RU2113836C1 - Dynamic apparatus for exercising walking by patients with posture irregularity and diminished locomotor activity of motorium origin - Google Patents

Abstract

FIELD: therapeutic equipment. SUBSTANCE: dynamic apparatus for exercising walking has metal detachable carcass-type frame is made in the form of truncated pyramid with annular top to which axilla rests are attached and annular or equilateral hexagon bottom of larger diameter. Rollers are mounted to pyramid bottom. Pelvis supporting member is formed as breeches-hammock or hanger-hammock and mounted on upper part of frame by means of springy hangers. Flexible members for supporting lower limbs are joined to breeches-hammock by means of detachable connections and carry connecting links extending in vertical and transverse directions. Flexible members are positioned within connecting links. Flexible member arranged on rear part of breeches-hammock has widened upper sector mounted for pulling up gluteal muscles. Apparatus allows deprivation of handicapped person with diminished motor function and irregular coordination of corticosubcortical and cerebellar localization to be eliminated and autoactivation of brain reserve cortical functions to be potentiated. EFFECT: increased efficiency in rehabilitation of patients with irregular locomotor activity. 3 cl, 5 dwg

Description

 The invention relates to medical equipment and can be used for the formation and training of posture, physical activity and walking of patients with cerebral pathologies.

 The invention is intended for the rehabilitation of children and adolescents in the residual period of cerebral palsy (cerebral palsy), especially with atonic-astatic, hemiparetic forms.

The invention can be used:
for patients in the residual period of cerebral strokes with impaired motor function;
as a method of drug-free treatment of epilepsy in cerebral palsy;
with some forms of neuromuscular diseases (myopathy, neuromuscular dystrophy);
during posture correction;
for patients with the indicated forms of impaired posture and motor activity as a vehicle when moving outside the home.

 By the last time, despite various rehabilitation measures, according to statistics, the number of patients with the consequences of perinatal disorders of the brain substance is steadily increasing by 5% per year and, according to known information, already reaches up to 200 thousand people.

 The number of patients with the consequences of disorders and intracerebral vascular circulation (cerebral strokes, heart attacks) is also calculated by rather high numbers.

 The problem of the rehabilitation of patients with cerebral palsy and other disorders of the central passage organs in Russia and around the world is relevant from the standpoint of the number of patients, the everyday life of families with such disabled people, the burden on the social protection organs of the population and the psychology of the patients themselves.

 To date, a number of methods and devices aimed at the rehabilitation of patients with impaired motor activity and verticalization of the posture are known.

 A known method of treating patients with impaired posture and motor activity [1, 2], including phased casting followed by rigid fixation of the position of the limb. Along with gypsum correction, various methods of reflex afferent stimulation were used. The disadvantage of these methods is the long-term treatment, which allowed various complications in the form of limitations of the patient's motor activity (immobility), age-related pathological and physiological development of deformations of the joints, spine, atrophy of the musculoskeletal-muscular apparatus, the formation of an increase in pathological motor synergies, consolidation of the convulsive mechanism, pathological development psyche and speech. In 60% of patients, according to the recognition of Semenova K.A., “reverse contractures and deformations” arise.

 A device for treating patients with impaired posture and motor activity, containing the shoulder, pelvic and foot supports mounted on the trunk and limbs of a person and interconnected by elastic load elements (elastic traction), creating a load on the bone apparatus and antigravity muscles (ed. St. N 58929 dated 10.10.71). The purpose of this device is to create a gravitational effect and train the muscles of a healthy person in conditions of cosmic weightlessness, preserving locomotion.

 The disadvantage of this device is narrowly focused tasks in the form of a training load suit "Athlete", which does not allow for sufficient correction for various forms of cerebral palsy.

 A device for treating patients with locomotor dysfunction and verticalization [3] is known, which contains systems of supporting shoulder, pelvic-lumbar, knee and ankle belts located at appropriate levels of the patient’s body and connected by a system of elastic traction, according to the patient’s pathological muscular synergies .

 The main disadvantage of the device is the impossibility of its use for young children with a delay in the formation of an age-related physiological formation of body verticalization and the beginning of physiological walking in older children who cannot keep the body upright and walk independently. An important disadvantage is the vertical arrangement of elastic rods, creating a longitudinally compressive load on the spine.

 The closest analogue of the invention is a device for teaching walking patients with impaired posture and locomotor activity of central origin, containing a non-metallic detachable frame, on the upper part of which axillary stops are installed, installed with the ability to move in height, and on the bottom - rollers, a soft seat mounted on the upper part of the frame (see England Catalog Blanco, Blancomed, 1993, pp. 1-6).

 The objective of the invention is to overcome the delays and pathological development of body verticalization, the ability to walk and, conversely, help accelerate the physiological development of these age-related functions, teach how to take the first steps, which requires the patient to feel reliable stability of the vertical position of the body, eliminate fear, recreate the physiological position as much as possible , which is characteristic of the normal physiological age of the onset of walking, to teach to take the first independent steps with the maximum preservation of physiol a logical position, to develop self-motivation for independent walking, and also to prevent deforming complications of the skeleton after moving the weight load towards the physiological center of gravity and the vertical axis running along the spine.

 The basis of the invention lies in the need for a device for patients 2 to 5 years old who have not been able to previously hold the body in an upright position and have not been able to walk independently before, as well as the need for a device for patients 5 to 10 years old with atonic-astatic, hemiparetic, hyperkinetic forms of cerebral palsy as well as spastic diplegia with anthropometric development, close or somewhat delayed to passport age, not able and unable to walk and keep the body upright, but with a stably formed phobic syndrome that interferes with the formation of locomotor functions.

 The problem is solved in the invention due to the fact that in it the frame frame is made in the form of a truncated pyramid, the upper part of which is made in the form of a ring on which axillary stops are located, and the lower - in the form of a ring of a larger diameter or an equilateral hexagon, on which six freely rotating rollers are installed for moving couplings, while the patient's pelvic support element is made in the form of a hammock panties, attached to the top of the frame frame using spring suspensions and mounted on with the help of detachable joints, elastic shoe covers for the lower extremities, on which the wings are located in the vertical and transverse directions, in which the elastic elements are installed in the corresponding directions, installed with the possibility of adjusting the length and tension, while the elastic element located on the back of the hammock pants has an expanded sector in the upper part with the ability to tighten the gluteal muscles; that the support element of the pelvis of the patient is attached to the upper part of the frame frame using 4 to 6 spring suspensions with the possibility of adjusting their length and tension; that in it the patient’s pelvic support element is made in the form of a hammock suspension from a wide braid, while the main transverse strip is located with the ability to fix the hips, and the middle strip is the gluteal muscles, and the main and middle stripes are interconnected using a lock-lock.

 In FIG. 1 shows a dynamic corrective device for teaching walking patients with impaired posture and motor activity of central origin according to this invention, front view; in FIG. 2 - the same side view; in FIG. 3 - dynamic device with boot covers removed; in FIG. 4 - a dynamic device designed for cases when adolescents and adults use a hammock pendant made of wide braid as an element of pelvic support; in FIG. 5 - pendant-hammock in the initial position.

 The dynamic device for teaching walking patients with impaired posture and motor activity of central origin according to this invention contains a metal frame detachable frame 1 having the form of a truncated pyramid, the upper part 2 of which is made in the form of a ring with a diameter 5-10 cm greater than the diameter of the patient’s waist. On the upper part of the frame there are axillary stops 3 mounted on the rod 4 with holders 5 for adjusting the height of the patient. The lower part 6 of the frame is made in the form of a ring or an equilateral hexagon with a diameter calculated by the formula D = l + 2 • n, where D is the diameter of the lower part of the frame; l - part of the patient’s growth from the floor to his center of gravity (navel region), n - the number of years the patient. The rollers 7, freely rotating in the amount of six pieces, are installed on the lower part of the frame using couplings 8 at equal distances with the possibility of their movement along the lower part of the frame. Clutches 8 are provided with clamps 9 (not shown) securing the rollers in the required position. Racks 10 in an amount of 4 to 6 pieces with a vertically inclined arrangement connect the upper and lower parts of the frame. For the purposes of transportation and storage, the frame is made detachable using sockets 11 located on the upper and lower parts of the frame. The pelvic support element is made in the form of panties-hammock 12, is attached to the upper part 2 of the frame using spring suspensions 13 in the amount of 4 to 6 pieces. The shoe covers 14 for the lower extremities are attached to the hammock pants with the help of detachable joints 15 (tape-zippers). On the shoe covers 14 in the vertical and transverse directions are mounted the wings 16, in which the elastic elements 17 are placed in the respective directions. The upper 2 and lower 6 parts of the frame are made of duralumin or titanium, and the side posts are made of titanium.

 Panties-hammock 12 are made individually from elastic (rubberized fabric) or dense inelastic material, depending on the clinical needs and age of the patient. Shoe covers 14 are also made individually from an elastic material, such as rubberized fabric. The elastic elements 17 are made of rubber and have a flat or round shape. As spring suspensions 13 apply metal springs with a certain tensile coefficient or rubber traction.

 For older ages and adults, a hammock pendant 19 from a wide braid is used as an element of pelvic support, while the main strip 19 is located with the possibility of fixation around the hips, and the middle strip 20 is of the gluteal muscles, the main and middle strips connected by a lock latch 21.

 The device can be used autonomously as a vehicle when moving outside the house without the bottom of the frame frame and with the struts shifted.

The device allows you to take into account the age of patients in the following groups:
1 - for children aged 1.5 to 3 years,
2 - for children aged 2 - 5 - 10 years,
3 - for children and adolescents 10-17 years old and adults.

 For the first group, to the upper part of the frame frame are attached panties made of elastic or, for individual needs, of inelastic fabric using 4-6 spring suspensions with the possibility of adjusting their length and tension. As spring suspensions, metal springs or rubber rods are used. The ability to adjust the length and tension of the spring suspensions is carried out by locks or hooks (not shown) inserted into the corresponding holes 18 located on the upper edge of the hammock pants and the upper part of the frame frame. If necessary, one or all spring suspensions can be replaced with others with different lengths and tension ratios.

 For the first group, shoe covers 14 for lower limbs of elastic fabric are attached to the hammock pants, and elastic elements passing in the wings are placed on the front, rear, side outer and side inner surfaces of the shoe covers. Elastic elements are fixed at one end of the shoe covers, and at the opposite end are connected to a tension regulator (not shown). The wings 16 for positioning the elastic elements in them in the required directions are placed both in the longitudinal and transverse directions, while the rear elastic element 22 has an expanded sector in the upper part for tightening the gluteal muscles.

 For the third group, instead of hammock panties, a hammock pendant made of wide braid is used, with the main transverse strip being fixable on the hips and the middle strip on the gluteal muscles, with the main and middle stripes interconnected using a lock-lock .

 A dynamic device for teaching walking patients with impaired posture and motor activity of central origin according to this invention is used as follows.

 Depending on the age of the patient, his static and motor capabilities, at the time of starting treatment, choose the appropriate device layout.

 In the case where correction of pathological muscle synergies is required, a combined type is used in which a real device for teaching walking and various known devices for dynamic correction are combined. Using known devices and methods for functional-dynamic correction and adaptive biocontrol, body and limb correction corresponding to the clinical form of cerebral palsy is performed to obtain physiological positions. Next, the patient is placed inside this device for teaching walking with the landing of his pelvis in the hammock pants, and axillary stops are placed in axillary spaces. Using spring suspensions 13 give the body a state of unstable equilibrium, and the axillary stops 3 must be solid, located below the axillary cavity at a distance of 1/2 - 3/4 of the foot length of the patient. Spring suspensions 13 must allow vertical movement of the body from 1/2 to 3/4 of the length of the foot at different moments of walking or running or supporting a full foot in a standing position. In this case, the optimal position of the body at the upper point should be brought to the optimum by selecting the tension of the spring suspensions 13 for stable maintenance of the body in a tiptoe position without tension of the calf and foot muscles. The tension of the spring suspensions 13 should occur under the influence of the total weight of the patient in the parameters of reaching the floor with the full surface of the foot. After reaching the desired position, the spring pendants are locked with locks. The device is ready to use.

 In cases where the walking training device is used autonomously, without combining it with a dynamic correction device, shoe covers 14 with backstage are used to correct the position of the legs and feet 16. The shoe covers are connected to the hammock pants using detachable joints 15. Putting on the shoe covers is possible either immediately with hammock pants, or sequentially when the patient is in the device. After putting on and fixing the shoe covers on the patient's legs, elastic elements 17 are pulled through the wings 16 in the direction required for this pathological synergy. One end of the elastic elements 17 is fixed, and the other is tensioned and adjusted until the position of the body, limbs and motion parameters in them are close to physiological for a given age of the patient. The number and location of elastic elements in the wings should be optimal to achieve the required dynamic correction.

 Autonomous use of this device can be from 1 hour to 6 - 12 hours per day with breaks for periods of food intake, sanitary-hygienic processing and physiological departures. The level of fatigue in the device is much lower than in other training devices due to the fact that it does not require overcoming loads and can be used in the game mode of the patient. In other words, this device creates the conditions for maximally maintaining the positive emotional tone of the patient’s central nervous system, not only during the periods of targeted training of locomotor training, but also as a means of facilitating the patient’s interpersonal contacts with the environment, especially of young and middle-aged children. The device expands the gaming capabilities, creates a sense of comfort, confidence, security.

 Device usage cycles last up to 15-30 days on average. They can be lengthened depending on the insufficient age-related physiological maturity of the patient’s brain structures at the beginning of the rehabilitation process. The device can be used in staged courses of treatment, if necessary, to maintain the processes of subsequent age-related maturation and consolidate the results of the correction of statomotor functions.

 It should be noted that in contrast to well-known domestic and foreign devices, the dynamic device according to this invention has a significant therapeutic and rehabilitation effect. This effect is associated with the presence of an elastic suspension of the patient in the frame frame and the location of the lower extremities in elastic shoe covers. This arrangement of the patient provides a dynamic wave effect both on the muscle corset and on its entire musculoskeletal system. As a result of this effect, impulses arise in the central nervous system, leading to the elimination of personality deprivation of patients with impaired movement functions and coordination of cortical-subcortical localization, as well as the potentiation of autoactivation of reserve cortical functions of the brain. The device provides the possibility of unlimited movements characteristic of the physiological behavior of the child. The presence of an elastic suspension and elastic elements creates a physiologically stable and unstable balance of the organs of motion and the entire musculoskeletal system, which is also characteristic of the physiological age of the patient and facilitates his self-motivation for movement.

A dynamic device for teaching walking patients with impaired posture and motor activity of central origin allows
the possibility of independent movement on the floor of the room, prompted by the patient’s own active motivation with symptoms of motor deprivation;
stability, confidence, elimination of fear of an upright body position, unusual for the patient before treatment; when the scheme is on six rollers - the lack of overturn in any direction and loading;
ease of locomotor actions of the patient, which does not require a waste of effort to move the device itself, while the direction of movement depends on the direction of the patient's body inclination;
ease of the process of self-concentration of attention and will of the patient in the process of learning to walk, working out coordination and other actions;
reliance on axillary stops - the release of the arm, hand, which contributes to the development of dynamic freedom of the upper extremities, and the absence of provocation of pathological synkinesia;
facilitate training and strengthen the coordination of the trunk and limbs, which helps to turn off the link pathological synkinesia and restore physiological reciprocity.

Claims (3)

 1. A dynamic device for teaching walking patients with impaired posture and motor activity of central origin, containing a metal detachable frame frame, on the upper part of which axillary stops are installed with the ability to move in height, and on the bottom - rollers, pelvic support elements mounted on the upper part frames, characterized in that in it the frame frame is made in the form of a truncated pyramid, the upper part of which is made in the form of a ring on which axillary stops are located, and the lower - in the form of A ring of larger diameter or an equilateral hexagon on which six rollers are freely rotating using moving clutches, while the pelvic support element is made in the form of hammock pants, attached to the upper part of the frame frame using spring suspensions and elastic mounted on them using detachable joints shoe covers for the lower extremities, on which the wings are located in the vertical and transverse directions, in which elastic elements are placed in the corresponding directions, nnye with adjustable length and tension, and the elastic member disposed on the back of pants-gamachka, has an extended section in the upper part with the possibility of tightening the gluteal muscles.  2. The device according to p. 1, characterized in that the pelvic support element is attached to the upper part of the frame of the frame using 4-6 spring suspensions with the possibility of adjustment in length and tension.  3. The device according to paragraphs. 1 and 2, characterized in that in it the pelvic support element is made in the form of a hammock pendant from a wide braid, while the main transverse strip is located with the possibility of fixing the hips, and the middle - of the gluteal muscles, the main and middle strips being interconnected using lock-lock.

Images