-positioning means comprises a heel stop and foot securing straps to position and secure each foot.

7. Apparatus according to claim 6 wherein the heel stop is longitudinally adjustable.

8. Apparatus according to any preceding claim wherein the knee-positioning means comprises a knee-supporting member arranged to be to the front of the legs of the patient and to be abutted by a portion of the lower leg.

9. Apparatus according to claim 8 wherein the knee-supporting member comprises a transversely extending pad and securing straps extend from the member for fastening around the patient's legs.

10. Apparatus according to either of claims 8 and 9 wherein the knee-supporting member is mounted to pivot about a transverse axis of the apparatus for adjustment of the position of the knee-supporting member longitudinally of the apparatus.

11. Apparatus according to claim 10 wherein extensible means extends between the knee-positioning means and the foot-positioning means and is lockable to determine the position of adjustment of the knee supporting member relative to the foot-positioning means.

12. Apparatus substantially as described hereinbefore with reference to the accompanying drawings.