RU149204U1 - COSTUME OF NEURODYNAMIC CORRECTION FOR RESTORATION OF MOTOR, POSITIVE, SENSOR AND COGNITIVE FUNCTIONS IN PATIENTS WITH THE PATHOLOGY OF THE NERVOUS SYSTEM AND MOTOR-VEHICLE APPARATUS - Google Patents

Abstract

1. The device of neurodynamic correction for the restoration of motor, posture, sensory and cognitive functions in patients with pathology of the nervous system and musculoskeletal system, containing shoulder, pelvic and foot supports, interconnected by fixing elements, elbow, wrist and knee supports, and fixing the elements are made in the form of rods located on the front, side and rear surfaces of the parts of the patient’s body, with each elastic rod rigidly connected at one end to the corresponding support, and the other - of its tension regulator, characterized in that the upper extremity comprise a rod adapted to simultaneous rotation and extension outward (supination) of the upper konechnosti.2. The device according to claim 1, characterized in that it further comprises a shoulder screed and shoulder tension loops fixing it on the suit, an adjusting elbow screed secured to the shoulder screed on the elbow side, to which tension belts are fixed from the side of the arm elbow joint, and tension belts made with the function of imitation of the palmar muscle and flexor of the wrist, which are fixed in the area of the beginning of the hand. 3. The device according to claim 2, characterized in that a thrust with the function of imitating the radial flexor of the wrist is withdrawn from the side of the hand from the palm of the elbow, and this thrust is fixed by means of holders attached to the elbow tie from the elbow. The device according to claim 1, characterized in that on the front surface of the shoulder is a thrust that simulates the biceps of the shoulder.

Description

The claimed solution relates to the field of medicine, in particular, to the treatment of children and adults with neurological and orthopedic diseases, accompanied by motor and postural (postural) disorders, pathology of the musculoskeletal system, sensory and cognitive functions (memory, attention, speech and intelligence). The device can be used to treat patients with pathology of the nervous and musculoskeletal system, training athletes and other types of activities that have high demands on the state of motor, posture, sensory and cognitive functions.

The prior art solutions: Suit for medical conductive rehabilitation of neurological patients with motor disorders according to the patent for the invention of the Russian Federation No. 2201177 (2000, Isanova VA), A method of restoring the motor functions of patients who are unable to move and hold the pose of the patent for the invention RF №2422119 (2009, Isanova V.A.), A multifunctional neuroorthopedic suit according to the patent for a utility model of the Russian Federation №112625 (2011, Aronskind EV), A method for creating a stable position of the patient’s body and limbs and a device for its implementation ticipate patent for the invention of Russian Federation №2187292 (2001 Kachesov VA), which are injected into the overalls with them gas or liquid.

The disadvantage of these devices is their complexity and the need for tanks with gas or liquid, as well as the fact that the load in these devices is uniform, and does not allow correction with additional effort of pathological settings and deformations of the joints of the extremities, which is possible only when creating a traction load, opposite to the patient’s pathological installation of the limb or joint deformation (for example, if the patient has flexion contracture of the elbow joint, traction the load should not be uniform on all sides, but aimed at the extension of this joint, for which the traction, simulating the extensor muscles of the arms should be pulled harder, which is possible in the device we offer). In addition, these methods, in contrast to what we offer, do not have a corrective effect on sensory and cognitive functions (perception, memory, hand-eye coordination, intellectual functions).

Also known: A method for the treatment of spastic forms of cerebral palsy and an orthopedic apparatus for its implementation according to the patent for the invention of the Russian Federation No. 2040923 (1995, Tychina VP), A device for the treatment of patients with impaired posture and motor activity according to the patent for the invention of the Russian Federation No. 2054907 (1996, Afanasenko N.I. et al.), Overalls for the treatment of patients with cerebral palsy and patients with consequences of traumatic brain injury (prototype) according to the patent of the Russian Federation No. 2131232 (1999, A. Averyanov .), Suit for forced change of pose of people century and creating increased load on the musculoskeletal system according to the patent for the invention of the Russian Federation No. 2295321 (2004, A. Grigoryev and others), Suit for the treatment of cerebral palsy according to the patent for utility model of the Russian Federation No. 2151 (2001 , Shamarin T.G., and others.), Load suit according to the patent for the invention of the Russian Federation No. 1473255 (1986, Bezhanov V.T. et al.).

All of the above structures have a common structural drawback - the lack of a dosed traction load on the upper limbs, due to the lack of rods in the upper limbs, therefore they can not contribute to: improving the muscle strength of the hands, as well as correcting pathological settings of the upper limbs and deformations of the joints of the upper limbs ( contractures of the shoulder, elbow, wrist joints), since this requires the creation of an additional metered traction load, opposite to the prevailing pain pathological installation of the limb or joint deformation.

The closest analogue selected as a prototype is the Adele costume [http://medprom.ru/medprom/mpp_0005486, http://www.adeli-suit.com/en/kostjum-adeli.html], also patented as Utility model of the Russian Federation No. 86458 and as the invention of the Russian Federation No. 2054907.

These solutions protect the device for the treatment of patients with impaired posture and motor activity, including the supporting elements of the device for attaching fastening clips and adjustable rods to them to create force vectors: a cap placed on the patient’s head, an upper supporting element placed on the shoulders, chest and the back of the patient; lower support element placed on the hip of the patient; elbow pieces, support elements placed on the patient’s hands, support elements for the wrist and finger supports, knee pads, support elements placed on the patient’s feet, and a support element made on the patient’s shoes, with power tapes attached to each support element on which mounting brackets for fixing adjustable power rods on them, which are made in the form of elastic bundles, these adjustable power rods are mounted on the fixing brackets of the respective support elements and / or connect between at a said support elements of the device to create force vectors in view of the anatomical structure of the patient muscle skeletal muscle to create the correct posture and movement trajectory of the trunk and extremities.

These solutions have a constructive drawback, namely, the absence of rods that contribute to the simultaneous extension and outward rotation (supination) of the upper limb, which does not allow the prevention and correction of pathological (pronator-flexion) installation and deformation of the joints (contracture) of the upper limb (which manifests itself in flexion and turning inward a sore arm).

The technical result of the claimed solution is the ability to prevent and correct almost any pathological settings and deformations of the joints of the upper and lower extremities by dosed selective tension of the rods on the trunk, legs and arms; increased resistance to pathological posture; strengthening correction and preventing the formation of deformities of the joints of the upper and lower extremities (hip, knee, ankle, shoulder, elbow and wrist joints); increase in muscle strength of the hands; improved hand motility; improving the development of sensory functions; improvement of cognitive functions.

The specified technical result is achieved due to the fact that the neurodynamic correction device for the restoration of motor, posture, sensory and cognitive functions in patients with pathology of the nervous system and musculoskeletal system, containing shoulder, pelvic and foot supports, interconnected by fixing elements, elbow, wrist and knee supports, and the fixing elements are made in the form of rods located on the front, side and rear surfaces of the patient’s body parts, with each elastic rod rigidly connected at one end with the corresponding support, and the other through its tension regulator, characterized in that the upper limbs contain traction made with the possibility of simultaneous extension and rotation to the outside (supination) of the upper limb.

Preferably, the shoulder tension loops on the suit fix the shoulder strap, to which the adjusting elbow strap is attached on the elbow side, to which the straps of tension on the side of the elbow joint of the hand are fixed, and the tension belts made with the function of imitating the palmar muscle and wrist flexor, which are in the beginning area the hands are fixed on the tension ring of the interphalangeal belts and to the wrist band.

The ring tension of the interphalangeal belts and the wrist strap are made into one element.

From the side of the hand from the palm of the elbow tie, the thrust is allotted, with the function of imitating the radial flexor of the wrist, and this thrust is fixed by means of holders attached to the elbow tie from the elbow. On the front surface of the shoulder can be located traction that simulates the biceps of the shoulder.

Brief Description of the Drawings

Figure 1 shows the constructive device of the zone of tension of the belts of the suit on the arm (front view of the left hand (a) and the view of the right hand from the back (b)). Figure 2 shows a General view of the device of the suit as a whole, including the supporting elements of the device, placed on the corresponding parts of the patient's body.

Utility Model Implementation

The device can be implemented as follows (see Figure 1). The shoulder loops (2) of the shoulder tension on the suit (1) hold the shoulder strap (11) and, on the one hand, are fixed by the shoulder strap (3) of the suit tension, hooked, for example, in the grommet holes in the belt (4), on which the hooks are attached with a tension loop. Adjustable circular elbow screed (5) allows you to change the length of the shoulders by tightening the screws, due to which the degree of load changes.

From the screed (5) there are tension belts (6) from the side of the elbow joint of the hand, tension belts (7) are imitators of the palmar muscle and flexor of the wrist, which pull the ring (8) of tension of the interphalangeal belts and the wrist band in the area of the beginning of the hand (9) . The latter can be made combined into one element, for example, on the basis of a flap, which is used to protect the brush when riding on roller skates). From the ring (8) and screed (9) from the back of the palm of the hand, the tension (10) of the thumb (it is on both sides) and, if necessary, the rest of the phalanges are tensioned. From the side (14), the hands from the palm of the phalanx can also be connected by tension (16) from the screed (9) and from the screed (5) the rod (12), which imitates the radial flexor of the wrist, is removed. The rod (12) is held by means of holders (13), attached to the elbow tie (5) on the side of the elbow and holding a connecting ring (20), to which the rod 12 is attached. On the front surface of the shoulder there can be a rod (17) that imitates the biceps muscle shoulder.

Thus, all the main traction is formed on the elbow (15) side of the arm and biceps, although under load, it is always free, which creates comfortable conditions for the child.

In the device we offer, traction located in the region of the upper extremities duplicates the location and function of the muscles of the upper limb (flexors, extensors, pronators and arch supports), which allows to prevent and correct almost any pathological settings and deformations of the joints of the upper extremities by dosed selective tension of the rods.

In FIG. Figure 2 shows a general view of the costume device as a whole, including supporting elements of the device located on the corresponding parts of the patient's body: cap (27), supporting element (26) on the shoulders, chest and back, supporting element (18), on the hip part, knee pads (19), a foot support element, a link (20) of the rods (12) and (13), a hand support element, a support element (21) for the hands and fingers, and a support element (22) on the patient’s shoes. To achieve directional correction of the posture and the patient’s movement, on the front side of the cap, each supporting element of the device and shoes, power tapes (23) are made, on which fixing clips (24) are installed. The ends of the adjustable elastic rods (25) are fastened in the indicated fastening clamps in the form of strands that create a load, while these elastic strands are placed under load on each supporting element of the device and / or on adjacent supporting elements of the device. Adjustable elastic traction is placed relative to the surface of the body, taking into account the anatomical structure of the skeletal muscles of the patient, depending on the differently directed force vectors of the physiologically correct trajectory of the patient's trunk and limbs. Depending on the load (a total of approximately 1 to 40 kg), the adjustable elastic rods have different diameters and lengths.

The suit gives the correct postural positioning of the trunk and lower extremities, restores the correct anatomical and physiological relationships in the joints of the lower extremities, and movements in a worn suit with fixed rods are carried out with a certain additional effort. The load is distributed along the longitudinal axis of the body, from the shoulders to the feet. The degree of tension of the draft-shock absorbers is selected individually taking into account the characteristics of the patient’s gait, state of muscle tone (flexors and extensors), the presence of contractures in the joints of the lower extremities (especially ankle), severity and type (tetraparesis, hemiparesis) of muscle paresis.

Patients with hemiparesis often have seizures on a sore leg when walking, pelvic distortions, functional scoliosis, shortening and hypotrophy of the limbs, asymmetric violation of tone and a decrease in muscle strength, foot deformities. In view of this, the shock absorbers in this form of the disease should be tensioned on both sides, and it is necessary to try to align the position of the shoulder and pelvic girdles as much as possible with them, to compensate for the distortion of the pelvis and spine. For this purpose, a gradual, from session to session, but rather intense tension of the rods going back from the shoulder pads to the belt of the suit is made, which helps to straighten the back and correct posture. Traction going in front of the shoulder pads to the belt pulls weaker, only to maintain balance. At the same time, the iliac-lumbar muscle (which is a synergist of the large adductor and gluteus maximus muscle) relaxes, the spasticity of which contributes to the formation of the flexion system in the hip joints, which can be observed not only in patients with hemiparesis, but with spastic tetraparesis. In order to reduce the tone of the gluteus maximus muscle, a stronger tension is required on the front foot shock absorber than the rear. In patients with hemiparesis, mainly on the affected side, and in patients with spastic tetraparesis on both sides, adduction and rotation into the thighs is often noted. To correct pathological adduction of the thigh, an external oblique thigh shock absorber is pulled. Thigh rotation outward and its partial extension is achieved by tensioning the external oblique shock absorbers.

To correct the equinus deformity of the feet, when the foot is in the position of the plantar flexion, it is necessary to attach a “stirrup” to the toe of the boot with traction on the patella. With the tension of such an external shock absorber located between the toe of the boot and the patella, and performing the function of the flexor muscles of the foot (anterior tibial muscle, long extensor of the fingers and thumb), plantar extension of the foot is achieved. In order to correct the equino-varus (most common) or equino-valgus deformity of the feet, it is necessary to determine the fixation points of the shock absorbers around the perimeter of the boot, and if necessary, use additional traction between the patella (belt) and the boot, depending on the task.

The distribution of the traction load on the right and left, front and rear is approximately 10 kgf (98 Newton). Examined during the entire period of use of the suit should be in motion: walking, running, jumping, crouching, which creates a load on the muscles of the limbs and trunk. During the use of the suit, the patient is recommended to make movements with his hands, especially fine motor skills, with an imitation of the movements most often used in everyday life, and also to talk.

The use of a treatment-and-loading suit should be carried out in the presence of an exercise therapy practitioner, whose responsibility is to monitor the position of the head, posture, step features, correct support on the sole, if necessary, correct the patient’s actions, and also monitor the appearance of possible somatic complaints - pain in the heart , in the back, dizziness, general weakness, possible at the beginning of the course due to the patient's condition factor.

Due to this factor, in the first days of the use of neurodynamic correction, the patient should be in the suit for no more than 20 minutes, then the time can be increased to 1 hour 30 minutes. Classes of exercise therapy, begun before the course of the use of the medical-loading suit, allowed to significantly reduce the number of somatic complaints. The course of application of neurodynamic correction can last up to 1-1.5 months; the duration of the use of the medical-loading suit is, on average, 20 sessions, daily, with breaks on weekends.

It was also found that when using the method of neurodynamic (neurosensory) correction (CPVD) in patients with cerebral palsy, the clinical picture, vertical stability are improved with an increase in the role of the visual analyzer in its regulation, gait, intellectual and speech functions, and the state of brain bioelectric activity (according to the results of electroencephalography) .

The basis of the action of this method may be the strengthening and correction of the proprioceptive afferent flow, which leads to the "loosening" of the pathological postural stereotype that has developed throughout the life of a patient with cerebral palsy, and contributes to the formation of correct postural and locomotor attitudes, as well as, due to a change in the functioning of associative parts of the brain , improving the functions of thinking and speech.

As our studies have shown, in patients with cerebral palsy, a significant decrease in vertical stability is noted, with a decrease in the role of the visual analyzer in its regulation (Yavorsky A.B., Nemkova S.A., Kobrin V.I. et al., 1997, 1998; Nemkova S.A., 2000). When using the KNDK method, stabilization indices are improved by a factor of 2 or more, which indicates an increase in vertical stability in patients with cerebral palsy, with the normalization of the role of visual and vestibular analyzers, due to a change in the interaction of sensory systems under changing proprioceptive load. It was revealed that the effect of applying the method of duodenal ulcer is not the same for various forms of cerebral palsy: improvement of vertical stability, gait biomechanics, increase in muscle strength are most pronounced with the hyperkinetic form of cerebral palsy, the least - in patients with hemiparesis; in patients with the atonic-astatic form of cerebral palsy, a sustained effect was observed only after several courses of duodenum (Yavorsky AB, Sologubov EG, Nemkova SA, 1997; Nemkova SA, 2000).

The use of a suit improves the interaction of visual and vestibular analyzers, cerebellar, rubrospinal and reticulospinal influences, which, according to researchers, leads to normalization of the main parameters of the statokinesiogram when standing with open and closed eyes (Yavorsky AB, Nemkova SA, Kobrin V .I., 1998). A biomechanical examination showed an improvement in the spatial and temporal characteristics of the gait using the duodenal ulcer method, with an increase in stride length, perinosal period, and range of motion in the hip, knee and ankle joints (Yavorsky AB, Sologubov EG, Nemkova S. A., 2004).

For the first time, we have identified the possibility of improvement in patients with cerebral palsy, as a result of the course application in the comprehensive rehabilitation of the duodenal ulcer method, verbal and non-verbal cognitive functions (memory, intelligence), with a change in interhemispheric interaction, which indicates an improvement in the functioning of the associative cortex (possibly due to the formation of new neuronal connections) and is confirmed by EEG studies (Nemkova S.A., 1999-2012). It was noted that in patients with cerebral palsy as a result of the use of the duodenal ulcer method, EEG correlates of “ripening” of the frontal and parieto-occipital parts of the cerebral cortex are observed (a decrease in the representation of slow-wave vibrations and an increase in the representation of alpha-rhythms), with a change in interhemispheric relationships (Nemkova S. A., Sologubov E.G. Yavorsky A.B., 2003).

We can assume several leading mechanisms that determine the effect of the neurodynamic correction suit. It is obvious that the costume has both a generalized effect on the central nervous system and an effect on the main brain structures that control motor activity, while the flow of proprioceptive afferent impulse is strengthened and normalized in the central parts of the nervous system, which contributes to a change in the pathological postural and motor stereotype, etc. to. the range of movements in the joints is restored by suppressing the spasticity of the muscles, normalizing their tone and increasing their strength. As a result of the use of a neurodynamic (neurosensory) correction suit, a gravitational background is artificially created that affects the state of antigravity structures, which in patients with cerebral palsy are either insufficiently developed or damaged, such as the nucleus of Deiters, Schwalbe, Ankylosing spondylitis, and the nuclei of the reticular formation of the trunk and midbrain, including and the nuclei of the vestibular system.

The use of a neurodynamic (sensorineural) correction suit enhances the impulse coming from the visual tubercles to the motor cortex, as well as the indicators of the functional activity of both motor and associative cortical zones (Nemkova S.A., 2000, 2003, 2012). The most important role in this is played not only by strengthening, but also by correcting the disturbed proprioceptive flow from the peripheral section, which contributes to the suppression of the pathological activity of the subcortical-stem mechanisms, the restoration of voluntary motility controlled by more highly organized parts of the motor analyzer.

In the study of the effectiveness of the use of a comprehensive rehabilitation system using a neurodynamic correction suit in children and adolescents with the consequences of a traumatic brain injury in the long-term period (S. Nemkova, 2003), an improvement in vertical stability in patients with consequences of a mild head injury was found to be 34.2% , moderate TBI - by 66%, severe TBI - by 54%, while the normalization of the role of the visual analyzer in the regulation of the vertical posture was noted, which may be one of the compensation mechanisms.

As a result of the use of the rehabilitation system using the neurodynamic correction suit, we observed an improvement in the temporal and spatial biomechanical characteristics of gait in patients with the consequences of moderate TBI by 20.5%, severe TBI by 16%, which indicated an improvement in locomotor function and significantly exceeded the results of traditional treatment , with a decrease of more than 2 times contractures and deformations. It was shown that a change in the functioning of the associative parts of the cerebral cortex during treatment with duodenal ulcer therapy may underlie the improvement of intellectual and mnestic functions in patients with consequences of mild CCT by 19%, moderate CCT by 38%, severe CCT by 43.5% (Nemkova S .A., 2003).

We have found that a comprehensive system of medical and social rehabilitation using a neurodynamic correction suit is more effective in treating patients with traumatic brain injury than traditional methods, and allows achieving restoration of motor and intellectual-mnestic functions in 95% of patients with consequences of mild head injury % of patients with consequences of moderate TBI, in 68% of patients with consequences of severe TBI, which contributes to better social adaptation, with the restoration of self-care ability in 67% of patients those with the consequences of moderate TBI and 63% of patients with the consequences of severe TBI, 83% and 72%, respectively, of learning functions, 56% and 45%, respectively (Nemkova S.A., 2003, 2004).

Thus, the results of our studies indicate that the neurodynamic correction suit has a complex effect, contributing to the compensation of postural, motor, speech and intellectual disorders in patients with cerebral palsy.

The method of complex neurodynamic (neurosensory) correction when using the claimed costume is aimed at the combined restoration of motor, postural, sensory and cognitive functions in children with cerebral palsy, based on the integrated use of new, pathogenetically directed methods of rehabilitation therapy (one of which is the use of treatment and exercise costume), combined at various stages of treatment, with cognitive and motor methods of medical, social and psychological pedology Gogic rehabilitation, taking into account their complementary multi-level influence on the complex mechanisms of disorders of higher mental functions in cerebral palsy.

It is shown that as a result of the use of the complex neurodynamic correction system (CPVD) using the suit of neurodynamic correction, in patients with cerebral palsy with mental retardation, sensory, postural and motor functions improve, with various forms of the disease, by 37.5-63.8%, in patients with mental retardation - by 50-54.2%. After applying the complex neurodynamic correction system using a neurodynamic correction suit, in patients with cerebral palsy with ZPR there was an improvement in visual memory by 35.4-40.9%, in patients with mental retardation - by 18.4-28%. As a result of the use of the KNDK system with the use of a neurodynamic correction suit in patients with cerebral palsy, both with mental retardation and with mental retardation, a more pronounced improvement in intellectual functions was noted than after using traditional therapy methods. In patients with mental retardation, depending on the form of the disease, as a result of the use of a neurodynamic correction suit, there was an improvement in verbal intelligence by 32.3-54.3% (with conventional treatment - by 16.2-21%), non-verbal intelligence - by 11.2-15.8% (after traditional treatment - by 1.9-3.5%). Patients with mental retardation as a result of the use of KNDK showed an improvement in verbal intelligence by 20-23.8% (with traditional treatment - by 2.9-15.3%), indicators of nonverbal intelligence - 25.5-30.6% ( after traditional treatment - by 4.5-5.1%), which indicates the high efficiency of the proposed rehabilitation system using a neurodynamic correction costume to compensate for cognitive impairment in children with cerebral palsy with impaired intellectual development.

Thus, a suit for complex neurodynamic (neurosensory) correction as a whole provides: creation (increase) of the longitudinal load on the skeleton structure (including the spine, upper and lower limbs); correction of disturbed proprioceptive flow by creating the correct position of the body and its segments in space; increased muscle load when performing movements; restructuring the interaction of sensory systems (proprioceptive and visual) in a changing proprioceptive load; activation of the motor zones of the cortex, responsible for the implementation of the motor functions of the trunk and limbs; activation of associative parts of the brain responsible for the implementation of cognitive functions, with the restructuring of interhemispheric interaction.

These properties achieve the following effects:

A) counteracting the pathological postures that are noted in a number of diseases of the nervous system and musculoskeletal system (for example, with cerebral palsy, the consequences of traumatic brain injuries, strokes, etc.) by normalizing the mechanisms of maintaining vertical posture and locomotion,

B) correction and prevention of the formation of deformities of the joints of the limbs (contractures of the ankle, knee, hip, shoulder, elbow and wrist joints), which are observed in diseases of the nervous system and musculoskeletal system, by creating the correct anatomical and physiological relationships in the joints,

C) an increase in the strength of the muscles of the trunk and limbs, the normalization of muscle tone, due to the correction of afferent flow,

D) improvement of hand motility, due to the activation of the sensorimotor and kinesthetic parts of the brain,

E) improving the development of sensory functions, due to the activation of the mechanism of intersensory transfer (improving the perception of stimuli of one sensory modality, for example, visual, when changing the intensity of the stimulus flow of another sensory modality, in this case, proprioceptive),

E) improving cognitive functions (memory, perception, hand-eye coordination, intelligence) by improving the functioning of associative parts of the brain, due to increased polysensory afferentation and the development of compensatory rearrangements, due to the presence of polymodal neurons in the associative parts of the brain and the implementation of neuroplasticity mechanisms.

Claims (4)

1. The device of neurodynamic correction for the restoration of motor, posture, sensory and cognitive functions in patients with pathology of the nervous system and musculoskeletal system, containing shoulder, pelvic and foot supports, interconnected by fixing elements, elbow, wrist and knee supports, and fixing the elements are made in the form of rods located on the front, side and rear surfaces of the parts of the patient’s body, with each elastic rod rigidly connected at one end to the corresponding support, and the other to of its tension regulator, characterized in that the upper extremity comprise a rod adapted to simultaneous rotation and extension outward (supination) of the upper limbs. 2. The device according to claim 1, characterized in that it further comprises a shoulder brace and shoulder tension loops fixing it on the suit, an adjusting elbow brace is fixed to the shoulder brace from the elbow side, to which tension belts are fixed from the side of the arm elbow joint, and tension belts performed with the function of imitating the palmar muscle and flexor of the wrist, which are fixed in the area of the beginning of the wrist. 3. The device according to claim 2, characterized in that a thrust with the function of imitating the radial flexor of the wrist is allotted from the side of the hand from the palm of the elbow tie, and this thrust is fixed by means of holders attached to the elbow tie from the elbow side. 4. The device according to claim 1, characterized in that on the front surface of the shoulder is a thrust that simulates the biceps of the shoulder.

Images